CAJ | 학술논문

目的：比较不同无创肝纤维化评分指标对2型糖尿病（type 2 diabetes mellitus ，T2DM ）伴非酒精性脂肪肝病（non‐alco‐holic fatty liver disease ，NAFLD）患者肝纤维化的评价作用。方法：将996例明确诊断为T2DM、同时经超声诊断为NAFLD的患者（男性578例，女性418例）纳入分析，采集患者的空腹静脉血，测定血常规及肝脏相关酶。计算天门冬氨酸氨基转移酶（aspartate aminotransferase ，AST）／丙氨酸氨基转移酶（alanine aminotransferase ，ALT）比值、FIB‐4指数、BARD评分、AST／血小板比值指数（APRI）及NAFLD纤维化评分（NAFLD fibrosis score ，NFS）。以NFS作为评价肝纤维化的标准，采用相关性分析比较其余指标与NFS的相关性，进一步采用Bland‐Altman方法评价这些指标的一致性。结果：T2DM伴NAFLD的男性和女性患者中，AST／ALT比值、FIB‐4指数、BARD评分及APRI均与NFS呈线性正相关，其中FIB‐4指数与NFS的相关性最强（r＝0．619，P＜0．01）。Bland‐Altman分析结果表明，AST／ALT比值及FIB‐4指数与NFS一致性良好，以FIB‐4指数最佳。结论：AST／ALT比值及FIB‐4指数可以用来评价T2DM伴NAFLD患者是否存在肝纤维化。
목적：비교불동무창간섬유화평분지표대2형당뇨병（type 2 diabetes mellitus ，T2DM ）반비주정성지방간병（non‐alco‐holic fatty liver disease ，NAFLD）환자간섬유화적평개작용。방법：장996례명학진단위T2DM、동시경초성진단위NAFLD적환자（남성578례，녀성418례）납입분석，채집환자적공복정맥혈，측정혈상규급간장상관매。계산천문동안산안기전이매（aspartate aminotransferase ，AST）／병안산안기전이매（alanine aminotransferase ，ALT）비치、FIB‐4지수、BARD평분、AST／혈소판비치지수（APRI）급NAFLD섬유화평분（NAFLD fibrosis score ，NFS）。이NFS작위평개간섬유화적표준，채용상관성분석비교기여지표여NFS적상관성，진일보채용Bland‐Altman방법평개저사지표적일치성。결과：T2DM반NAFLD적남성화녀성환자중，AST／ALT비치、FIB‐4지수、BARD평분급APRI균여NFS정선성정상관，기중FIB‐4지수여NFS적상관성최강（r＝0．619，P＜0．01）。Bland‐Altman분석결과표명，AST／ALT비치급FIB‐4지수여NFS일치성량호，이FIB‐4지수최가。결론：AST／ALT비치급FIB‐4지수가이용래평개T2DM반NAFLD환자시부존재간섬유화。
Objective:To compare different non‐invasive hepatic fibrosis evaluation criteria for the evaluation of hepatic fibrosis in patients with type 2 diabetes mellitus(T2DM ) combined with non‐alcoholic fatty liver disease(NAFLD) .Methods:A total of 996 patients(male 578 ,female 418) definitely diagnosed with T2DM ,who were simultaneously identified as NAFLD by ultrasonography ,were involved in the analysis .The venous fasting blood was collected from patients ,and blood routine and hepatic enzymes were evaluated .Aspartate aminotransferase(AST)/alanine aminotransferase(ALT) ratio ,FIB‐4 index ,BARD score ,AST to platelet ratio index (APRI) and NAFLD fibrosis scores(NFS) were calculated .NFS was set as the evaluation criterium for hepatic fibrosis .The correlations between the other indexes and the NFS were compared with correlation analysis . As the next step ,consistency of these indexes was evaluated by Bland‐Altman method .Results:AST/ALT ratio ,FIB‐4 index , BARD score and APRI ratio had linear positive correlation with NFS among male and female patients with T2DM combined with NAFLD .Furthermore ,the most significant correlation was observed between FIB‐4 index and NFS(r=0 .619 ,P<0 .01) . Bland‐Altman analysis indicated that AST/ALT ratio and FIB‐4 index were highly consistent with NFS ,and the FIB‐4 index was the best among the indexes .Conclusions:AST/ALT ratio and FIB‐4 index can be used to identify whether there is hepatic fibrosis in patients with T2DM combined with NAFLD .