不同无创肝纤维化评分指标评估2型糖尿病伴非酒精性脂肪肝病患者肝纤维化的比较

摘要

目的：比较不同无创肝纤维化评分指标对2型糖尿病（type 2 diabetes mellitus ，T2DM ）伴非酒精性脂肪肝病（non‐alco‐holic fatty liver disease ，NAFLD）患者肝纤维化的评价作用。方法：将996例明确诊断为T2DM、同时经超声诊断为NAFLD的患者（男性578例，女性418例）纳入分析，采集患者的空腹静脉血，测定血常规及肝脏相关酶。计算天门冬氨酸氨基转移酶（aspartate aminotransferase ，AST）／丙氨酸氨基转移酶（alanine aminotransferase ，ALT）比值、FIB‐4指数、BARD评分、AST／血小板比值指数（APRI）及NAFLD纤维化评分（NAFLD fibrosis score ，NFS）。以NFS作为评价肝纤维化的标准，采用相关性分析比较其余指标与NFS的相关性，进一步采用Bland‐Altman方法评价这些指标的一致性。结果：T2DM伴NAFLD的男性和女性患者中，AST／ALT比值、FIB‐4指数、BARD评分及APRI均与NFS呈线性正相关，其中FIB‐4指数与NFS的相关性最强（r＝0．619，P＜0．01）。Bland‐Altman分析结果表明，AST／ALT比值及FIB‐4指数与NFS一致性良好，以FIB‐4指数最佳。结论：AST／ALT比值及FIB‐4指数可以用来评价T2DM伴NAFLD患者是否存在肝纤维化。%Objective:To compare different non‐invasive hepatic fibrosis evaluation criteria for the evaluation of hepatic fibrosis in patients with type 2 diabetes mellitus(T2DM ) combined with non‐alcoholic fatty liver disease(NAFLD) .Methods:A total of 996 patients(male 578 ,female 418) definitely diagnosed with T2DM ,who were simultaneously identified as NAFLD by ultrasonography ,were involved in the analysis .The venous fasting blood was collected from patients ,and blood routine and hepatic enzymes were evaluated .Aspartate aminotransferase(AST)/alanine aminotransferase(ALT) ratio ,FIB‐4 index ,BARD score ,AST to platelet ratio index (APRI) and NAFLD fibrosis scores(NFS) were calculated .NFS was set as the evaluation criterium for hepatic fibrosis .The correlations between the other indexes and the NFS were compared with correlation analysis . As the next step ,consistency of these indexes was evaluated by Bland‐Altman method .Results:AST/ALT ratio ,FIB‐4 index , BARD score and APRI ratio had linear positive correlation with NFS among male and female patients with T2DM combined with NAFLD .Furthermore ,the most significant correlation was observed between FIB‐4 index and NFS(r=0 .619 ,P<0 .01) . Bland‐Altman analysis indicated that AST/ALT ratio and FIB‐4 index were highly consistent with NFS ,and the FIB‐4 index was the best among the indexes .Conclusions:AST/ALT ratio and FIB‐4 index can be used to identify whether there is hepatic fibrosis in patients with T2DM combined with NAFLD .