Correlations And Diagnostic Value Of Serological Indexes In Advanced Fibrosis Of Nonalcoholic Fatty Liver Disease

Background and purpose:Non-alcoholic fatty liver disease(NAFLD)is a clinical and pathological syndrome characterized by the non-alcoholic fatty liver disease(NAFLD).Including simple fatty liver(NAFL),non-alcoholic steatotitis(NASH),and liver cirrhosis.with metabolic syndrome such as obesity,blood fat,In recent years,the prevalence of NAFLD in China has increased significantly,and has become one of the most common chronic liver diseases in China.At present,there is no ideal drug treatment for NAFLD.The main therapeutic measures are to evaluate the degree and risk of liver fibrosis in NAFLD patients early,so as to detect cirrhosis as soon as possible,and to delay the progress of liver fibrosis by actively eliminating the etiology.Improve the prognosis of patients.Liver biopsy is a gold standard for evaluating histological changes of the liver,but its clinical application is limited because of its invasiveness.Therefore,non-invasive detection is particularly important for the prediction of advanced fibrosis in NAFLD.Recent studies have shown that serum marker detection systems such as: aspartate aminotransferase platelet ratio index(APRI),FIB-4 index,NAFLD hepatic fibrosis score and so on,related to liver fibrosis after viral hepatitis,and have certain predicted value.A similar study of the value of these indicators in the treatment of the progression of hepatic fibrosis in patients with NAFLD was reported to be less.In this study,we aim to study the relationship between serum markers and the progression of non-alcoholic fatty liver disease and its diagnostic value.Methods:The clinical data of 231 patients with nonalcoholic fatty liver hospitalized in the second affiliated Hospital of Nanchang University from January 2015 to December 2018 were analyzed retrospectively.the transient elasticity of liver was detected by(FibroScan)in all patients.According to the liver hardness value(E),they were divided into LSM ≥9.7 kPa(group A)and LSM < 9.7kPa(group B)group.Basic information such as height and weight of all patients were collected.Serological indexes included PLT,ALT,AST,Alb,FBG,TG,TC,LDL,HDL,calculation of BMI,AST/ALT,APRI,FIB-4 index and NAFLD fibrosis score(NFS),were used to compare the difference of serum markers between group A and group B.the single factor and multivariate analysis were carried out by Logistic regression model,and the independent risk factors of advanced fibrosis of NAFLD were obtained.SPSS24.0 software was used for statistical analysis.Result:Among the 231 patients with NAFLD in this study,19(8.2%)had LSM ≥ 9.7 KPA,and ALT,AST,BMI,TG,APRI,FIB-4 and other indexes in LSM ≥ 9.7kPa group were significantly higher than those in LSM < 9.7kPa group.The difference was statistically significant(P < 0.05).In the multivariate analysis,AST(OR= 1.148,P < 0.001),BMI(OR= 1.462,P = 0.002),FBG(OR= 1.30,P = 0.009),APRI(OR= 1.582,P=0.002),FIB-4(OR=21.861,P=0.002),HDL(OR<0.001,P < 0.001)were independent risk factors for advanced fibrosis of NAFLD,HDL was inversely correlated with progressive liver fibrosis.The optimal cut-off value of the diagnostic efficiency of(AUC),under the curve for predicting the progressive fibrosis of NAFLD was calculated,and the sensitivity,specificity,positive and negative predictive values were calculated.The comparison of the indexes showed that the AUC predicted by APRI for progressive fibrosis of NAFLD was 0.794.The optimal cut-off value of diagnostic efficiency was 0.674,which was helpful for the diagnosis of advanced fibrosis of NAFLD.Because of its high specificity(89.6%),the negative value of the cut-off value could also lead to better rejection of advanced fibrosis of NAFLD.Conclusion:The indexes of AST,BMI,FBG,HDL,APRI,FIB-4 were the risk factors of the progression of NAFLD in the progression of NAFLD.Therefore,serological APRI is a reliable index to predict advanced liver fibrosis in NAFLD.