| Background:Non-alcoholic fatty liver disease(NAFLD)is currently one of the most common chronic liver diseases worldwide.NAFLD is not a single disease.Its disease spectrum is manifested as a series of liver damage: simple asymptomatic liver Steatosis changes to non-alcoholic steatohepatitis(NASH),liver fibrosis,cirrhosis and even progress to hepatocellular carcinoma(HCC),end-stage liver disease [1-2].With the development of my country’s economic level and the continuous improvement of material levels,the incidence and symptoms of NAFLD continue to increase.NAFLD has replaced viral hepatitis B as my country’s largest chronic liver disease.Liver fibrosis is a key link in the process of many chronic liver diseases prolonging to cirrhosis,and it is also an important factor affecting the prognosis of patients with chronic liver disease.The all-cause mortality of NAFLD also increased significantly with the increase of liver fibrosis [9].Therefore,early diagnosis of liver fibrosis is particularly important for the prognosis and quality of life of NAFLD patients.Liver biopsy is the "gold standard" for diagnosing liver fibrosis.Because of its limitations,it cannot be widely carried out clinically,and it is impossible to track changes in the patient’s condition in time.In recent years,many non-invasive diagnostic criteria have been proposed.This study analyzed the basic data and serological indicators of patients who were confirmed by liver biopsy to explore the effects of serological indicators and NFS,BARD,FIB-4 and NIKEI on NAFLD.The predictive value of patients with liver fibrosis,and the application of Logistic regression to establish a predictive model,which can judge liver fibrosis,so as to intervene in time before the patient progresses to liver cirrhosis and hepatocellular carcinoma,and improve the prognosis and quality of life of the patients.Liver biopsy is the "gold standard" for diagnosing liver fibrosis.Because of its limitations,it cannot be widely carried out clinically,and it is impossible to track changes in the patient’s condition in time.In recent years,many non-invasive diagnostic criteria have been proposed.This study analyzed the basic data and serological indicators of patients who were confirmed by liver biopsy to explore the effects of serological indicators and NFS,BARD,FIB-4 and NIKEI on NAFLD.The predictive value of patients with liver fibrosis,and the application of Logistic regression to establish a predictive model,which can judge liver fibrosis,so as to intervene in time before the patient progresses to liver cirrhosis and hepatocellular carcinoma,and improve the prognosis and quality of life of the patients.Objective :This study aimed to explore noninvasive diagnostic model NFS,the predictive value of BARD,FIB-4 and NIKEI liver fibrosis in patients with NAFLD,and to establish a Logistic regression model to predict liver fibrosis.Methods:Collect complete clinical data of 168 patients with NAFLD who were hospitalized in the Liver Disease Department of Taizhou People’s Hospital from April 2010 to October 2020,collect and sort out the pathological and serological data of eligible patients,and use statistical methods for analysis.It is recommended that the ROC curve compare its value.At the same time,serological indexes were analyzed,indexes with independent risk factors were selected,and a predictive model was established by Logistic regression.Results:In this study,the statistical analysis of the NFS scoring system of 168 patients indicated that the scoring system has better diagnostic performance for NAFLD liver fibrosis(AUROC=0.649).In addition,the cut-off value of NFS for the diagnosis of NAFLD fibrosis in this study was-0.275,the sensitivity was 0.513,and the specificity was 0.727.It helps to distinguish whether the liver of NAFLD patients has fibrosis.The cut-off value of BARD scoring system for distinguishing liver fibrosis in NAFLD patients is 1.5,AUROC=0.658,sensitivity of 0.725,and specificity of 0.545.The AUROC of NIKEI in this study was 0.857,the sensitivity was 0.738,and the specificity was 1,suggesting that it has a higher value in diagnosing advanced fibrosis in NAFLD;the cut-off value of FIB-4 for judging fibrosis in NAFLD patients is 3.45,AUROC=0.803,sensitivity of 0.538,specificity of 0.989,P<0.05,indicating that the score is valuable in predicting liver fibrosis.The AUROCs of NFS,BARD,and FIB-4 are 0.649,0.658,and 0.803,respectively,which are smaller than the AUROC of NIKEI.Therefore,in this study,NIKEI is better than NFS,BARD and FIB-4 in the diagnosis and diagnosis of NAFLD liver fibrosis.In this study,a multivariate logistic regression analysis was performed on risk factors such as ALT,AST,ALB,TBIL,TBA,PLT,BMI,etc.,and found that the larger the alanine aminotransferase index,the more likely to cause fibrosis(B=0.016,P <0.05),the larger the platelet index,the less likely to cause fibrosis(B=-0.005,P<0.05),the larger the BMI index,the more likely to cause fibrosis(B=0.119,P<0.05).Therefore,this study included ALT,BMI and PLT into the binary Logistic regression,and established a binary Logistic regression model to predict advanced fibrosis based on the analysis results.The specific formula is as follows:-3.735+0.016*ALT+0.119*BMI-0.005*PLT.Draw the ROC curve of ALT,BMI,PLT and the newly-built regression model to predict the performance of advanced fibrosis,and calculate the area under the curve.Among them,the newly built regression model predicts the largest area under the curve for NAFLD advanced fibrosis.When the best cut-off value is-0.5928 according to the Youden index,the sensitivity is 56.3% and the specificity is 79.5%.Therefore,models based on ALT,BMI,and PLT are relatively reliable indicators for predicting advanced fibrosis in NAFLD,and the indicators included in the model are common and easily available in clinics,and can be used to evaluate the disease in time,so as to intervene in the disease at an early stage and improve patients The prognosis.Conclusion:1.In the NAFLD advanced fibrosis group,the score of NIKEI is higher than that of the non-significant fibrosis group;2.The value of NIKEI in diagnosing advanced fibrosis of NAFLD is higher than that of NFS,BARD,and FIB-4;3.The levels of AST,ALT,ALB and BMI in the NAFLD advanced fibrosis group were significantly higher than those in the non-significant advanced fibrosis group,and the PLT level in the significantly advanced fibrosis group was significantly lower than that in the non-significant advanced fibrosis group.4.ALT,BMI and PLT are independent risk factors for advanced fibrosis in NAFLD patients.5.The predictive value of the regression model based on ALT,BMI and PLT for advanced fibrosis in NAFLD patients is better than the three independent diagnosis. |
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