Clinical Study On Risk Factors And TCM Syndrome Types Of Liver Fibrosis In NAFLD Progression Based On LSM

Objectives:Based on the liver hardness value(LSM)of patients with non-alcoholic fatty liver disease(NAFLD)detected by Fibroscan,the degree of fibrosis and TCM syndrome differentiation were graded,and the differences of gender,age,body mass index(BMI),ALT,AST,GGT and PLT in different TCM syndrome types were compared and analyzed.To analyze the influence of the above indicators on progressive liver fibrosis in NAFLD patients and the correlation between the above indicators and the degree of fibrosis,and to compare the diagnostic efficacy of fi B-4 index and GPR for progressive liver fibrosis in patients with non-alcoholic fatty liver disease,so as to identify the risk factors of progressive fibrosis in the early stage.To provide reference for diagnosis of nonalcoholic fatty liver disease progressive fibrosis.Methods:A total of 148 patients with NAFLD who were initially diagnosed with NAFLD and had voluntarily improved blood routine,liver function and other serological indicators as well as Fibroscan were collected from the digestive Medicine Outpatient department and ward of Fuzhou Second Hospital affiliated to Xiamen University.The patients were divided into groups according to the LSM value detected by Fibroscan.The patients were divided into non-progressive liver fibrosis group(LSM < 9.8kpa)and progressive liver fibrosis group(LSM≥ 9.8kpa).The general information of the patients,such as gender,age,height,weight,BMI,ALT,AST,GGT and PLT,was recorded.Bivariate analysis was used to analyze the correlation between the above indexes and LSM values.Logistic binary regression was used to analyze the influencing factors of LSM value in the non-progressive liver fibrosis group and the progressive liver fibrosis group.The differences between TCM syndrome types and ALT,AST,GGT,PLT,LSM and CAP values were analyzed by one-way an OVA.Results :1.There was no statistical difference in age(P=0.223)and gender(P=0.000)between the non-progressive liver fibrosis group and the progressive liver fibrosis group.2.In the comparison between the non-progressive liver fibrosis group and the progressive liver fibrosis group,the levels of BMI,ALT,AST and GGT in the progressive liver fibrosis group were higher than those in the non-progressive liver fibrosis group,the differences were statistically significant(P=0.003;P= 0.000;P=0.000;P=0.002).BMI,ALT,AST and GGT were positively correlated with LSM(r=0.208,P=0.011;r= 0.436,P=0.000;r=0.431,P=0.000;r=0.206,P= 0.012).There was no significant difference in PLT level(P=0.768).3.There was no significant difference in FIB-4 between the non-progressive liver fibrosis group and the advanced liver fibrosis group(P=0.268).FIB-4 was positively correlated with LSM(r=0.213,P=0.009).When the cutoff value of FIB-4 was 0.975,the sensitivity,specificity and accuracy of diagnosing advanced liver fibrosis in NAFLD patients were 0.939,0.640 and 0.579,respectively.The area of FIB-4 curve under ROC was 0.823 in the diagnosis of progressive liver fibrosis of NAFLD,indicating that FIB-4 has diagnostic value for progressive liver fibrosis(P=0.000).4.There was a statistically significant difference in GPR between the non-progressive liver fibrosis group and the progressive liver fibrosis group(P=0.013).There was positive correlation between GPR and LSM(r=0.194,P=0.018).When the cut-off value of GPR was1.145,the sensitivity,specificity and accuracy of the diagnosis of advanced liver fibrosis in NALFD patients were 0.990,0.940 and 0.930,respectively.The curve area under ROC of GPR for the diagnosis of progressive NAFLD liver fibrosis was 0.980,indicating that GPR has diagnostic value for progressive liver fibrosis(P=0.002).5.There was no statistical difference in age and gender among the four TCM syndromes of liver depression and spleen deficiency,damp-heat accumulation syndrome,phlegm turbidity internal obstruction syndrome,and phlegm and blood stasis syndrome(P=0.060;P =0.152).6.There were statistically significant differences in BMI,ALT and GGT levels among four different TCM syndromes(P=0.000;P= 0.040;P= 0.017).7.There was no statistical significance in AST and PLT levels among the four TCM syndromes of liver depression and spleen deficiency syndrome,damp-heat accumulation syndrome,phlegm-turbidness internal obstruction syndrome and phlegm-stasis mutual syndrome(P=0.141;P= 0.288).8.The LSM values of four different TCM syndromes were statistically significant(P=0.002).The LSM values of patients with phlegm and blood stasis syndrome were the highest.There was no significant difference in CAP value among the four different TCM syndromes(P=0.469).Conclusion:1.BMI,ALT and GGT levels are closely associated with advanced liver fibrosis in NAFLD patients,and are risk factors for advanced liver fibrosis in NAFLD patients.2.FIB-4 index and GPR have certain predictive value for the diagnosis of progressive liver fibrosis in NAFLD,and THE diagnostic accuracy of GPR is higher than FIB-4 index3.The ALT,GGT and LSM values of liver depression and spleen deficiency syndrome,damp-heat accumulation syndrome,phlegm turbidity internal obstruction syndrome and phlegm and blood stasis mutual syndrome are different,and the ALT,GGT and LSM values are helpful for TCM syndrome differentiation.