FibroScan及肝纤维化指数在NAFLD合并HBV感染患者肝纤维化评估中的应用

The application of FibroScan and liver fibrosis index in evaluating liver fibrosis in NAFLD patients with comorbid HBV infection

目的探讨瞬时弹性成像系统(FibroScan)及肝纤维化指数对非酒精性脂肪性肝病(NAFLD)合并HBV感染患者肝纤维化的评估价值。方法回顾性分析2021年6月至2023年6月在三台县人民医院就诊的93例NAFLD合并HBV感染患者的临床资料,经病理学检查结果显示轻中度纤维化70例,重度纤维化23例。收集患者的性别、年龄、体质量指数(BMI)、糖尿病、高血压、饮酒、吸烟、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)、血小板(PLT)、白蛋白(Alb)、HBeAg、NAFLD纤维化评分(NFS)、肝脏硬度测定值(LSM)、肝纤维化指数-4(FIB-4)等。非条件Logistic逐步回归分析NAFLD合并HBV感染患者重度肝纤维化的危险因素;ROC曲线分析LSM、FIB-4对NAFLD合并HBV感染患者肝纤维化的评估价值;Spearman相关系数分析LSM、FIB-4与NAFLD合并HBV感染患者肝纤维化分期的相关性。结果轻中度组ALT、AST、NFS、LSM、FIB-4水平分别为(41.76±8.52)U/L、(31.58±8.07)U/L、-2.62±0.71、(5.75±1.24)kPa、(1.21±0.39),显著低于重度组的(61.89±7.33)U/L、(45.36±12.94)U/L、-1.44±0.45、(10.71±2.97)kPa、(1.88±0.62),轻中度组PLT水平为(177.26±48.31)×10^(9)/L显著高于重度组(138.74±41.65)×10^(9)/L(P<0.05);两组性别、年龄、BMI、糖尿病、高血压、饮酒、吸烟、Alb、HBeAg比较差异无统计学意义(P>0.05)。经多因素logistic回归分析证实,ALT、AST、PLT、NFS、LSM、FIB-4是NAFLD合并HBV感染患者重度肝纤维化的危险因素(P<0.05)。相关性分析结果显示,LSM、FIB-4与NAFLD合并HBV感染患者肝纤维化分期呈正相关(r=0.614、0.583)。ROC曲线分析结果显示,LSM、FIB-4评估NAFLD合并HBV感染患者重度肝纤维化的曲线下面积分别为0.853、0.842,且P<0.05。两者联合评估NAFLD合并HBV感染患者重度肝纤维化的曲线下面积为0.888,敏感度为0.826,特异度为0.929。结论FibroScan及肝纤维化指数在NAFLD合并HBV感染患者肝纤维化评估中均有一定价值,且两者联合效能更高。

Objective To investigate the value of instantaneous elastic imaging system(FibroScan)and hepatic fibrosis index in evaluating hepatic fibrosis in patients with nonalcoholic fatty liver disease(NAFLD)complicated with hepatitis B virus(HBV).Methods The clinical data of 93 patients with NAFLD with comorbid HBV infection admitted from June 2021 to June 2023 were retrospectively analyzed.According to pathological examination there were 70 cases with mild to moderate fibrosis and 23 cases with severe fibrosis.The general and clinical data of these patients were collected,including gender,age,body mass index(BMI),diabetes mellitus,hypertension,alcohol consumption,smoking,the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),platelets(PLT),albumin(ALB),hepatitis B virus e antigen(HBeAg),NAFLD fibrosis score(NFS),liver stiffness measurement(LSM)and liver fibrosis index-4(FIB-4).The risk factors of severe liver fibrosis in patients with NAFLD and HBV infection were analyzed by unconditional Logistic stepwise regression;Receiver operating characteristic curve(ROC)was used to analyze the value of LSM and FIB-4 in evaluating liver fibrosis in NAFLD patients with HBV infection;Spearman correlation coefficient was used to analyze the correlation between LSM,FIB-4 and liver fibrosis stage in NAFLD patients with HBV infection.Results The levels of ALT,AST,NFS,LSM and FIB-4 in mild to moderate group were(41.76±8.52)U/L,(31.58±8.07)U/L,(-2.62±0.71)g/dL,(5.75±1.24)kPa,and(1.21±0.39),which were significantly lower than those of(61.89±7.33)U/L,(45.36±12.94)U/L,(-1.44±0.45)g/dL,(10.71±2.97)kPa,and(1.88±0.62)in severe group.The level of PLT in mild to moderate group was(177.26±48.31)10^(9)/L],which was significantly higher than that of (138.74±41.65)10^(9)/L in severe group(P<0.05).There was no significant difference in gender,age,BMI,diabetes,hypertension,drinking,smoking,ALB and HBeAg between the two groups(P>0.05).By multiple logistic regression analysis it was confirmed that ALT,AST,PLT,NFS,LSM and FIB-4 were risk factors for severe liver fibrosis in patients with NAFLD and HBV infection(P<0.05).The results of correlation analysis showed that LSM and FIB-4 were positively correlated with liver fibrosis stage in patients with NAFLD and HBV infection(r=0.614,0.583),and all P<0.05.By ROC curve analysis it was showed that the area under the curve(AUC)of LSM and FIB-4 in evaluating severe liver fibrosis was 0.853 and 0.842,respectively,and P<0.05.The AUC of the combined evaluation of the two methods for severe liver fibrosis in patients with NAFLD and HBV infection was 0.888,the sensitivity was 0.826,and the specificity was 0.929.Conclusion Both FibroScan and liver fibrosis index have a certain value in evaluating liver fibrosis in NAFLD patients with comorbid HBV infection,and the efficacy of a combined evaluation is higher.