Multifactor Analysis Of Controlled Attenuation Parameters In NASH Patients

BackgroundNon-alcoholic fatty liver disease is a clinical pathological syndrome characterized by diffuse hepatocyte bullous steatosis which excluded alcohol,viruses,drugs and other definite liver damage factors.Spectrum of the disease including simple fatty liver to nonalcoholic steatohepatitis to eventually cirrhosis and liver cancer.With the change of lifestyle,the incidence and prevalence of NAFLD are increasing in the world.Therefore,it is imminent to screen out NAFLD patients from healthy people and take standardized treatment in time.At present,the gold standard for NASH diagnosis is still a pathological diagnosis obtained by liver biopsy.However,liver biopsy is a invasive examination,and there are various complications such as pain and bleeding.It is not suitable to screen diseases among the population.Liver color Doppler ultrasound is widely used in the clinical practice to detect the fatty infiltration of the liver,but it does not quantify the fat content of the liver.In this article,63 cases of NASH confirmed by liver biopsy were collected,analysis the factors affecting the accuracy of controlled attenuation parameter by the noninvasive examination Fibrotouch in assessing hepatic steatosis.ObjectiveTo explore the factors influencing controlled attenuation parameters(CAP)obtained by Fibrotouch in patients with nonalcoholic steatohepatitis(NASH).MethodsPatients with NASH diagnosed by liver biopsy in the First Affiliated Hospital of Zhengzhou University from December 2015 to December 2016 were collected,CAP was detected and recorded by Fibrotouch before liver biopsy.We also staining of liver biopsy tissue.Clinical data were collected,including gender,age,body mass index(BMI),biochemical test value,CAP test value,liver pathology and other indexes for statistical analysis.According to the steatohepatitis degree grouping,the CAP detection value and the insulin level between the groups were analyzed.Results1.Taking CAP as the dependent variable,liver pathology indexes(degree of steatosis,lobular inflammation and ballooning)were taken as independent variables,multiple linear regression analysis was carried out to statistical analysis.The regression equation was CAP=226.24+23.34×steatosis +15.33× ballooning.2.Taking CAP as the dependent variable,BMI and biochemical indicators(TG,ALT,AST,TBIL,GGT,ALP,fasting insulin)were taken as independent variables,multiple linear regression analysis was carried out to analysis.The regression equation was CAP=210.64+9.03×TG+2.04×BMI.3.Single factor variance analysis of CAP value was performed in different degrees of hepatic steatosis,the result is :F=14.96,P<0.05,Which indicating CAP measurements are different under the different degrees of hepatic steatosis,then we compare each other with LSD-t test.The results is: steatosis grade 1 vs 2 is make sense,steatosis grade 2 vs3 is meaningless.4.Single factor variance analysis of insulin level was performed in different degrees of hepatic steatosis,the result is :F = 2.664,P > 0.05.Conclusion1.The steatosis and ballooning can be reacted by CAP values.And affected by BMI and serological indicators:triglycerides.It is not affected by inflammation,fibrosis,ALT,AST,TBIL,and fasting insulin levels.2.CAP can differentiate fatty degeneration of different degrees,but it has poor effect in determining the degree of hepatocyte steatosis,especially for moderate to severe steatosis.3.Different levels of insulin value have no significance to distinguish different degrees of hepatocyte steatosis.