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

Abstract

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

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.

References

[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.

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)

Knowledge

Abstract

Cite this article

share this article

References

Related Articles 15

Recommended Articles

Metrics

Comments

[1]	Lu Yifan, Chen Hao, Huai Jiaxian, et al. Hashimoto's thyroiditis and nonalcoholic fatty liver disease:contingency or causality? [J]. Journal of Practical Hepatology, 2025, 28(3): 326-329.
[2]	Liu Qian, Yang Jie, Zhang Jing, et al. Implication of peripheral blood mononuclear cell galectin-3 and galectin-9 in patients with chronic hepatitis B and concomitant metabolism-related fatty liver disease [J]. Journal of Practical Hepatology, 2025, 28(3): 338-341.
[3]	Wang Yu, Liu Jie, Fan Jianmin, et al. Sound touch elastography in predicting liver fibrosis in patients with chronic hepatitis B [J]. Journal of Practical Hepatology, 2025, 28(3): 342-345.
[4]	Xu Lingling, Lu Yuan, Zheng Yanchai, et al. Improvement of liver function tests by oral bicyclol in patients with type 2 diabetes mellitus and nonalcoholic steatohepatitis [J]. Journal of Practical Hepatology, 2025, 28(3): 358-361.
[5]	Qin Hao, Fang Chunhua, He Jing, et al. Comparison of diagnostic performance of six non-invasive evaluation scores for type 2 diabetes mellitus with metabolic associated fatty liver disease [J]. Journal of Practical Hepatology, 2025, 28(3): 366-369.
[6]	Wen Dachao, Zhang Qiuping, Shi Ling. Short-term observation of acupoint application and exercise in the treatment of patients with non-alcoholic fatty liver disease [J]. Journal of Practical Hepatology, 2025, 28(3): 370-373.
[7]	Ma Chengxi, Xu Jing, Wang Yanqiu. Ultrasound attenuation coefficient and serumALT/AST ratio in evaluating liver steatosis in patients with nonalcoholic fatty liver disease [J]. Journal of Practical Hepatology, 2025, 28(3): 374-377.
[8]	Wang Xintian, Kang Xiaobo, Wu Xia, et al. Changes of serum osteocalcin,β-I type collagen carboxy-terminal peptide and angiotensin levels in patients with non-alcoholic fatty liver diseases [J]. Journal of Practical Hepatology, 2025, 28(3): 378-381.
[9]	Zhai Feifei, Wang Cai, Wang Junling, et al. Diagnostic performance of sound touch elastography and semi-quantitative ultrasound scoring in assessing early liver cirrhosisin patients with chronic hepatitis B [J]. Journal of Practical Hepatology, 2025, 28(3): 402-405.
[10]	Gao Jianjun, Zhang Huaxi, Fan Renbao, et al. CT portography quantitative parameters in predicting portal hypertension and esophagogastric variceal bleeding in patients with decompensated liver cirrhosis [J]. Journal of Practical Hepatology, 2025, 28(3): 418-421.
[11]	Dong Yanhong, Jiang Kun, Huang Hui, et al. MRI evaluation of intrahepatic residual lesions in patients with primary liver cancer after transcatheter arterial chemoembolization [J]. Journal of Practical Hepatology, 2025, 28(3): 434-437.
[12]	Sha Xinjie, Xia Xiaoliang. Diagnosis of benign and malignant liver tumors by magnetic resonance imaging enhancement scanning and diffusion-weighted imaging [J]. Journal of Practical Hepatology, 2025, 28(3): 438-441.
[13]	Liu Qianqian, Duan Zhijiao, Chen Ping. Non-invasive assessment of liver fibrosis in patients with non-alcoholic fatty liver disease [J]. Journal of Practical Hepatology, 2025, 28(3): 477-480.
[14]	Zhu Tingting, Chen Yiyun, Xie Fanci, et al. Non-invasive assessment of liver fibrosis reverse in patients with chronic liver diseases [J]. Journal of Practical Hepatology, 2025, 28(2): 169-172.
[15]	Yu Kai, Mei Yunhua, Zhou Jinrong, et al. Ultrasonic transient elastography in predicting liver fibrosis in patients with chronic hepatitis B and liver steatosis [J]. Journal of Practical Hepatology, 2025, 28(2): 190-193.