代谢相关脂肪性肝病发生脂肪性肝炎的无创诊断模型构建及分析  

Construction and analysis of a noninvasive diagnostic model for steatohepatitis in metabolic associated fatty liver disease

作　　者：陈智恒 高博文 桂蓓 施梅姐[2,3] 萧焕明 谢玉宝[2,3] 黎胜 池晓玲[2,3] CHEN Zhiheng;GAO Bowen;GUI Bei;SHI Meijie;XIAO Huanming;XIE Yubao;LI Sheng;CHI Xiaoling(The Second Clinical Medical College of Guangzhou University of Chinese Medicine,Guangzhou 510006,China;Department of Hepatology,Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510006,China;The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510006,China;State Key Laboratory of Dampness Syndrome of Traditional Chinese Medicine Jointly Built by Province and Ministry,The Second Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510120,China)

机构地区：[1]广州中医药大学第二临床医学院,广州510006 [2]广东省中医院肝病科,广州510006 [3]广州中医药大学第二附属医院,广州510006 [4]省部共建中医湿证国家重点实验室(广州中医药大学第二附属医院),广州510120

出　　处：《临床肝胆病杂志》2023年第8期1857-1866,共10页Journal of Clinical Hepatology

基　　金：国家“十三五”重大传染病专项课题(2018ZX10725506-003,2018ZX10725505-004);广东省中医院院内专项(YN2022DB04,YN10101903);国家中医药管理局全国名老中医药专家池晓玲传承工作室建设项目(国中医药人教函〔2022-75号〕);省部共建中医湿证国家重点实验室开放课题(SZ2021KF08)。

摘　　要：目的通过临床一般资料、血清学指标及肝脏弹性成像无创检查手段,基于LASSO及Logistic回归建立代谢相关脂肪性肝病(MAFLD)发生脂肪性肝炎的诊断模型,并评估该模型的诊断价值。方法纳入2018年1月—2021年12月于广东省中医院诊断为MAFLD且完善肝病理活检的患者为研究对象299例,根据肝病理NAS评分将其分为脂肪性肝炎组(n=170)例和无脂肪性肝炎组(n=129)。先后通过LASSO回归及多因素Logistic回归筛选MAFLD发生脂肪性肝炎的影响因素,并建立无创诊断模型,利用列线图形式可视化,采用加强Bootstrap法进行内部验证,绘制ROC曲线及Calibration曲线,并在MAFLD+NAFLD和MAFLD+cHBVi两个亚组人群中观察模型的诊断效能,并与其他诊断模型进行比较分析。计数资料组间比较采用χ^(2)检验;符合正态分布的计量资料组间比较采用成组t检验,不符合正态分布的计量资料组间比较采用Mann-Whitney U检验。采用多因素Logistic回归分析,筛选最佳诊断因素,构建列线图诊断模型,绘制受试者工作特征曲线(ROC曲线),计算ROC曲线下面积(AUC),并进一步采用加强Bootstrap法对模型进行内部验证,绘制Calibration曲线显示校准度。结果两组间BMI、ALT、AST、ADA、ALP、GGT、TBA、TCO_(2)、UA、HbA1c比较差异均有统计学意义(P值均<0.05);FibroScan方面,两组LSM及CAP比较提示差异具有统计学意义(P值均<0.001);病理学方面,两组的纤维化等级、脂肪变积分、小叶炎症积分、气球样变积分及NAS总分差异均有统计学意义(P值均<0.001)。亚组队列方面,MAFLD+NAFLD有、无脂肪性肝炎组分别为63、48例,MAFLD+cHBVi有、无脂肪性肝炎组分别为90、71例。通过LASSO回归及多因素Logistic回归筛选出LSM、CAP、BMI、AST是判断MAFLD患者是否发生脂肪性肝炎的最佳诊断因素,并以此构建LCBA模型。LCBA模型结果提示,总MAFLD、MAFLD+NAFLD和MAFLD+cHBVi人群的AUC分别为0.816、0.866、0.764(P�Objective To establish a diagnostic model for steatohepatitis in metabolic associated fatty liver disease(MAFLD)based on LASSO and logistic regression analyses by using general clinical data,serological parameters,and noninvasive liver elastography,and to evaluate the diagnostic value of this model.Methods A total of 299 patients who were diagnosed with MAFLD and underwent liver biopsy in Guangdong Provincial Hospital of Traditional Chinese Medicine from January 2018 to December 2021 were enrolled as subjects,and according to NAS score,they were divided into steatohepatitis group with 170 patients and non-steatohepatitis group with 129 patients.The LASSO regression analysis and the multivariate logistic regression analysis were used to identify the influencing factors for steatohepatitis in MAFLD,and a noninvasive diagnostic model was established,visualized in the form of nomogram,and internally validated by the enhanced Bootstrap method.The receiver operating characteristic(ROC)curve and the calibration curve were plotted for the model,and its diagnostic efficacy was observed in the MAFLD+NAFLD and MAFLD+cHBVi subgroups,which was then compared with other diagnostic models.The chi-square test was used for comparison of categorical data between groups;the independent-samples t test was used for comparison of normally distributed continuous data between groups,and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between groups.A multivariate logistic regression analysis was used to determine optimal diagnostic factors,and a nomogram diagnostic model was established;the ROC curve was plotted,and the area under the ROC curve(AUC)was calculated;the enhanced Bootstrap method was used for internal validation of the model,and the calibration curve was plotted to show the level of calibration.Results There were significant differences between the two groups in body mass index(BMI),alanine aminotransferase,aspartate aminotransferase(AST),adenosine deaminase,alkaline phosphatase,ga

关 键 词：非酒精性脂肪性肝病 代谢相关脂肪性肝病 诊断 

分 类 号：R575[医药卫生—消化系统]