Objective: To investigate the clinical and diagnostic value of liver stiffness measurement (LSM) for the evaluation and comparison of aspartate aminotransferas/platelet ratio index (APRI), fibrosis 4 indexes (FIB-4) and NAFLD fibrosis score (NFS) with liver fibrosis staging in relation to nonalcoholic fatty liver disease (NAFLD). Methods: 103 cases with NAFLD who met the inclusion criteria confirmed by liver biopsy were selected for retrospective analysis. The results of serological tests and LSM were recorded. The APRI, FIB-4 and NFS were calculated. The accuracy and applicability of four liver fibrosis models in the diagnosis of liver fibrosis in NAFLD patients were compared with the receiver operating characteristic curve (ROC), and the diagnostic cut-off value of LSM was established. Results: Varying degrees of LSM, APRI, FIB-4 and NFS had shown positive correlations with the increasing degree of liver fibrosis. Among them, LSM was positively correlated with the degree of liver fibrosis, and the correlation coefficient was r = 0.727, P < 0.0001. Consistent with this, the area under the receiver operating characteristic curve, sensitivity, and specificity of LSM diagnosis of liver fibrosis in different stages was significantly higher than APRI, FIB-4 and NFS. Area under receiver operating characteristic curve of LSM was 0.862 and 0.928 for significant liver fibrosis (f ≥ 2), and advanced liver fibrosis (f ≥ 3). Conclusion: LSM has a good diagnostic exclusion value for NAFLD-induced fibrosis, and its sensitivity and specificity are better than APRI, FIB-4 and NFS.
目的： 探讨肝脏弹性测定（LSM）对非酒精性脂肪性肝病（NAFLD）相关肝纤维化分期评估的临床价值，并与天冬氨酸转氨酶/血小板比值指数（APRI）、FIB-4指数（FIB-4）及NAFLD纤维化评分（NFS）的诊断价值进行对比。 方法： 采用回顾性分析方法选取符合纳入标准的103例经肝活体组织检查确诊的NAFLD患者，记录其血清学及LSM等检测结果，计算其APRI、FIB-4及NFS。用受试者工作特征曲线（ROC）比较4种肝纤维化模型对NAFLD患者肝纤维化诊断的准确性及适用性，并探索建立LSM的诊断阈值。 结果： 随着肝脏纤维化程度的不断升高，LSM、APRI、FIB-4及NFS均呈现出不同程度的正相关，其中以LSM与肝纤维化程度分级呈强正相关，相关系数r = 0.727，P < 0.000 1。与之一致，LSM诊断肝纤维化不同分期的ROC曲线下面积及灵敏度、特异度均明显高于APRI、FIB-4及NFS。对于显著肝纤维化（F≥2），LSM的ROC曲线下面积为0.862；对于进展期肝纤维化（F≥3），LSM的ROC曲线下面积为0.928。 结论： LSM对NAFLD引起的肝纤维化有很好的排除诊断及较好的诊断价值，其灵敏度及特异度均优于APRI、FIB-4及NFS。.
Keywords: Fatty liver, nonalcoholic; Liver fibrosis; Liver stiffness measurement (LSM).