剪切波弹性成像联合APRI诊断2型糖尿病合并NAFLD患者肝纤维化程度价值研究*

doi:10.3969/j.issn.1672-5069.2025.03.016

摘要/Abstract

摘要： 目的探讨应用剪切波弹性成像检测联合天冬氨酸氨基转移酶/血小板比率指数(APRI)诊断2型糖尿病(T2DM)合并非酒精性脂肪性肝病(NAFLD)患者肝纤维化程度的价值。方法 2021年1月～2023年12月我院诊治的T2DM合并NAFLD患者73例,使用瞬时弹性成像(TE)行肝硬度检测(LSM),使用超声剪切波弹性成像检查获得杨氏模量值。常规临床检测,计算APRI。绘制受试者工作特征(ROC)曲线,分析指标的诊断效能,采用Kappa一致性分析评估剪切波弹性成像联合APRI与TE诊断的一致性。结果以LSM＞7.4 kPa诊断为进展期肝纤维化,本组发现进展期肝纤维化患者19例(26.0%);存在进展期肝纤维化患者体质指数、合并糖尿病肾病比率、血清AST、ALT水平、LSM、APRI和杨氏模量值分别为(30.7±2.8)kg/m²、42.1%、(92.3±10.5)U/L、(120.5±9.6)U/L、(12.7±3.1)kPa、(1.2±0.4)和(10.7±3.1)kPa,均显著高于非进展期肝纤维化患者[分别为(25.2±2.4)kg/m²、20.4%、(49.8±8.1)U/L、(47.8±7.3)U/L、(6.1±1.6)kPa、(0.8±0.3)和((5.1±1.6))kPa,P＜0.05]; ROC分析显示杨氏模量值联合APRI诊断T2DM合并NAFLD患者进展期肝纤维化的AUC为0.891,其敏感度为94.7%,特异度为74.1%,显著优于两指标单独预测(P＜0.05);剪切波弹性成像联合APRI诊断T2DM合并NAFLD患者进展期肝纤维化与TE检测诊断的Kappa值为0.563(P＜0.05),一致性中等。结论剪切波弹性成像联合APRI对T2DM合并NAFLD患者肝纤维化具有一定诊断价值。

关键词: 非酒精性脂肪性肝病, 2型糖尿病, 肝纤维化, 剪切波弹性成像, 天冬氨酸氨基转移酶/血小板比率指数, 诊断

Abstract: Objective The aim of this study was to explore diagnostic performance of shear wave elastography and aspartate aminotransferase/platelet ratio index (APRI) combination in predicting significant liver fibrosis (SLF) in patients with type 2 diabetes mellitus (T2DM) and non-alcoholic fatty liver disease (NAFLD). Methods 73 patients with T2DM and NAFLD were enrolled in our hospital between January 2021 and December 2023, and all underwent transient elastography (TE) to obtain liver stiffness measurement (LSM), underwent shear wave elastography to obtain Yang’s modulus, and routine blood detection for APRI. Receiver operating characteristic (ROC) curves were drawn for assess diagnostic efficacy, and the consistency between shear wave elastography and APRI combination, and LSM in the diagnosis of SLF was analyzed by Kappa test. Results SLF was found in 19 cases (26.0%) based on LSM＞7.4 kPa; body mass index, percentage of concomitant renal injury, serum AST, ALT level, LSM, APRI and Yang’s modulus in patients with SLF were (30.7±2.8)kg/m², 42.1%, (92.3±10.5)U/L, (120.5±9.6)U/L, (12.7±3.1)kPam (1.2±0.4) and (10.7±3.1)kPa, all much higher than [(25.2±2.4)kg/m², 20.4%, (49.8±8.1)U/L, (47.8±7.3)U/L, (6.1±1.6)kPa, (0.8±0.3) and ((5.1±1.6))kPa, respectively, P＜0.05] in patients without SLF; the ROC analysis showed that the AUC was 0.891, with sensitivity of 94.7% and specificity of 74.1%, when Yang’s modulus and APRI combination in predicting SLF in patients with T2DM and with underlying NAFLD, much superior to any parameters doing alone (P＜0.05); Kappa value between shear wave elastography and APRI combination, and TE in the diagnosis of SLF was 0.563 (P<0.05), suggesting moderate result. Conclusion Shear wave elastography and APRI combination in predicting SLF in patients with T2DM and NAFLD is efficacious, which might guide clinicians for further management.

Key words: Non-alcoholic fatty liver disease, Type 2 diabetes mellitus, Liver fibrosis, Shear wave elastography, Aspartate aminotransferase/platelet ratio index, Diagnosis

曾艾, 王聪, 李敏, 赵伊婷, 张琴, 何梅. 剪切波弹性成像联合APRI诊断2型糖尿病合并NAFLD患者肝纤维化程度价值研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 382-385.

Zeng Ai, Wang Cong, Li Min, et al. Diagnostic performance of shear wave elastography and APRI combination in predicting significant liver fibrosis in patients with type 2 diabetes mellitus and NAFLD[J]. Journal of Practical Hepatology, 2025, 28(3): 382-385.

参考文献

[1] Christensen MB, Gæde P, Hommel E, et al. Glycaemic variability and hypoglycaemia are associated with C-peptide levels in insulin-treated type 2 diabetes. Diabetes Metab, 2020, 46(1):61-65.
[2] Rinella ME, Neuschwander-Tetri BA, Siddiqui MS, et al. AASLD Practice Guidance on the clinical assessment and management of nonalcoholic fatty liver disease. Hepatology, 2023, 77(5):1797-1835.
[3] Duell PB, Welty FK, Miller M, et al. Nonalcoholic fatty liver disease and cardiovascular risk: a scientific statement from theAmerican heart association. Arterioscler Thromb Vasc Biol, 2022, 42(6):e168-e185.
[4] Hu C, Zhuang X, Zhang J, et al. Serum metabolomics in patients with coexisting nafld and t2dm using liquid chromatography-mass spectrometry. Lab Med, 2022, 53(4):360-368.
[5] Powell EE, Wong VW, Rinella M. Non-alcoholic fatty liver disease. Lancet, 2021, 397(10290):2212-2224.
[6] Caussy C, Aubin A, Loomba R. The relationship between type 2 diabetes, nafld, and cardiovascular risk. Curr Diab Rep, 2021, 21(5):15.
[7] Kumar V, Xin X, Ma J, et al. Therapeutic targets, novel drugs, and delivery systems for diabetes associated NAFLD and liver fibrosis. Adv Drug Deliv Rev, 2021, 176:113888.
[8] 中国肝炎防治基金会,中华医学会感染病学分会,中华医学会肝病学分会和中国研究型医院学会肝病专业委员会.瞬时弹性成像技术诊断肝纤维化专家共识(2018年更新版).中华肝脏病杂志,2019,27(3):182-191.
[9] Meyer G, Dauth N, Grimm M, et al. Shear wave elastography reveals a high prevalence of nafld-related fibrosis even in type 1 diabetes. Exp Clin Endocrinol Diabetes, 2022, 130(8):532-538.
[10] Amernia B, Moosavy SH, Banookh F, et al. FIB-4, APRI, and AST/ALT ratio compared to FibroScan for the assessment of hepatic fibrosis in patients with non-alcoholic fatty liver disease in Bandar Abbas, Iran. BMC Gastroenterol, 2021, 21(1):453.
[11] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2020年版).中华糖尿病杂志,2021,13(4):315-409.
[12] 中华医学会肝病学分会.代谢相关(非酒精性)脂肪性肝病防治指南(2024年版).实用肝脏病杂志,2024,27(4): 494-510.
[13] Hansen CD, Gram-Kampmann EM, Hansen JK, et al. Effect of calorie-unrestricted low-carbohydrate, high-fat diet versus high-carbohydrate, low-fat diet on type 2 diabetes and nonalcoholic fatty liver disease : a randomized controlled trial. Ann Intern Med, 2023, 176(1):10-21.
[14] 李敏,张丽,曾艾,等.2型糖尿病合并非酒精性脂肪性肝病患者肝纤维化检出率及预测因素分析.实用肝脏病杂志,2024,27(2):193-197.
[15] Lee J, Vali Y, Boursier J, et al. Prognostic accuracy of FIB-4, NAFLD fibrosis score and APRI for NAFLD-related events: A systematic review. Liver Int, 2021, 41(2):261-270.
[16] Li L, Huang Q, Yang L, et al. The association between non-alcoholic fatty liver disease (nafld) and advanced fibrosis with serological vitamin b12 markers: results from the NHANES 1999-2004. Nutrients, 2022, 14(6):1224.
[17] Ji Y, Wei CB, Gu W, et al. Relevance of vitamin D on NAFLD and liver fibrosis detected by vibration controlled transient elastography in US adults: a cross-sectional analysis of NHANES 2017-2018. Ann Med, 2023, 55(1):2209335.
[18] Soleimani D, Rezaie M, Rajabzadeh F, et al. Protective effects of propolis on hepatic steatosis and fibrosis among patients with nonalcoholic fatty liver disease (NAFLD) evaluated by real-time two-dimensional shear wave elastography: A randomized clinical trial. Phytother Res, 2021, 35(3):1669-1679.
[19] Selvaraj EA, Mózes FE, Jayaswal ANA, et al. Diagnostic accuracy of elastography and magnetic resonance imaging in patients with NAFLD: A systematic review and meta-analysis. J Hepatol, 2021, 75(4):770-785.
[20] Yu JH, Lee HA, Kim SU. Noninvasive imaging biomarkers for liver fibrosis in nonalcoholic fatty liver disease: current and future. Clin Mol Hepatol, 2023, 29(Suppl):S136-S149.
[21] Pennisi G, Enea M, Falco V, et al. Noninvasive assessment of liver disease severity in patients with nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes. Hepatology, 2023, 78(1):195-211.

剪切波弹性成像联合APRI诊断2型糖尿病合并NAFLD患者肝纤维化程度价值研究^*

Diagnostic performance of shear wave elastography and APRI combination in predicting significant liver fibrosis in patients with type 2 diabetes mellitus and NAFLD

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	陈春如, 齐浩龙, 鲁聪, 戴锴, 余佳. 昼夜节律在非酒精性脂肪性肝病发病过程中的作用研究进展^*[J]. 实用肝脏病杂志, 2025, 28(3): 321-325.
[2]	陆逸凡, 陈号, 怀家轩, 孙婧, 王高祥, 吴其标, 周希乔. 桥本氏甲状腺炎与非酒精性脂肪性肝病关系研究进展^*[J]. 实用肝脏病杂志, 2025, 28(3): 326-329.
[3]	刘倩, 杨洁, 张静, 宫克, 郭瑞丹. 慢性乙型肝炎合并代谢相关脂肪性肝病患者外周血单个核细胞Galectin-3和Galectin-9水平及其临床意义探讨^*[J]. 实用肝脏病杂志, 2025, 28(3): 338-341.
[4]	王钰, 刘洁, 樊健敏, 王成, 叶苗青. 超声声触诊弹性成像诊断慢性乙型肝炎患者肝纤维化价值研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 342-345.
[5]	徐玲玲, 卢远, 郑燕钗, 杨本场. 二甲双胍联合双环醇治疗非酒精性脂肪性肝炎患者短期疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 358-361.
[6]	秦浩, 方春华, 何競, 张磊, 冉斌, 汪丽萍, 张振华. 六种无创评分诊断2型糖尿病合并代谢相关脂肪性肝病患者效能比较^*[J]. 实用肝脏病杂志, 2025, 28(3): 366-369.
[7]	温大超, 张秋萍, 石凌. 穴位贴敷联合运动处方治疗非酒精性脂肪性肝病患者疗效初步研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 370-373.
[8]	马晨曦, 许静, 王艳秋. 超声声衰减系数联合血清ALT/AST比值评估非酒精性脂肪性肝病患者肝脂肪变程度价值研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 374-377.
[9]	王新田, 康晓波, 吴霞, 韦颖. 非酒精性脂肪性肝病患者血清OCN、β-CTX和血管紧张素水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2025, 28(3): 378-381.
[10]	翟菲菲, 王彩, 王俊玲, 韩悦. 声触诊超声弹性成像联合超声半定量评分诊断慢性乙型肝炎患者早期肝硬化效能研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 402-405.
[11]	刘玉华, 张源, 郭家婷. 肝脏超声血流参数联合肝脾硬度检测预测乙型肝炎肝硬化并发食管静脉曲张破裂出血价值研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 414-417.
[12]	高建军, 张华西, 范仁宝, 王玺. CTP定量参数预测失代偿期肝硬化患者并发食管胃底静脉曲张破裂出血价值研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 418-421.
[13]	董彦宏, 姜琨, 黄辉, 彭钊, 程艾. MRI扫描评估原发性肝癌患者TACE术后病灶残留价值研究^*[J]. 实用肝脏病杂志, 2025, 28(3): 434-437.
[14]	沙新杰, 夏晓亮. 磁共振成像增强扫描联合弥散加权成像评估良恶性肝脏肿瘤价值分析^*[J]. 实用肝脏病杂志, 2025, 28(3): 438-441.
[15]	刘倩倩, 段志娇, 陈平. 无创性评估非酒精性脂肪性肝病患者肝纤维化应用进展^*[J]. 实用肝脏病杂志, 2025, 28(3): 477-480.