非酒精性脂肪性肝病患者C/RL-r、APRI、FIB-4水平与肝纤维化发生的相关性

Correlation between C/RL-r,APRI,FIB-4 levels and hepatic fibrosis in patients with nonalcoholic fatty liver disease

目的分析非酒精性脂肪性肝病(NAFLD)患者改良肝尾状叶/右叶比值(C/RL-r)、天门冬氨酸氨基转移酶与血小板比值指数(APRI)、基于4因子的纤维化指数(FIB-4)与肝纤维化发生的相关性。方法选择2021年2月至2022年12月在保定市第一中心医院治疗的NAFLD患者153例,根据病理学结果,将患者分为无肝纤维化组81例、肝纤维化组72例。行MRI扫描检测C/RL-r;计算APRI、FIB-4水平;分析NAFLD患者实验室指标、C/RL-r、APRI、FIB-4水平与发生肝纤维化的相关性,发生肝纤维化的独立危险因素及C/RL-r、APRI、FIB-4对NAFLD患者发生肝纤维化的预测价值。结果肝纤维化组ALT、AST、TBil、GGT、TG、C/RL-r、APRI、FIB-4水平显著高于无肝纤维化组,分别为(42.32±10.21)U/L比(36.21±7.78)U/L、(45.36±8.72)U/L比(27.45±5.40)U/L、(13.52±3.65)μmol/L比(12.24±2.16)μmol/L、(60.53±13.41)U/L比(53.69±12.44)U/L、(1.99±0.53)mmol/L比(1.05±0.33)mmol/L、(1.15±0.12)比(0.92±0.09)、(0.52±0.15)比(0.32±0.10)、(1.47±0.47)比(0.94±0.30),高密度脂蛋白胆固醇(HDL-C)水平显著低于无肝纤维化组为(1.03±0.26)mmol/L比(1.32±0.45)mmol/L,(t=4.189、15.453、2.674、3.272、13.322、13.501、4.302、8.405、4.801,均P<0.05);NAFLD患者ALT、AST、TG、C/RL-r、APRI、FIB-4与发生肝纤维化呈正相关(r=0.531、0.435、0.571、0.605、0.771、0.716,均P<0.001);ALT、AST、TG、C/RL-r、APRI、FIB-4水平高是影响NAFLD患者发生肝纤维化的独立危险因素(P<0.05);C/RL-r、APRI、FIB-4、三者联合预测NAFLD患者发生肝纤维化的曲线下面积(AUC)分别为0.767、0.830、0.754、0.936;相较于C/RL-r、APRI、FIB-4单独预测的AUC,三者联合预测的AUC更高(Z=4.495、3.999、4.677,均P<0.001)。结论发生肝纤维化的NAFLD患者C/RL-r、APRI、FIB-4水平较高,三者联合检测对NAFLD患者发生肝纤维化具有较高预测价值。

Objective To analyze the relationship between the modified caudate-right lobe ratio(C/RL-r),aspartate aminotransferase-to-platelet ratio index(APRI),fibrosis-4 index(FIB-4),and the development of liver fibrosis in patients with non-alcoholic fatty liver disease(NAFLD).Methods A total of 153 patients diagnosed with NAFLD treated at Baoding First Central Hospital between February 2021 and December 2022 were included in this study.The patients were divided into non-hepatic fibrosis group(81 cases)and hepatic fibrosis group(72 cases)based on liver puncture and pathology result.MRI scanning was performed to detect C/RL-r and laboratory tests were conducted to calculate the APRI and FIB-4.The analysis aimed to investigate the the correlation between laboratory indices,C/RL-r,APRI,FIB-4 and the presence of liver fibrosis in patients with NAFLD,as well as to identify independent risk factors for liver fibrosis.Additionally,the study sought to evaluate the predictive value of C/RL-r,APRI,FIB-4 for liver fibrosis in NAFLD patients.Results Significant differences were observed in the levels of alanine aminotransferase(ALT)[(42.32±10.21)U/L vs(36.21±7.78)U/L],aspartate aminotransferase(AST)[(45.36±8.72)U/L vs(27.45±5.40)U/L],total bilirubin(TBIL)[(13.52±3.65)μmol/L vs(12.24±2.16)μmol/L],γ-glutamyltransferase(GGT)[(60.53±13.41)U/L vs(53.69±12.44)U/L],triglyceride(TG)[(1.99±0.53)mmol/L vs(1.05±0.33)mmol/L],C/RL-r[(1.15±0.12)vs(0.92±0.09)],APRI[(0.52±0.15)vs(0.32±0.10)]and FIB-4[(1.47±0.47)vs(0.94±0.30)]between the hepatic fibrosis group and the non-hepatic fibrosis group.The level of high density lipoprotein-cholesterol(HDL-C)[(1.03±0.26)mmol/L vs(1.32±0.45)mmol/L]was significantly lower in the hepatic fibrosis group(t=4.189,15.453,2.674,3.272,13.322,13.501,4.302,8.405,4.801,all P<0.05).Furthermore,ALT,AST,TG,C/RL-r,APRI,FIB-4 were positively correlated with liver fibrosis in NAFLD patients(r=0.531,0.435,0.571,0.605,0.771,0.716,all P<0.001).High levels of ALT,AST,TG,C/RL-r,APRI and FIB-4 were identified as independent risk factors for liver fibrosis in NAFLD patients(P<0.05).The combination of C/RL-r,APRI,and FIB-4 demonstrated a significantly higher AUC(0.936)in predicting liver fibrosis in NAFLD patients compared to the AUC of C/RL-r(0.767),APRI(0.830),and FIB-4(0.754)alone(Z=4.495,3.999,4.677,all P<0.001).Conclusion Elevated levels of C/RL-r,APRI and FIB-4 are observed in NAFLD patients with liver fibrosis,and the combined detection of these indices demonstrates a high predictive value for the occurrence of liver fibrosis in NAFLD patients.