中国全科医学2025，Vol.28Issue(32)：4067-4074,4081,9.DOI:10.12114/j.issn.1007-9572.2024.0560
无创模型在评估慢性乙型肝炎合并非酒精性脂肪性肝病患者肝纤维化中的比较研究
Comparative Study on the Potential of Non-invasive Models in Evaluating Liver Fibrosis in Patients with Chronic Hepatitis B Combined with Non-alcoholic Fatty Liver Disease
摘要
Abstract
Background Liver fibrosis is a major risk factor for overall and liver-specific mortality of chronic hepatitis B(CHB)combined with non-alcoholic fatty liver disease(NAFLD).Combination of type 2 diabetes mellitus(T2DM)or hyperuricemia(HUA)accelerates the progression of liver fibrosis in CHB patients combined with NAFLD.Therefore,accurately assessing the stage of liver fibrosis using non-invasive diagnostic models is crucial for effective treatment and control of CHB combined with NAFLD disease progression.Objective To compare the efficacy of five non-invasive diagnostic models[fibrosis-4(FIB-4),aspartate aminotransferase-to-platelet ratio index(APRI),aspartate-to-alanine aminotransferase ratio(AAR),S index,and gamma-glutamyl transpeptidase to platelet ratio index(GPRI)]in diagnosing advanced liver fibrosis in CHB patients combined with NAFLD and T2DM/HUA,and to assess their feasibility for grassroots implementation.Methods One hundred and ninety-five CHB patients combined with NAFLD diagnosed by clinical evidence and liver pathology admitted in the Beijing Ditan Hospital,Capital Medical University from 2008 to 2021 were retrospectively recruited.They were divided into CHB&NAFLD(n=46),CHB&NAFLD&T2DM(n=80),and CHB&NAFLD&HUA groups(n=69)based on the comorbidities of T2DM or HUA.Using pathological results as the gold standard for diagnosis of liver fibrosis,DeLong's test was used to compare the area under the receiver operating characteristic curve(AUC)and diagnostic performance of five non-invasive indicators for the assessment of liver fibrosis progression in the three groups.Additionally,clinical utility of each model was evaluated using decision curve analysis(DCA).Results In the CHB&NAFLD group,the AUC of FIB-4 in diagnosing liver fibrosis was 0.740,and that of AAR was 0.468,with an AUC difference of 0.272.In the CHB&NAFLD&T2DM group,FIB-4 also exhibited the highest diagnostic performance(AUC=0.677),while the S index had the lowest AUC(0.588).In the CHB&NAFLD&HUA group,FIB-4 maintained the highest diagnostic performance(AUC=0.753),while AAR had the lowest AUC(0.609).Although FIB-4 performed the best in all three groups,its diagnostic performance was significantly lower in the CHB&NAFLD&T2DM group compared to the CHB&NAFLD group(P<0.001)and CHB&NAFLD&HUA group(P<0.001).DCA showed that FIB-4 had a slightly higher clinical net benefit in the CHB&NAFLD and CHB&NAFLD&HUA groups.The optimal cut off value for FIB-4 in the CHB&NAFLD&T2DM group was 1.425,which was higher than that in the CHB&NAFLD group(cut off=1.117)and the CHB&NAFLD&HUA group(cut off=1.305).Conclusion The FIB-4 index is practical for assessing liver fibrosis in CHB patients combined with NAFLD and T2DM/HUA at the grassroots level.However,FIB-4 has a lower diagnostic efficacy and higher cutoff value in assessing liver fibrosis in CHB&NAFLD patients combined with T2DM than CHB&NAFLD and CHB&NAFLD&HUA patients.These results suggest that it is necessary to evaluate CHB&NAFLD patients with T2DM in combination with their specific characteristics and optimize the diagnostic strategy to improve accuracy.关键词
慢性乙型肝炎/非酒精性脂肪性肝病/2型糖尿病/高尿酸血症/肝活检/无创诊断模型Key words
Chronic hepatitis B/Nonalcoholic fatty liver disease/Type 2 diabetes mellitus/Hyperuricemia/Liver biopsy/Noninvasive diagnostic models分类
医药卫生引用本文复制引用
杨冰清,扬天元,侯辰雪,王琦..无创模型在评估慢性乙型肝炎合并非酒精性脂肪性肝病患者肝纤维化中的比较研究[J].中国全科医学,2025,28(32):4067-4074,4081,9.基金项目
北京市高层次公共卫生技术人才建设项目(学科骨干-02-29) （学科骨干-02-29）
