关键词: 糖尿病, 2型；肝疾病；非酒精性脂肪性肝病；肝硬化；FIB-4指数；肝脏硬度值

Abstract: Background　Patients with non-alcoholic fatty liver disease（NAFLD）and type 2 diabetes mellitus（T2DM）are prone to liver fibrosis.Objective　To explore the value of FIB-4 index and liver stiffness measurement（LSM）in the assessment of significant liver fibrosis in NAFLD with T2DM.Methods　A total of 265 patients who were diagnosed with NAFLD and T2DM in Department of Gastroenterology，Beijing Shijitan Hospital，Capital Medical University from December 2016 to December 2017 were enrolled.Data about gender，age，height，body weight，platelet count，glutamate aminotransferase（AST），aspartate aminotransferase（ALT），fasting glucose，albumin，LSM were collected，and BMI，FIB-4 index and NAFLD fibrosis score（NFS）were calculated.This study used NFS>0.676 as the golden standard for diagnosing significant hepatic fibrosis.The incidence of significant liver fibrosis was analyzed comparatively by FIB-4 index and LSM value.The ROC curves of FIB-4 index and LSM value were drawn and used to predict significant hepatic fibrosis in NAFLD with T2DM，and area under the ROC curve（AUC），sensitivity，specificity，positive predictive value，positive likelihood ratio and Youden index were calculated.Results　The incidence of significant hepatic fibrosis was significantly higher in patients with FIB-4 index>3.25 or LSM≥9.9 kPa（P<0.05）．According to previous studies，our study used FIB-4 index>3.25 and LSM≥9.9 kPa as critical values to predict significant hepatic fibrosis.ROC analysis of FIB-4 index for the prediction of the incidence of significant liver fibrosis in NAFLD with T2DM revealed that the AUC was 0.866〔95%CI（0.804，0.928）〕，the sensitivity was 44.4%，the specificity was 97.5%，the positive predictive value was 66.7%，the positive likelihood ratio was 17.8%，and the Youden index was 0.419.And ROC analysis of LSM value for the prediction of the incidence of significant hepatic fibrosis in NAFLD with T2DM showed that the AUC was 0.901〔95%CI（0.850，0.952）〕，and the sensitivity，specificity，positive predictive value，positive likelihood ratio，Youden index were 74.1%，90.7%，45.5%，8.00%，and 0.648，respectively.Conclusion　Both FIB-4 index and LSM can be used to predict significant hepatic fibrosis in NAFLD with T2DM.As LSM is simple and easy to use，it should be the first choice.But for hospitals without LSM，FIB-4 index can be used.

Key words: Diabetes mellitus, type 2；Liver diseases；Nonalcoholic fatty liver disease；Liver cirrhosis；FIB-4 index；Liver stiffness measurement