| Objects: To compare the demographic data,clinical characteristics,hepatic fibrosis distribution characteristics between NAFLD group and HBV infection combined with NAFLD group and explored the biochemical and pathological features of HBV-infected patients complicated with NAFLD,then compare E values,APRI,GPR,and FIB-4 index for diagnostic efficiency of hepatic fibrosis in patients with HBV-infected patients complicated with NAFLD.By analyzing the pathological features of patients with chronic HBV infection and NAFLD group,the main causes of liver inflammation and fibrosis were identified,and the indicators related to liver inflammation were distinguished to determine whether there was a non-invasive inflammatory diagnosis model to identify the current main cause of abmoral liver function in patients with chronic HBV infection coexist with NAFLD.Methods: Collect the demographic data,clinical characteristics and liver pathological features of 40 patients with NAFLD and 120 patients with HBV infection complicated with NAFLD who underwent liver pathology at the Tianjin Second People's Hospital from May 2016 to October 2017.We use univariate analysis to compare the clinical characteristics and fibrosis distribution characteristics between the two groups.Secondly,pathologists classified 120 patients with HBV infection complicated with NAFLD into two groups based on their pathological characteristics: active HBV infection group,and inactive HBV infection group.Then,we use univariate analysis to compare the differences of general characteristics,biochemical parameters and imaging examination,distribution of liver fibrosis distribution.Finally,according to the binary logistic regression analysis,we get the correlation index with the liver inflammation and a regression formula and verify its accuracy evaluation of the regression formula.Results 1.The levels of ALT,TBIL,and CRE in the HBV-infected complicated with NAFLD group were higher than those in NAFLD group.The levels of ?-GT,ALB,UA,TG,and CHO in the HBV-infected complicated with NAFLD group were lower than those in NAFLD group.the difference was statistically significant(P<0.05).There was no significant difference in AST,ALP,TP,BUN,HDL,LDL,GLU and INS between the two groups(P>0.05).2.The levels of FER,Ig G,E value,TT3,FT3 in the HBV-infected complicated with NAFLD group were higher than those in NAFLD group.The levels of C3,C4,PLT,CAP in the HBV-infected complicated with NAFLD group were lower than those in NAFLD group(P<0.05).3.There was a significant difference in the number of fibrosis and fiber density in the portal area,sinus,the central vein and the degree of densification among the two groups.The degree of fibrosis and fibrillary septum in the portal area among the HBV-infected complicated with NAFLD group were higher than those in NAFLD group.The degree of sinus fibrosis and peripheral venous fibrosis were higher than those in NAFLD group(P<0.05).4.In the diagnosis of obvious liver fibrosis(F?2),the diagnostic efficiency of E value was significantly better than the GPR,APRI,FIB-4 index(P<0.05),the difference between the other indicators were not statistical significance(P>0.05).In the diagnosis of obvious liver fibrosis of advanced liver fibrosis(F ? 3),the diagnostic efficacy of E value was better than GPR index,and there was no significant difference between the other index groups(P>0.05).5.According to the working definition we have established,120 patients with HBV infection and NAFLD were subdivided into inactive HBV inflammation group and active HBV inflammation group.The G and S stage in the inactive HBV inflammation group were lower than those in the active HBV group,suggesting that the degree of inflammation and fibrosis in the active HBV inflammation group was higher and severe than that of the inactive HBV inflammation group.6.The levels of ALT,AST,GGT and HDL in inactive HBV inflammation group were lower than active HBV inflammation group.The levels of TP,ALB and UA were higher than active HBV group.There was significant difference between groups(P<0.05).There was no significant difference in TBIL,BUN,CRE,CHO,LDL,and GLU between the two groups(P>0.05).7.The levels of CAP,PLT,C3 and C4 in inactive HBV inflammation group were higher than those in active HBV inflammation group.The HBV-DNA load,E value,MCV,MPV and Ig G levels were lower than active HBV inflammation group(P<0.05).There was no significant difference in WBC,HCT,HBs Ag,HBe Ag,Ig M,Ig M,HA,LN,IV,IV between the two groups(P>0.05).8.The difference of liver fibrosis distribution,fibrosis density,and lobular structural disorder in patients with inactive HBV inflammation and active HBV inflammation group was statistically significant.The degree of sinus fibrosis in the inactive HBV inflammation group was higher than that in the HBV infection group combined with NAFLD;the fibrillary septum formation was lower than that in the HBV infection group combined with NAFLD(P<0.05).There was no significant difference in the degree of fibrosis in the portal area and the degree of fibrosis around the central vein between the two groups(P>0.05).9.By logistic regression analysis,the differences in age,CAP,PLT,E,and ALT were statistically significant.The regression equation was Y=0.034× ? ?-0.025×CAP+0.396×E+0.051×ALT-0.186,the overall correct rate of prediction was 86.9%.The corresponding AU-ROC was 0.934,and the cut-off value was 0.59.The sensitivity and specificity were 80.73%,94.08%.Conclusions: 1.Combining HBV infection can affect the lipid metabolism of NAFLD patients,and may lead to the reduction of C3 and C4,which may aggravate the body's immune system damage.2.Hepatic fibrosis in patients with HBV infection combined with NAFLD group is mainly distributed in the portal area,with a small amount of sinus fibrosis,and it is much easier to form fibrillary septa.Liver fibrosis in patients with NAFLD group is mainly distributed around the sinusoids and the central vein.3.When diagnosing obvious hepatic fibrosis in patients with HBV infection complicated with NAFLD,the diagnostic value of E value was the best among the GPR,APRI and FIB-4 index.4.The degree of inflammation and fibrosis in inactive HBV inflammation group was lower than that in active HBV inflammation group;the increased levels of transaminase in inactive HBV inflammation group were lower than active HBV inflammation group.5.The degree of sinus fibrosis in inactive HBV inflammation group was higher than active HBV infection group,and the proportion of fibrillary septum formation was lower than active HBV infection group.The liver fibrosis in the inactive HBV inflammation group was mainly distributed around the sinusoids,and the proportion of fibroid septum formation was lower.6.In clinical work,we can use the regression equation Y=0.034×??-0.025×CAP+0.396×E+0.051×ALT-0.186 to conduct initial screening for the causes of liver funcion in HBV-infected patients combined with NAFLD.When the value is higher than 0.59,considering that the current liver inflamation is mainly related to HBV infection,it is necessary to strengthen the detection of HBV and give antiviral treatment if necessary.The utility of the equation has to be verified by increasing the sample size. |
PDF Full Text Request