基于Fibrotouch探讨代谢相关脂肪性肝病与肝纤维化的相关性

目的:基于Fibrotouch探讨代谢相关脂肪性肝病(MAFLD)与肝纤维化水平的相关性。方法:选取2020~2022年新疆医科大学附属中医医院住院,经影像学诊断为脂肪肝且符合MAFLD诊断标准,行瞬时弹性成像技术(TE)检查的患者401例。根据其体重指数(BMI)与是否伴糖尿病(DM),分为MAFLD瘦人/正常体重组(n=25)、MAFLD超重组(n=52)、MAFLD肥胖组(n=249)和MAFLD糖尿病(MAFLD-DM)组(n=75),收集患者空腹血糖(FPG)、糖化血红蛋白(HbA_(1)c)、肝肾功能、血脂、血常规、肝脏硬度值(LSM)、受控衰减参数(CAP)等指标,应用多种无创肝纤维化指标如NAFLD纤维化评分(NFS)、天冬氨酸氨基转移酶(AST)与血小板(PLT)比值指数(APRI)、糖尿病评分(BARD)和纤维化-4指数(FIB-4)评估肝纤维化风险,比较各组间的一般资料、生化指标、无创肝纤维化指标等。根据是否伴肝纤维化,分单纯MAFLD组与MAFLD合并肝纤维化组,行单因素分析和多因素Logsitics回归分析MAFLD与肝纤维化的相关性。结果:各组别间收缩压(SBP)、舒张压(DBP)、PLT、AST、丙氨酰氨基转移酶(ALT)、碱性磷酸酶(ALP)、γ-谷氨酰基转移酶(GGT)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、极低密度脂蛋白胆固醇(VLDL-C)、白蛋白(Alb)、APRI、FIB-4、调脂药用药史、高血脂和病毒性肝炎病史(乙肝、丙肝),差异均没有统计学意义。各组别间年龄、性别、体重指数(BMI)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、肌酐(Cr)、尿酸(UA)、FPG、HbA_(1)c、NFS评分、BARD评分、LSM、CAP、是否有糖尿病病史、降糖药或降压药用药史、饮酒史、吸烟史,差异有统计学意义。MAFLD肥胖组和MAFLD-DM组发生中重度肝纤维化的比例明显高于其余两组。通过单因素和多因素分析中,发现BMI、CAP和APRI评分的增加与MAFLD肝纤维化风险增加有关。结论:BMI、CAP、APRI评分是MAFLD发生肝纤维化的危险因素。

Correlation between metabolic dysfunction-associated fatty liver disease and liver fibrosis based on Fibrotouch

Objective:The study aimed to investigate the correlation between metabolic dysfunctionassociated fatty liver disease and liver fibrosis based on Fibrotouch.Methods:During the years 2015-2018,a total of 401 patients with fatty liver diagnosed by imaging and met the diagnostic criteria of MAFLD,examined by transient elastography(TE)were enrolled in the Department of Hepatology of the Traditional Chinese Medical Hospital Affiliated to Xinjiang Medical University.The patients were classified into 4 MAFLD subgroups:MAFLD lean/normal weight group(n=25),MAFLD overweight group(n=52),MAFLD obese group(n=249)and MAFLD diabetic(MAFLD-DM)group(n=75),according to their body mass index(BMI)with or without diabetes mellitus(DM).Fasting plasma glucose(FPG),glycated hemoglobin A1c(HbA1c),liver and kidney function,blood lipid,routine blood test,liver stiffness value(LSM),controlled attenuation parameter(CAP)and so on,were collected.A variety of noninvasive hepatic fibrosis indexes such as NAFLD fibrosis score(NFS),aspartate aminotransferase(AST)to platelet(PLT)ratio index(APRI),diabetes score(BARD)and fibros-4 index(FIB-4)were used to evaluate the risk of hepatic fibrosis,comparing the general information,biochemical indicators and non-invasive liver fibrosis indicators among them.Whether accompanied with liver fibrosis or not.The patients were divided into MAFLD group and MAFLD liver fibrosis group Univariate analysis and multivariate Logsitics regression analysis were performed to analyze the correlation between MAFLD and liver fibrosis.Results:Systolic blood pressure(SBP),diastolic blood pressure(DBP),PLT,AST,alanyl aminotransferase(ALT),alkaline phosphatase(ALP),gamma-glutamyltransferase(GGT),total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),very low density lipoprotein cholesterol(VLDL-C),albumin(A lb),APRI,FIB-4,hyperlipidemia,history of lipid-regulating drugs,and history of viral hepatitis(hepatitis B and hepatitis C)were not statistically significant.Age,sex,body mass index(BMI),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),creatinine(Cr),uric acid(UA),FPG,HbA1c,NFS score,BARD score,LSM,CAP,diabetes mellitus,hypoglycemic or antihypertensive drug use history,drinking history,smoking history were statistically significant.The proportion of significant and advanced liver fibrosis in MAFLDobese group and MAFLD-DM group was significantly higher than other two groups.Increased BMI,CAP,and APRI scores were associated with an increased risk of liver fibrosis in MAFLD by univariate and multivariate analyses.Conclusion:BMI,CAP and APRI score are risk factors for the progression of liver fibrosis in MAFLD.