血生化指標(biāo)和瞬時(shí)彈性成像技術(shù)聯(lián)合診斷2型糖尿病伴NAFLD肝纖維化程度的價(jià)值

陳軍 黃斌 李燕青 潘林 湯曉飛 劉 芳

[摘要] 目的 探討血生化指標(biāo)和瞬時(shí)彈性成像技術(shù)（TE）聯(lián)合診斷2型糖尿病伴NAFLD肝纖維化程度的價(jià)值。 方法 選取我院2017年9月至2019年9月間收治的T2DM伴NAFLD患者106例，依據(jù)Metavir分期分為肝纖維化低危組（n=43）和明顯肝纖維化組（n=63），選取同期健康志愿者106名作為對(duì)照組，測定其血生化指標(biāo)、LSM指標(biāo)。 結(jié)果 三組間APRI、FIB-4、Glb、ALT、AST、LN、HA、PCⅢ、Ⅵ-C水平比較，差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）;APRI、FIB-4、HA、LSM等指標(biāo)與肝纖維化呈正相關(guān)（P<0.05），是影響肝纖維化程度的因素;HA、APRI、FIB-4、LSM等指標(biāo)具有較高的肝纖維化程度診斷效能。 結(jié)論 HA、APRI、FIB-4、LSM四項(xiàng)指標(biāo)聯(lián)合檢測可有效提高T2DM伴NAFLD患者的肝纖維化程度診斷效能，具有較高的臨床價(jià)值，可在臨床廣泛推廣。

[關(guān)鍵詞] 血生化指標(biāo);瞬時(shí)彈性成像技術(shù);2型糖尿病;NAFLD

[中圖分類號(hào)] R575.5? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] B? ? ? ? ? [文章編號(hào)] 1673-9701（2021）24-0137-04

The value of biochemical blood indexes combined with transient elastography in the diagnosis of liver fibrosis in type 2 diabetes with NAFLD

CHEN Jun? ?HUANG Bin? ?LI Yanqing? ?PAN Lin? ?TANG Xiaofei? ?LIU Fang

Department of Ultrasound，Hangzhou Xixi Hospital Affiliated to Zhejiang Chinese Medical University，Hangzhou 310023，China

[Abstract] Objective To explore the value of biochemical blood indicators and transient elastography （TE） in the diagnosis of liver fibrosis in type 2 diabetes with NAFLD. Methods A total of 106 patients with T2DM and NAFLD admitted to our hospital between September 2017 and September 2019 were selected and divided into low-risk liver fibrosis group （43 cases） and significant liver fibrosis group （63 cases） according to Metavir staging. One hundred six healthy volunteers during the same period were selected as the control group.Their biochemical blood indexes and LSM indexes were measured. Results The differences in the levels of APRI，F(xiàn)IB-4，Glb，ALT，AST，LN，HA，PCⅢ，and Ⅵ-C among the three groups were statistically significant （P<0.05）. The APRI，F(xiàn)IB-4，HA，and LSM were positively correlated with liver fibrosis （P<0.05），which were influencing factors of the degree of liver fibrosis.HA，APRI，F(xiàn)IB-4，and LSM had high diagnostic efficiency for liver fibrosis. Conclusion The combined detection of HA，APRI，F(xiàn)IB-4，and LSM can effectively improve the diagnostic efficiency of liver fibrosis in patients with T2DM and NAFLD.It has a high clinical value and can be widely used in clinical practice.

[Key words] Biochemical blood indicators; Transient elastography technology; Type 2 diabetes; NAFLD

糖尿病臨床分型以2型糖尿病（Type 2 diabetes，T2DM）較為多見，以胰島素分泌不足、胰島素敏感性降低、胰島素抵抗（Insulin resistance，IR）為主要發(fā)病機(jī)制[1]。近年來，隨著我國人口老齡化和生活方式的改變，我國T2DM發(fā)病率逐年攀升，已成為臨床慢病防治的重點(diǎn)[2]。非酒精性脂肪性肝病（Nonalcoholic fatty liver disease，NAFLD）是指除酒精和其他明確肝損因素之外的原因?qū)е赂渭?xì)胞內(nèi)脂肪過度沉積，從而引起肝細(xì)胞脂肪變性的臨床病理綜合征[3]，屬獲得性代謝應(yīng)激性肝損傷，與IR、肥胖、脂代謝紊亂、遺傳因素等密切相關(guān)。該病可參與T2DM和動(dòng)脈粥樣硬化的發(fā)病，并直接導(dǎo)致肝細(xì)胞癌、移植肝復(fù)發(fā)和失代償期肝硬化[4]，對(duì)患者身體健康構(gòu)成嚴(yán)重威脅。臨床研究顯示[5]，NAFLD常伴隨T2DM出現(xiàn)，為臨床準(zhǔn)確診斷和治療增加了難度。有文獻(xiàn)報(bào)道[6]，肝纖維化及部分早期肝硬化是可以逆轉(zhuǎn)的，因此，準(zhǔn)確評(píng)估患者肝纖維化程度對(duì)臨床治療具有重要意義?；诖?，本研究采用血生化指標(biāo)聯(lián)合瞬時(shí)彈性成像技術(shù)（Transient elastography，TE）診斷T2DM伴NAFLD纖維化程度，探究其臨床價(jià)值，現(xiàn)報(bào)道如下。