Abstract:

Objective The impact of hepatic steatosis on the diagnostic capability of liver stiffness measurement（LSM）has not been completely investigated. Therefore，we aimed at exploring the associationbetween the existence of non-alcoholic fatty liver disease（NAFLD）and the diagnostic performance of LSM among patients with chronic hepatitis B virus（CHB）in a single center. Methods A total number of 752 patients with CHB from outpatients and inpatients who underwent FibroTouch examination in Tianjin ThirdCentral Hospital from March 2014 to December 2017 were included in this study. A total number of 506 patientswith CHB alone were included in thenon-NAFLD group，and 246 patients with CHB combined with NAFLD were included in the NALFD group. Results There were significant differences in BMI，CAP and LSMbetween the NAFLD group and non-NAFLD group. BMI were higher in NAFLD group than in non-NAFLD group （P ＜ 0.001）. CAP were higher in NAFLD group than in non-NAFLD group（P ＜ 0.001）. LSM were higher in NAFLD group than in non-NAFLD group（P ＜ 0.001）. Besides，the patients in NAFLD group had remarkably higher serum Hb，PLT，ALB，ALT，γ-GT，AST，Glu，TC，TG，TB，BUN，Cr，SPT levels than those without NAFLD. More male subjects were in NAFLD group than non-NAFLD group（P ＜ 0.001）.Multivariate linear regression analysis showed that gender（male）（B ＝ 0.004，P ＜ 0.120）、 CAP （B ＝ 0.098， P ＜ 0.001），ALB （B ＝ -0.265， P ＜ 0.001），γ-GT （B ＝ 0.128， P ＜ 0.001）， ALP （B ＝ 0.090，P ＝ 0.001），ALT （B ＝ 0.124，P ＝ 0.004）were positively correlated with LSM. Stratified analysis by gender showed higher BMI，CAP and LSM in NAFLD group than in non-NAFLD group in both genders（P ＜ 0.001）. Conclusion LSM is higherin CHB patients with NAFLD，which could lead to an overestimation of fibrosis in those patients. 

Key words:

Chronic hepatitis B , Non-alcoholic fatty liver disease , Transient elastography , Liver stiffness, Controlled attenuation parameter

摘要：

目的 肝脏脂肪变性会削弱肝硬度测定（liver stiffness measurement，LSM）的诊断效能， 本研究旨在探索慢性乙型病毒性肝炎（chronic hepatitis B virus，CHB）合并非酒精性脂肪性肝病（non-alcoholic fatty liver disease，NAFLD）对于 LSM 诊断效能的影响，并分析相关影响因素。方法 研究选取 2014 年 3 月至 2017 年 12 月期间于天津市第三中心医院行 FibroTouch 检查的门诊及住院慢性乙型病毒性肝炎752 例， 其 中 CHB 合 并 NAFLD 患 者 246 例 纳 入 NALFD 组， 单 纯 CHB 患 者 506 例 纳 入 非 NAFLD 组。通过数据统计分析比较 NAFLD 组及非 NAFLD 组一般资料和化验结果的差异，通过单因素及多因素线性回归探索影响 LSM 的因素。结果 NAFLD 组与非 NAFLD 组的体质指数（body mass index，BMI）、受控衰减参数（controlled attenuation parameter，CAP）及 LSM 值存在显著差异。NAFLD 组 BMI 高于非 NAFLD组（P ＜ 0.001）；NAFLD 组 CAP 值高于非 NAFLD 组（P ＜ 0.001）；NAFLD 组 LSM 值高于非 NAFLD 组（P ＜ 0.001）。此外，NAFLD 组血清血红蛋白（hemoglobin，Hb）、血小板（platelet，PLT）、白蛋白（albumin，ALB），丙氨酸转氨酶（alanine transaminase，ALT）、谷氨酰转肽酶（γ-glutamyl transpeptidase，γ-GT）、碱性磷酸酶（alkaline phosphatase，ALP）、葡萄糖（glucose，Glu）、总胆固醇（total cholesterol，TC）、甘油三酯（triglyceride，TG）、肌酐（creatinine，Cr）、尿素氮（blood urea nitrogen，BUN）及脾脏厚度（spleen thickness，SPT）均显著高于非 NAFLD 组（P ＜ 0.05）。NAFLD 组男性患者比例高于非 NAFLD 组（分别为71.5%、54%，P ＜ 0.001）。多因素回归分析结果显示性别（男性）（B ＝ 0.004，P ＜ 0.120）、CAP（B ＝ 0.098，P ＜ 0.001）、ALB（B ＝ -0.265，P ＜ 0.001）、γ-GT（B ＝ 0.128，P ＜ 0.001）、ALP（B ＝ 0.090，P ＝ 0.001）、ALT（B ＝ 0.124，P ＝ 0.004）与 LSM 呈显著相关。按性别分层，结果显示在不同性别中 NAFLD 组的BMI、CAP 及 LSM 值均显著高于非 NAFLD 组（P ＜ 0.001）。结论 合并 NAFLD 的慢性乙型病毒性肝炎患者行肝硬度检查时，所得 LSM 值较单纯慢性乙型病毒性肝炎患者偏高，故合并 NAFLD 会影响慢性乙型病毒肝炎患者 LSM 的诊断效能，可能导致对患者实际肝纤维化程度的高估。

关键词:

慢性乙型病毒性肝炎 , 非酒精性脂肪性肝病 , 瞬时弹性成像技术 , 肝硬度 , 受控衰 减参数