Study on the relationship between liver fibrosis progression and metabolic factors in nonalcoholic fatty liver disease
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摘要: 目的:基于FibroTouch确定非酒精性脂肪性肝病(NAFLD)患者肝脏硬度值(LSM),围绕BMI、血脂、空腹血糖、肾功能等代谢相关指标,分析NAFLD肝纤维化进展与代谢因素的相关性,为NAFLD肝纤维化进展继发代谢系统疾病提供早期预警。方法:选择2019年4月-2020年12月经B超确诊的327例NAFLD患者,计算BMI、空腹血脂、空腹血糖、肾功能等代谢因素相关血清学指标,同时均行FibroTouch测量LSM值,根据LSM值对代谢因素指标进行比较及作相关性分析。结果:①据LSM值分为无肝纤维化组、轻微肝纤维化组、显著肝纤维化组,3组CHOL、TG、HDL、GLU、BMI与LSM值比较差异有统计学意义(P<0.05),其中BMI、CHOL、GLU与LSM值呈正相关(r>0),HDL、TG与LSM值呈负相关(r<0);②根据LSM值分为无肝纤维化组与肝纤维化组,2组BMI、GLU与LSM值差异有统计学意义(P<0.05),其系数分别为1.136、1.531;③根据LSM值分为进展期肝纤维化组与显著肝纤维化组,2组TG、BMI、GLU与LSM值差异有统计学意义(P<0.05),其系数为1.257、1.189、2.230;BMI、GLU与LSM值有明显相关性。结论:BMI、GLU与NAFLD的LSM值关系密切,NAFLD肝纤维化进展对BMI、GLU有一定影响;控制NAFLD患者肝纤维化进展,对于改善机体肥胖、糖类代谢异常有积极意义。
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关键词:
- 非酒精性脂肪性肝病 /
- 代谢综合征 /
- FibroTouch /
- 肝纤维化 /
- 肝脏硬度值
Abstract: Objective: To determine liver stiffness value(LSM) of patients with nonalcoholic fatty liver disease(NAFLD) based on fibrotouch, and analyze the correlation between liver fibrosis progression and metabolic factors of NAFLD around metabolic related indicators such as body mass index(BMI), blood lipid, fasting blood glucose and renal function, so as to provide early warning for metabolic system diseases secondary to liver fibrosis progression of NAFLD. Methods: From April 2019 to December 2020, 327 patients with NAFLD diagnosed by B-ultrasound were selected.BMI was calculated. Fasting blood samples were taken to detect serum lipid, fasting blood glucose, renal function and other metabolic factors. The LSM value was measured by fibrotouch. The metabolic factors were compared and analyzed according to the LSM value. Results: ①According to LSM value, there were significant differences in CHOL, TG, HDL, GLU, BMI and LSM value among non fibrosis group, mild fibrosis group and significant fibrosis group(P<0.05), in which BMI, CHOL, GLU and LSM value were positively correlated(r>0), HDL, TG and LSM value were negatively correlated(r<0). ② According to LSM value, there were significant differences in BMI, GLU and LSM value between non fibrosis group and fibrosis group, the difference was statistically significant(P<0.05), and the coefficients were 1.136 and 1.531 respectively. ③According to the LSM value, they were divided into advanced hepatic fibrosis group and significant liver fibrosis group, and the differences of TG, BMI, GLU and LSM values were statistically significant(P<0.05), and the coefficients were 1.257, 1.189 and 2.230; BMI, GLU and LSM values were significantly correlated. Conclusion: BMI and GLU are closely related to LSM of NAFLD, and the progression of liver fibrosis in NAFLD has a certain impact on BMI and GLU; controlling the progression of liver fibrosis in NAFLD patients has a positive significance for improving obesity and abnormal carbohydrate metabolism. -
[1] 中华医学会肝病学分会脂肪肝和酒精性肝病学组.非酒精性脂肪性肝病防治指南(2018年更新版)[J].实用肝脏病杂志, 2018, 21(2):177-186.
[2] Seokhun Y, Soongu K, Jeong-hoon L, et al.Nonalcoholic Fatty Liver Disease Is an Early Predictor of Metabolic Diseases in a Metabolically Healthy Population[J].PloS One, 2019, 14(11):224626.
[3] Adriana S, Luis H, Martha L, et al.New Gene Therapy Strategies for Hepatic Fibrosis[J].World J Gastroenterol, 2015, 21(13):3813-3825.
[4] 邓超文, 龚正华, 胡国信.《2016年亚太肝病学会共识指南:肝纤维化的侵入性和非侵入性评估》摘译[J].临床肝胆病杂志, 2017, 33(3):413-416.
[5] Monica L, Diana F, Horia S, et al.Diagnostic Accuracy of Controlled Attenuation Parameter Measured By Transient Elastography for the Non-invasive Assessment of Liver Steatosis:a Prospective Study[J].J Gastrointest Liver Dis, 2015, 24(1):35-42.
[6] Zeng J, Cai S, Liu J, et al.Dynamic Changes in Liver Stiffness Measured By Transient Elastography Predict Clinical Outcomes Among Patients with Chronic Hepatitis B[J].J Ultrasound Med, 2017, 36(2):261-268.
[7] Soholm J, Thiele MS, Christensen PB.Controlled Attenuation Parameter Is a Novel Technique in Screening for Non-alcoholic Fatty Liver Disease[J].Ugeskr Laeger, 2018, 18(5):281-286.
[8] 李军祥, 陈誩, 王允亮.非酒精性脂肪性肝病中西医结合诊疗共识意见(2017年)[J].中国中西医结合消化杂志, 2017, 25(11):805-811.
[9] Sung KJ.New Perspectives in Pediatric Nonalcoholic Fatty Liver Disease:Epidemiology, Genetics, Diagnosis, and Natural History[J].Pediatric Gastroenterol Hepatol Nutri, 2019, 22(6):501-510.
[10] Zhou F, Zhou J, Wang W, et al.Unexpected Rapid Increase in the Burden of Nafld in China From 2008 to 2018:a Systematic Review and Meta-analysis[J].Hepatology, 2019, 70(4):1119-1133.
[11] Harrison SA, Gawrieh S, Roberts K, et al.Prospective Evaluation of the Prevalence of Non-alcoholic Fatty Liver Disease and Steatohepatitis in a Large Middle-aged Us Cohort[J].J Hepatol, 2021.
[12] Zhu J, Zhou Q, Wang Y, et al.Prevalence of Fatty Liver Disease and the Economy in China:a Systematic Review[J].World J Gastroenterol, 2016, 21(18):5695-5706.
[13] Zhou J, Cai J, She Z, et al.Noninvasive Evaluation of Nonalcoholic Fatty Liver Disease:Current Evidence and Practice[J].World J Gastroenterol, 2019, 25(11):1307-1326.
[14] Gomez EV, Bertot LC, Wong VWS, et al.Fibrosis Severity as a Determinant of Cause-specific Mortality in Patients with Advanced Nonalcoholic Fatty Liver Disease[J].Gastroenterology, 2018, 155(2):443-457.
[15] 刘旭东, 吕萍, 赵壮志, 等.非酒精性脂肪性肝病对全身多系统的影响[J].世界华人消化杂志, 2017, 25(11):951-957.
[16] Targher G, Lonardo A, Byrne CD.Nonalcoholic Fatty Liver Disease and Chronic Vascular Complications of Diabetes Mellitus[J].Nat Rev Endocrinol, 2017, 14(2):99-114.
[17] Hazlehurst JM, Woods C, Marjot T, et al.Non-alcoholic fatty liver disease and diabetes[J].Metabolism, 2016, 65(8):1096-1108.
[18] Won LH, Kyung KB, Up KS, et al.Prevalence and Predictors of Significant Fibrosis Among Subjects with Transient Elastography-defined Nonalcoholic Fatty Liver Disease[J].Dige Dis Sci, 2017, 62(8):2150-2158.
[19] Rinella ME.Nonalcoholic Fatty Liver Disease:a Systematic Review[J].JAMA, 2015, 313(22):2263-2273.
[20] Ludovica FA, Salvatore P, Rosa L, et al.Liver and Cardiovascular Damage in Patients with Lean Nonalcoholic Fatty Liver Disease, and Association with Visceral Obesity[J].Clin Gastroenterol Hepatol, 2017, 15(10):1604-1611.
[21] 刘容, 刘旭东, 黎宝珍, 等.体重指数对评估非酒精性脂肪性肝病患者肝纤维化的意义[J].世界最新医学信息文摘, 2020, 20(53):128-130, 136-136.
[22] 梁倩玉.BMI、AST及TBIL对非酒精性脂肪性肝病进展期纤维化的预测价值[D].长春:吉林大学, 2020.
[23] 赵壮志.瞬时弹性成像技术(FibroTouch)诊断慢乙肝患者肝纤维化的影响因素分析[D].南宁:广西中医药大学, 2019.
[24] 王一.慢性乙型病毒性肝炎患者肝脏炎症与肝脏瞬时弹性检测值关系的研究[D].太原:山西医科大学, 2018.
[25] Fraquelli M, Rigamonti C, Casazza G, et al.Reproducibility of Transient Elastography in the Evaluation of Liver Fibrosis in Patients with Chronic Liver Disease[J].Gut, 2007, 56(7):968-973.
[26] Rhee EJ.Nonalcoholic Fatty Liver Disease and Diabetes:an Epidemiological Perspective[J].Endocrinol Metab(seoul), 2019, 34(3):226-233.
[27] Mcpherson S, Hardy T, Henderson E, et al.Evidence of Nafld Progression From Steatosis to Fibrosing-steatohepatitis Using Paired Biopsies:Implications for Prognosis and Clinical Management[J].J Hepatol, 2015, 62(5):1148-1155.
[28] Jessica B, Michele D, Neuschwandertetri BA, et al.Clinical Model for NASH and Advanced Fibrosis in Adult Patients With Diabetes and NAFLD:Guidelines for Referral in NAFLD[J].Diabetes Care, 2015, 38(7):1347-1355.
[29] 孙涛, 杜凤梅, 戴立娟.恩替卡韦治疗对慢性乙型肝炎患者血糖和血脂的影响[J].肝脏, 2019, 24(6):680-683.
[30] 刘瑜, 张静.慢性乙型肝炎患者糖代谢水平对肝脏炎症及纤维化的影响[J].牡丹江医学院学报, 2019, 24(2):14-16.
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