中西医结合肝病杂志2026，Vol.36Issue(5)：550-554,5.DOI:10.3969/j.issn.1005-0264.2026.005.004
肝脏硬度值对慢性乙型肝炎合并非酒精性脂肪性肝病肝纤维化的诊断价值及与中医证型的相关性
Liver stiffness measurement for diagnosing fibrosis in CHB patients with NAFLD and its association with TCM syndrome
摘要
Abstract
Objective:To evaluate the diagnostic value of liver stiffness measurement(LSM)in assessing liver fibrosis in patients with chronic hepatitis B(CHB)complicated by non-alcoholic fatty liver disease(NAFLD),and to explore its correlation with traditional Chinese medicine(TCM)syndromes,aiming to develop a novel integrative diagnostic approach for determining the severity of liver fibrosis.Methods:A total of 536 patients with CHB complicated by NAFLD,admitted to the Xiamen Liver Disease Center and Xiamen Hongai Hospital from 2018 to 2023,were consecutively enrolled and retrospectively analyzed.Clinical data were collected.Liver biopsy was used as the gold standard.Receiver operating characteristic(ROC)curves were constructed to assess the diagnostic performance of LSM,fibrosis-4(FIB-4),aspartate aminotransferase to platelet ratio index(APRI),liver stiffness and platelet ratio index(LPRI),and the Hui score across different stages of fibrosis(S1-S4).The Kruskal-Wallis H test was employed to analyze the relationship between LSM values and TCM syndrome types.Results:Among patients with CHB complicated by NAFLD,prothrombin time,platelet count,albumin,and gamma-glutamyl transpeptidase levels differed significantly across fibrosis stages(P<0.05),whereas age,body mass index,globulin,alanine aminotransferase,aspartate aminotransferase,total bilirubin,and controlled attenuation parameter showed no significant differences(P>0.05).LSM,FIB-4,APRI,LPRI,and Hui score increased significantly with fibrosis progression(P<0.001),and all were positively correlated with histological staging,with LSM showing the strongest correlation(r=0.40).ROC curve analysis showed that LSM achieved area under the curve(AUC)values of 0.703,0.641,and 0.871 for diagnosing stage S1 to S3 fibrosis,respectively.The corresponding sensitivities were 75%,79.2%,and 90.9%,and the specificities were 56.4%,57.6%,and 78.8%,with cut-off values of 6.55,7.25,and 8.85 kPa.In all cases,LSM outperformed the other models in diagnostic performance(P<0.05).For diagnosing stage S4 fibrosis,LSM had an AUC of 0.859,with a sensitivity of 80%,a specificity of 91.4%,and a cut-off value of 11.45 kPa.Its diagnostic performance was second only to that of LPRI(AUC=0.899)(P<0.05).LSM values differed significantly among TCM syndrome types,with the highest values observed in patients with the syndrome of blood stasis blocking collaterals.(P<0.05).Conclusion:LSMprovides a relatively accurate assessment of liver fibrosis severity in patients with CHB combined by NAFLD.LSM demonstrates superior diagnostic accuracy for fibrosis stages below S4 compared to other non-invasive serum-based models,highlighting its value in the early detection of liver fibrosis.Moreover,the degree of liver fibrosis varies significantly across TCM syndrome types,with the most severe fibrosis observed in patients diagnosed with the syndrome of blood stasis blocking collaterals.关键词
慢性乙型肝炎/非酒精性脂肪性肝病/中医证型/肝脏硬度值/无创血清模型Key words
chronic hepatitis B/non-alcoholic fatty liver disease/traditional Chinese medicine certificate type/liver stiffness measurement/non-invasive model分类
医药卫生引用本文复制引用
许龙昊,唐金模,周超,康燕能,陈华笑,王敏..肝脏硬度值对慢性乙型肝炎合并非酒精性脂肪性肝病肝纤维化的诊断价值及与中医证型的相关性[J].中西医结合肝病杂志,2026,36(5):550-554,5.基金项目
国家自然科学基金项目(No.82305067),福建省科技厅引导性项目(No.2023D018),第七批全国老中医药专家学术经验继承工作项目(国中医药人教函[2022]76号) （No.82305067）
