Xu Nan, Xie Qinxiu, Li Jiang, Gao Yufeng, Li Xu
Department of Infectious Diseases, the First Affiliated Hospital of Anhui Medical University, Hefei, China.
Department of Liver and Infectious Diseases, the Second Affiliated Hospital of Anhui Medical University, Hefei, China.
J Int Med Res. 2020 Feb;48(2):300060520903667. doi: 10.1177/0300060520903667.
This study was performed to clarify the influence of nonalcoholic fatty liver disease (NAFLD) on liver stiffness measurement (LSM) and establish a new diagnostic model.
A retrospective cohort of 601 patients with chronic hepatitis B (CHB) was enrolled as the derivation group, and a prospective cohort of 30 patients with concurrent CHB and NAFLD was enrolled as the validation group.
The area under the receiver operating characteristic curve of LSM in patients with CHB without NAFLD (0.792) was higher than that in patients with concurrent CHB and NAFLD (0.720) in diagnosing significant liver fibrosis. Patients with concurrent CHB and NAFLD had significantly higher LSM values than those without NAFLD among the overall F0-F1 patients (6.88 vs. 5.80). The LSM value in the higher controlled attenuation parameter (CAP) quartile was significantly higher than that in the normal CAP quartile among F0-F1 patients (6.80 vs. 5.74). The efficacy of our new diagnostic model for liver fibrosis (Fibro-NAFLD) was higher than that of LSM in both study groups.
NAFLD with a high CAP value increases the risk of false-positive diagnosis of significant fibrosis. The Fibro-NAFLD model improves the diagnostic efficacy of LSM in patients with concurrent CHB and NAFLD.
本研究旨在阐明非酒精性脂肪性肝病（NAFLD）对肝脏硬度测量（LSM）的影响，并建立一种新的诊断模型。
选取601例慢性乙型肝炎（CHB）患者的回顾性队列作为推导组，选取30例合并CHB和NAFLD的患者的前瞻性队列作为验证组。
在诊断显著肝纤维化方面，不合并NAFLD的CHB患者中LSM的受试者操作特征曲线下面积（0.792）高于合并CHB和NAFLD的患者（0.720）。在总体F0-F1患者中，合并CHB和NAFLD的患者的LSM值显著高于不合并NAFLD的患者（6.88对5.80）。在F0-F1患者中，较高控制衰减参数（CAP）四分位数组的LSM值显著高于正常CAP四分位数组（6.80对5.74）。在两个研究组中，我们新的肝纤维化诊断模型（Fibro-NAFLD）的效能均高于LSM。
高CAP值的NAFLD增加了显著纤维化假阳性诊断的风险。Fibro-NAFLD模型提高了LSM对合并CHB和NAFLD患者的诊断效能。
