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

摘要： 背景　非酒精性脂肪性肝病（NAFLD）合并2型糖尿病（T2DM）患者易发生肝纤维化。目的　探讨FIB-4指数、肝脏硬度值（LSM）对NAFLD合并T2DM患者出现显著肝纤维化的评估作用。方法　选取2016年12月—2017年12月在首都医科大学附属北京世纪坛医院消化内科诊断为NAFLD合并T2DM的患者265例为研究对象。收集患者性别、年龄、身高、体质量、血小板计数、谷氨酸氨基转移酶（AST）、天冬氨酸氨基转移酶（ALT）、空腹血糖、清蛋白、LSM，计算BMI、FIB-4指数、肝纤维化评分（NFS）。本研究以NFS>0.676分作为诊断显著肝纤维化的金标准。比较不同FIB-4指数、LSM患者显著肝纤维化发生率；绘制FIB-4指数、LSM预测NAFLD合并T2DM患者发生显著肝纤维化的ROC曲线，计算ROC曲线下面积（AUC）、灵敏度、特异度、阳性预测值、阳性似然比、Youden指数。结果　FIB-4指数>3.25患者显著肝纤维化发生率大于FIB-4指数≤3.25患者（P<0.05）；LSM≥9.9 kPa患者显著肝纤维化发生率大于LSM<9.9 kPa患者（P<0.05）。根据既往研究结果，将FIB-4指数>3.25、LSM≥9.9 kPa作为预测显著肝纤维化的临界值。FIB-4指数预测NAFLD合并T2DM患者发生显著肝纤维化的AUC为0.866〔95%CI（0.804，0.928）〕，灵敏度为44.4%，特异度为97.5%，阳性预测值为66.7%，阳性似然比为17.8%，Youden指数为0.419；LSM预测NAFLD合并T2DM患者发生显著肝纤维化的AUC为0.901〔95%CI（0.850，0.952）〕，灵敏度、特异度、阳性预测值、阳性似然比、Youden指数分别为74.1%、90.7%、45.5%、8.00%、0.648。结论　FIB-4指数与LSM均可用于预测NAFLD合并T2DM患者发生显著肝纤维化；LSM简便、易检测，应作为首选，而对于无条件地区，可选择FIB-4指数。

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