| Objective: In order to explore the value of Fibro Scan,non-alcoholic fatty liver disease fibrosis score(NFS)and fibrosis index based on the 4 factor(FIB-4)in the diagnosis of advanced liver fibrosis in patients of non-alcoholic fatty liver disease(NAFLD)combined with hepatitis B virus(HBV)infection.Methods: This is a retrospective collection that includes the data of 103 patients who had been performed liver biopsy and diagnosed as NAFLD combined with HBV infection by liver pathology between November 2014 and August 2018 at Sichuan Provincial People's Hospital.The data includes:(1)demography: gender,age,weight,height,body mass index(BMI);(2)previous medical history: impaired fasting glucose/diabetes,hypertension,alcohol intake and other conditions that might lead to liver damage;(3)laboratory index:aspartate aminotransferase(AST),alanine aminotransferase(ALT),albumin(ALB),platelets(PLT),hepatitis Be antigen(HBe Ag);(4)liver stiffness measurement(LSM)measured by Fibro Scan;(5)the steatosis,activity,and fibrosis score(SAF)of hepatic histopathology.According to the liver pathological SAF grading,the patients were divided into the group of mild to moderate liver fibrosis(F1+F2,n=77)and the group of advanced liver fibrosis(F3,n=26)based on the degree of liver fibrosis;and the patients were divided into the group of liver activity score(A)< 3(n=57)and the group of liver activity score(A)>3(n=46)based on the degree of liver activity.These non-invasive diagnostic methods which included LSM measured by Fibro Scan,NFS and FIB-4 were used individually or jointly to evaluate the clinical value of the diagnosis of advanced liver fibrosis in patients of NAFLD combined with HBV infection.Results:(1)Fibro Scan,NFS and FIB-4 were positively correlated with the pathological staging of liver fibrosis(P<0.05).(2)Fibro Scan,NFS and FIB-4 have some value in the independent diagnosis of advanced liver fibrosis,and their AUC(95%CI)separately was 0.840(0.754~0.905),0.764(0.670~0.842),and 0.780(0.688~0.856),all P<0.0001.By combining Fibro Scan with NFS,compared with the single NFS,the specificity and positive predictive value in the diagnosis of advanced liver fibrosis were respectively increased by 14.06% and 14.35%,and compared with the single Fibro Scan,the sensitivity was increased by 11.54%.By combining Fibro Scan and FIB-4,compared with the single FIB-4,the specificity and positive predictive value in the diagnosis of advanced liver fibrosis were respectively increased by 16.62% and 11.66%,and compared with the single Fibro Scan,the sensitivity was increased by 11.54%.The combination of Fibro Scan,NFS and FIB-4 showed that the sensitivity,specificity,positive prediction,and negative prediction of diagnosing advanced liver fibrosis were similar to those of Fibro Scan combined with NFS or FIB-4.(3)The age,ALT,AST and PLT levels in the group of the mild and moderate liver fibrosis were significantly lower than those in the group of the advanced liver fibrosis,with statistical differences(P<0.05),while there were no statistical differences in gender,BMI,HBe Ag and ALB(P>0.05).(4)The age,BMI,ALT,AST levels in the group of liver activity score(A)<3 were significantly lower than those in the group of liver activity score(A)?3,with statistical differences(P<0.05),ALB level in the group of liver activity score(A)<3 was significantly higher than that in the group of liver activity score(A)?3,with statistical differences(P<0.05),while there were no statistical differences in gender,HBe Ag,PLT(P> 0.05).Conclusion:(1)The clinical value of Fibro Scan combined with NFS or FIB-4 in diagnosing the advanced liver fibrosis in patients of NAFLD combined with HBV infection is superior to the single non-invasive diagnostic methods.(2)In the patients of NAFLD combined with HBV infection,the age,ALT,AST and PLT levels might be correlated with advanced liver fibrosis;the age,BMI,ALT,AST and ALB levels might be correlated with liver activity. |
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