| Objective:Based on transient elastography technology to evaluate the degree of steatosis and fibrosis in patients with Nonalcoholic Fatty Liver Disease(Nonalcoholic Fatty Liver Disease,NAFLD),explore the risk factors affecting the degree of liver steatosis and fibrosis in NAFLD patients and the correlation between the two,and construct a non-invasive model that can predict liver fibrosis in NAFLD patients.Data and Methods:In strict accordance with the inclusion and exclusion criteria,this study collected the clinical data of 326 NAFLD patients who visited the Department of Hepatobiliary and Pancreatic Medicine of the First Hospital of Jilin University from September 2020 to December 2022.According to the Controlled Attenuation Parameter(CAP)of transient elastography technique,the subjects were divided into three groups: mild nonalcoholic fatty liver group: 240 d B/m ≤ CAP<264d B/m;moderate non-alcoholic fatty liver group: 265 d B/m ≤ CAP<294d B/m;severe non-alcoholic fatty liver group: CAP ≥ 295 d B/m.Then,based on the Liver Stiffness Measurement(LSM)of transient elastography technique,they were divided into two groups: LSM<7.3k Pa was the group without liver fibrosis;LSM≥7.3k Pa was the liver fibrosis group.At the same time,clinical data of 21 patients with NAFLD undergoing liver biopsy who visited our inpatient ward from January 2015 to December 2022 were collected.Applying the SPSS26.0 statistical software,To compare the differences in general characteristics and clinical characteristics between groups;Using Pearson or Spearman analysis to identify clinical indicators associated with liver steatosis and fibrosis in NAFLD patients;Univariate regression analysis was conducted to identify potential influencing factors,all meaningful variables were included in the multivariate regression analysis to identify independent risk factors for liver steatosis and fibrosis in NAFLD patients.A non-invasive model was established to predict liver fibrosis by combining relevant risk factors.The predictive performance of the model was evaluated based on the area under the Receiver Operating Characteristic Curve(ROC),the model was applied to 21 NAFLD patients undergoing liver biopsy,and Kappa test was used to verify the consistency between the non-invasive model and the pathological results of liver biopsy.Results:1、The LSM of patients with severe steatosis was higher than that of patients with mild to moderate steatosis,the levels of LSM was positively correlated with the degree of liver steatosis in NAFLD patients(r= 0.509,P<0.05)and LSM(P <0.001,OR = 1.690)was an independent risk factor for the severity of liver steatosis in NAFLD patients.The CAP in the group with liver fibrosis was higher than that in the group without liver fibrosis,the levels of CAP levels was positively correlated with the degree of liver fibrosis(r=0.484,P<0.05),and CAP(P<0.001,OR=1.044)is an independent risk factor for liver fibrosis in NAFLD patients.2、The levels of ALT,AST,GGT,CHE,ALB,BMI,FPG,SUA,TG,WBC,LY#,HGB,PDW were positively correlated with the degree of liver steatosis in NAFLD patients(r=0.441,0.379,0.305,0.310,0.241,0.612,0.169,0.331,0.139,0.136,0.128,0.196,0.190,all P<0.05),while HDL levels was negatively correlated with the degree of liver steatosis in NAFLD patients(r=-0.143,P<0.05).3、Through multiple ordered logistic regression analysis,in addition to LSM,ALT(P<0.05,OR=1.020)and BMI(P<0.001,OR=1.614)are also independent risk factors for the severity of liver steatosis in NAFLD patients.4、The levels of ALT,AST,GGT,CHE,BMI,FPG,SUA,TG and PDW were positively correlated with the degree of liver fibrosis(r=0.362,0.388,0.247,0.159,0.317,0.147,0.233,0.163,0.163,P<0.05),while the levels of Neutrophil to Lymphocyte Ratio(NLR)and HDL were negatively correlated with the degree of liver fibrosis(r=-0.171,-0.127,P<0.05).5、Through binary logistic regression analysis,in addition to CAP,AST(P<0.05,OR=1.053)and NLR(P<0.05,OR=0.524)are also related factors for NAFLD as a stage of liver fibrosis.6、Combining AST,CAP and NLR to establish a non-invasive model for predicting liver fibrosis:-13.902+0.052AST+0.043CAP-0.646 NLR.Using the ROC curve to analyze,and the best diagnostic cut-off value of the model was 0.492,the area under the curve(AUC)was 0.832,the sensitivity was 72.50%,and the specificity was 79.80%.7、The model was applied to 21 NAFLD patients undergoing liver biopsy,with an accuracy of 80.95%,sensitivity of 0.750,and specificity of 0.889.After Kappa consistency test,Kappa=0.622,P<0.05.Conclusion:1、The more severe the degree of liver steatosis in NAFLD patients,the more severe their liver fibrosis is,and vice versa.2、In addition to LSM,NAFLD patients with high ALT and BMI have a higher risk of severe fatty live.3、In addition to CAP,patients with NAFLD with high AST and low NLR levels are at higher risk of liver fibrosis.4、The non-invasive model composed of AST,CAP,and NLR was validated through the "gold standard" liver biopsy puncture,confirming that the non-invasive fibrosis model can effectively predict liver fibrosis. |
