FibroScan、MRI-PDFF和FAST评分识别高危非酒精性脂肪性肝炎患者临床应用研究

Increased liver stiffness measurement in patients with non-alcoholic fatty liver diseases might hints high-risk NASH

目的探讨瞬时弹性成像(FibroScan)、磁共振质子密度脂肪分数(MRI-PDFF)和FAST评分识别高危非酒精性脂肪性肝炎(NASH)患者的应用价值。方法2017年6月~2021年12月我院诊治的非酒精性脂肪肝病(NAFLD)患者107例,均接受肝活检和MRI-PDFF、FibroScan和血清学检查,计算FAST、FIB-4和APRI指数。采用单因素和多因素Logistic回归分析,应用受试者工作特征(ROC)曲线分析指标识别高危NASH患者的诊断效能。结果在107例NAFLD患者中,经肝组织病理学检查诊断高危非酒精性脂肪性肝炎(NASH)患者13例(12.1%),单纯性脂肪肝和非高危NASH患者94例(87.9%);高危NASH组LSM、FAST评分和APRI指数显著高于非高危组(P<0.05);多因素Logistic回归分析显示,FibroScan检测的肝脏硬度(LSM)是高危NASH患者的独立影响因素(P<0.05);ROC曲线分析显示LSM、FAST和APRI识别高危NASH患者有统计学意义(P<0.05),其曲线下面积(AUC)分别为0.795、0.713和0.682,以LSM的诊断效能最优,其排除截断点诊断的敏感度和特异度分别为92.3%和54.3%,而纳入截断点诊断则为53.8%和90.4%。结论对于FibroScan检测诊断的NAFLD患者,其LSM也同期升高高度提示NASH的存在,应进一步检查,以期早期干预。

Objective The purpose of this study was to explore the diagnostic performance of FibroScan,magnetic resonance imaging proton density fat-fraction(MRI-PDFF)and FibroScan-AST(FAST)score in judging patients with high risk non-alcoholic steatohepatitis(NASH)from those with non-alcoholic fatty liver diseases(NAFLD).Mthods A total of 107 patients with NAFLD were encountered in our hospital between June 2017 and December 2021,and all patients underwent liver biopsies.FibroScan,MRI-PDFF and serological detection were completed and three non-invasive models of FAST,FIB-4 and APRI were calculated.Univariate and multivariate Logistic regression analysis was used to screen out factors impacting high-risk NASH.The diagnostic performance of relevant parameters and three non-invasive models to identify high risk NASH was analyzed by ROC curve.Result Of 107 patients with NAFLD,the histo-pathological examination showed high risk NASH in 13 cases(12.1%),and simple alcoholic fatty liver and non-high risk NASH in 94 cases(87.9%);liver stiffness measurement(LSM)by Fibroscan,FAST score and aspartate aminotransferase/platelets(APRI)in patients with high risk NASH were significantly higher than in those with non-high risk NASH(P<0.05);multivariate Logistic regression analysis showed that only the LSM was the independent risk factor impacting high risk NASH(P<0.05);ROC analysis demonstrated that the LSM,FAST and APRI could identify high risk NASH(P<0.05),with AUCs of 0.795,0.713 and 0.682,and the LSM got the optimal diagnostic efficacy,with sensitivity(Se)and specificity(Sp)of 92.3%and 54.3%based on exclusion cut-off-value,and with Se and Sp of 53.8%and 90.4%based on inclusion cut-off-value.Conclusion The simultaneous increased LSM in patients with NAFLD hints existence of NASH,which might help clinicians make appropriate measures to tackle it.