Application Of Invasive And Non-invasive Tests In The Clinical Study Of Fatty Liver Disease

OBJECTIVE: In view of the increasing number of nonalcoholic fatty liver disease(NAFLD)and NAFLD merger of chronic hepatitis b(CHB)patients in our country,we carry out the clinical diagnostic test about fatty liver disease(FLD)and to explore invasive and noninvasive examination measures of the diagnosis efficiency of FLD.METHOD: 338 patients confirmed by liver biopsy with chronic liver disease form five clinical liver disease center of Shanghai,Beijing,Tianjin,Hangzhou and Zhangzhou province were included in this study.The etiology mainly contained NAFLD,CHB,and the merger of CHB and NAFLD.Invited three pathology doctors read each sample independently and assessed the inter-observer agreement between any two,furthermore compared the consistency in different biopsy length groups.Using Fibro Scan testing the live stiffness measurement(LSM)and controlled attenuation parameter(CAP)to predict the degree of fibrosis and the quantity of steatosis.In addition,determined and calculated the Fatty Liver Index(FLI),Hepatic Steatosis Index(HSI)of 100 cases,NAFLD Fibrosis Score,APRI and FIB-4 of 260 cases.Take these as noninvasive markers,and to compare these indexs with LSM and CAP in the diagnostic efficiency of FLD by taking liver biopsy as gold standard.RESULTS:(1)In consideration of different background,better consistency was between the comprehensive hospital doctors and liver pathology professor in NAFLD,the consistency of fatty,inflammation,ballooning were 0.727,0.529,0.524.The doctor from infectious disease hospital and liver pathology professor had higher agreement in fibrosis,not only in NAFLD but also in viral hepatitis,0.432 and 0.620,respectively(P<0.05).(2)Compared with NAFLD group,the consistency of fatty,inflammation,ballooning change and fibrosis stage in chronic viral hepatitis merge with NAFLD group are falling,respectively from 0.872,0.592,0.882,fell to 0.710,0.344,0.636;but the consistency of fibrosis increased from 0.691 to 0.768(P<0.05);Proper organization of article length can improve the consistency of NAFLD score,also helps to improve the detection rates of NASH and adanced fibrosis,trends P was 0.021,<0.001.(3)The AUROC of CAP diagnosis fatty liver is 0.882,significantly better than the FLI and HSI,were 0.763,0.696,and diagnostic value of 0.866 when diagnosis S≥2,also significantly better than that of HSI(AUROC = 0.681)(P<0.05).(4)LSM identify F≥1 in different length of biopsy in NAFLD group with the AUROC was 0.963,0.752 respectively,statistically significant difference;the LSM diagnosis of cirrhosis in NAFLD was significantly superior to APRI,AUROC were 0.969、0.859;and in CHB,the diagnosis of significant fibrosis(F≥2)、advanced fibrosis(F≥3)and cirrhosis value was significantly superior to NFS、APRI and FIB-4,AUROC were 0.830、0.918、0.906,respectively(P < 0.05).CONCLUSION:(1)The overall diagnostic efficiency is not ideal,and grading consistency for NAFLD in pathology doctors is influenced by the professional background,heterogeneity of pathological changes and the biopsy length.(2)Compared with NAFLD,pathology doctors have lower agreement for NAS score,included steatosis,balloons and inflammation,in NAFLD with chronic viral hepatitis,but increased in fibrosis.(3)Liver biopsy may be defined as the gold standard with "flawed",to evaluate the diagnostic value of noninvasive methods for liver biopsy needs pay attentaion to sampling error and observer aggrement.(4)In clinical work,Fibro Scan has a good application prospect,CAP has certain advantages of FLI,HSI and LSM has certain advantages of NAFLD Fibrosis Score,APRI and FIB-4.