非酒精性脂肪性肝炎患者发生显著肝纤维化的影响因素分析

Analysis of the Influencing Factors of Significant Liver Fibrosis in Patients with Nonalcoholic Steatohepatitis

目的探讨非酒精性脂肪性肝炎(NASH)患者发生显著肝纤维化的影响因素。方法选择我院2021年1月至2022年12月住院NASH患者120例,收集一般临床资料、血化验及肝穿刺病理结果,按肝穿刺病理结果分为显著肝纤维化组、非显著肝纤维化组,比较两组的观察指标差异。结果显著肝纤维化组体质量指数(BMI)、肝功能异常指标(ALT)、胰岛素抵抗指数(HOMA-IR)水平分别(29.33±3.86)kg/m^(2)、(146.73±64.71)U/L、(6.58±4.16),均明显高于非显著肝纤维化组,分别为(25.48±2.54)kg/m^(2)、(90.17±40.45)U/L、(3.01±1.52),P<0.001,非显著肝纤维化组高密度脂蛋白(HDL)水平为(1.07±0.21)mmol/L,明显高于显著肝纤维化组(0.87±0.13)mmol/L,P<0.001;Logistic回归分析结果显示BMI、ALT、HOMA-IR、HDL的OR分别为1.480(95%CI 1.219-1.796)、1.024(95%CI 1.011-1.037)、2.154(95%CI 1.485-3.125)、0.001(95%CI 0.000-0.023),P<0.001;BMI、ALT、HOMA-IR、HDL的ROC曲线分析示AUC(95%CI)分别为0.807(0.714-0.900)、0.779(0.678-0.880)、0.844(0.760-0.928)、0.804(0.705-0.904),P<0.001。对于性别、年龄、TG、LDL、TC、GGT,二者之间差异均无统计学意义(P>0.05)。结论BMI、ALT、HOMA-IR为NASH患者发生显著肝纤维化的危险因素,而HDL为其保护因素,BMI、ALT、HOMA-IR及HDL水平对预测NASH患者发生显著肝纤维化具有一定价值。

Objective To investigate the influencing factors of significant liver fibrosis in patients with non-alcoholic steatohepatitis(NASH).Methods A total of one hundred and twenty NASH patients hospitalized in our hospital from January 2021 to December 2022 were selected.General clinical data,blood test and liver puncture pathological results were collected.According to liver puncture pathological results,patients were divided into significant liver fibrosis group and non-significant liver fibrosis group,and the difference of observation indexes between the two groups was compared.Results The levels of BMI,ALT and HOMA-IR in the significant liver fibrosis group were(29.33±3.86)kg/m^(2),(146.73±64.71)U/L and(6.58±4.16),respectively,which were significantly higher than those in the non-significant liver fibrosis group(25.48±2.54)kg/m^(2),(90.17±40.45)U/L,(3.01±1.52),all P<0.001.The HDL level of non-significant liver fibrosis group was(1.07±0.21)mmol/L,which was significantly higher than that of significant liver fibrosis group(0.87±0.13)mmol/L,P<0.001.Logistic regression analysis showed that the OR of BMI,ALT,HOMA-IR and HDL were 1.480(95%CI 1.219-1.796),1.024(95%CI 1.011-1.037),2.154(95%CI 1.485-3.125)and 0.001(95%CI 0.000-0.023),respectively,all P<0.001;ROC curve analysis of BMI,ALT,HOMA-IR and HDL showed that AUC(95%CI)were 0.807(0.714-0.900),0.779(0.678-0.880),0.844(0.760-0.928)and 0.804(0.705-0.904),respectively,all P<0.001.There were no significant differences in gender,age,TG,LDL,TC and GGT between the two groups(P>0.05).Conclusions BMI,ALT and HOMA-IR are risk factors for significant liver fibrosis in NASH patients,while HDL is a protective factor.The levels of BMI,ALT,HOMA-IR and HDL are of certain value in predicting significant liver fibrosis in NASH patients.