无创诊断方法对慢性乙型病毒性肝炎合并非酒精性脂肪性肝病显著肝纤维化患者诊断效能评估

Evaluation of the diagnostic efficacy of noninvasive diagnosis in patients with chronic viral hepatitis B complicated with nonalcoholic fatty liver disease and significant liver fibrosis

目的:采用无创诊断方法及其联合模型,对慢性乙型病毒性肝炎(CHB)合并非酒精性脂肪性肝病(NAFLD)显著肝纤维化(≥S2)患者的诊断效能进行评估,并探讨其临床特征。方法:回顾性收集2018年1月~2023年1月就诊于新疆医科大学附属中医医院且诊断为CHB且合并NAFLD(肝穿病理提示存在肝脏脂肪变性)的住院患者104名。所有患者均进行肝穿刺活检,整理收集患者的一般资料、实验室检查结果、肝脏硬度(LSM)、FIB-4、APRI、GGT/PLT、AST/PLT等结果,以不同纤维化分期(S)进行分组,探讨<S2和≥S2期患者的临床及病理特征,并采用受试者工作特征曲线评价LSM、FIB-4、APRI、GGT/PLT、AST/PLT及其联合模型对CHB合并NAFLD患者显著肝纤维化患者的诊断价值。结果:104例患者中S1期患者55例,S2期患者32例,S3期患者11例,S4期患者6例。<S2期患者ALT(33.75±17.15)U/L,AST 24.00(19.77,29.00)U/L,G2期以上炎症占92.72%,GGT/PLT 0.07(0.10,0.15),AST/PLT 0.09(0.10,0.15),LSM 8.70(6.80,10.10)kPa,FIB-41.07±0.51,APRI 0.26(0.22,0.28)。≥S2期患者ALT(42.14±21.39)U/L,AST 29.04(24.00,40.32)U/L,G2期以上炎症占97.95%,GGT/PLT 0.15(0.10,0.28),AST/PLT 0.14(0.10,0.26),LSM 11.80(8.50,16.65)kPa,FIB-41.39±0.72,APRI 0.35(0.26,0.66),两组间差异具有统计学意义(P<0.05)。无创诊断方法LSM、FIB-4、APRI、GGT/PLT、AST/PLT受试者工作特征曲线下面积分别为0.716、0.623、0.669、0.644、0.669(P<0.05);联合模型LSM联合FIB-4、LSM联合APRI、LSM联合GGT/PLT、LSM联合AST/PLT受试者工作特征曲线下面积分别为0.712、0.719、0.715、0.719(P<0.05)。结论:目前临床常用的无创肝纤维化评估方法虽对CHB合并NAFLD显著肝纤维化具有一定的诊断效能,但无法替代肝活检,可作为肝活检的辅助方法在临床中用于定期评估。

Objective:To evaluate the diagnostic efficacy of chronic viral hepatitis B(CHB)with significant liver fibrosis(≥S2)in patients with nonalcoholic fatty liver disease(NAFLD)by using noninvasive diagnosis and the combined models,and to explore their clinical features.Methods:A total of 104 inpatients with CHB diagnosed and complicated with NAFLD(hepatic steatosis suggested by liver biopsy)were retrospectively collected from January 2018 to January 2023 in the Affiliated Hospital of Traditional Chinese Medicine of Xinjiang Medical University.Liver biopsy was performed in all patients.General data,laboratory test results,liver hardness(LSM),FIB-4,APRI,GGT/PLT,AST/PLT and other results of patients were collected and grouped according to different fibrosis stages(S)to explore the clinical and pathological characteristics of patients with<S2 and≥S2 stages.Receiver operating characteristic curve was used to evaluate the diagnostic value of LSM,FIB-4,APRI,GGT/PLT,AST/PLT and their combined models in patients with significant liver fibrosis in CHB patients with NAFLD.Results:Among the 104 patients,there were 55 patients had S1 fibrosis,inflammation above G2 stage accounted for 92.72%,with 32 patients had S2 fibrosis,11 patients had S3 fibrosis and 6 patients had S4 fibrosis.in patients of<S2 fibrosis,ALT(33.75±17.15)U/L,AST 24.00(19.77,29.00)U/L,GGT/PLT 0.07(0.10,0.15),AST/PLT 0.09(0.10,0.15),LSM 8.70(6.80,10.10)kPa,FIB-41.07±0.51,and APRI 0.26(0.22,0.28).In patients of≥S2 fibrosis,inflammation above G2 stage accounted for 97.95%,with ALT(42.14±21.39)U/L,AST 29.04(24.00,40.32)U/L,GGT/PLT 0.15(0.10,0.28),AST/PLT 0.14(0.10,0.26),GGT/PLT 0.15(0.10,0.28),AST/PLT 0.14(0.10,0.26).LSM 11.80(8.50,16.65)kPa,FIB-41.39±0.72,and APRI 0.35(0.26,0.66).The difference between the two groups was statistically significant(P<0.05).The area under the receiver operator characteristic curves of the subjects of LSM,FIB-4,APRI,GGT/PLT and AST/PLT were 0.716,0.623,0.669,0.644 and 0.669(P<0.05),respectively.In the combined model,the area under the receiver operator characteristic curves of LSM com-bined with FIB-4,LSM combined with APRI,LSM combined with GGT/PLT and LSM combined with AST/PLT were 0.712,0.719,0.715 and 0.719,respectively(P<0.05).Conclusion:Although the currently commonly used Noninvasive diagno-sis of liver fibrosis has certain diagnostic efficacy for significant liver fibrosis in CHB complicated with NAFLD,it cannot replace liver biopsy.Noninvasive Diagnosis can be used as an auxiliary method for regular clinical evaluation of liver biopsy.