肝脏硬度值对慢性乙型肝炎合并非酒精性脂肪性肝病肝纤维化的诊断价值及与中医证型的相关性OA

Objective:To evaluate the diagnostic value of liver stiffness measurement(LSM)in assessing liver fibrosis in patients with chronic hepatitis B(CHB)complicated by non-alcoholic fatty liver disease(NAFLD),and to explore its correlation with traditional Chinese medicine(TCM)syndromes,aiming to develop a novel integrative diagnostic approach for determining the severity of liver fibrosis.Methods:A total of 536 patients with CHB complicated by NAFLD,admitted to the Xiamen Liver Disease Center and Xiamen Hongai Hospital from 2018 to 2023,were consecutively enrolled and retrospectively analyzed.Clinical data were collected.Liver biopsy was used as the gold standard.Receiver operating characteristic(ROC)curves were constructed to assess the diagnostic performance of LSM,fibrosis-4(FIB-4),aspartate aminotransferase to platelet ratio index(APRI),liver stiffness and platelet ratio index(LPRI),and the Hui score across different stages of fibrosis(S1-S4).The Kruskal-Wallis H test was employed to analyze the relationship between LSM values and TCM syndrome types.Results:Among patients with CHB complicated by NAFLD,prothrombin time,platelet count,albumin,and gamma-glutamyl transpeptidase levels differed significantly across fibrosis stages(P<0.05),whereas age,body mass index,globulin,alanine aminotransferase,aspartate aminotransferase,total bilirubin,and controlled attenuation parameter showed no significant differences(P>0.05).LSM,FIB-4,APRI,LPRI,and Hui score increased significantly with fibrosis progression(P<0.001),and all were positively correlated with histological staging,with LSM showing the strongest correlation(r=0.40).ROC curve analysis showed that LSM achieved area under the curve(AUC)values of 0.703,0.641,and 0.871 for diagnosing stage S1 to S3 fibrosis,respectively.The corresponding sensitivities were 75%,79.2%,and 90.9%,and the specificities were 56.4%,57.6%,and 78.8%,with cut-off values of 6.55,7.25,and 8.85 kPa.In all cases,LSM outperformed the other models in diagnostic performance(P<0.05).For diagnosing stage S4 fibrosis,LSM had an AUC of 0.859,with a sensitivity of 80%,a specificity of 91.4%,and a cut-off value of 11.45 kPa.Its diagnostic performance was second only to that of LPRI(AUC=0.899)(P<0.05).LSM values differed significantly among TCM syndrome types,with the highest values observed in patients with the syndrome of blood stasis blocking collaterals.(P<0.05).Conclusion:LSMprovides a relatively accurate assessment of liver fibrosis severity in patients with CHB combined by NAFLD.LSM demonstrates superior diagnostic accuracy for fibrosis stages below S4 compared to other non-invasive serum-based models,highlighting its value in the early detection of liver fibrosis.Moreover,the degree of liver fibrosis varies significantly across TCM syndrome types,with the most severe fibrosis observed in patients diagnosed with the syndrome of blood stasis blocking collaterals.