Diagnostic value of two-dimensional ultrasound shear wave elastography combined with FIB-4 score for significant fibrosis in non-alcoholic fatty liver disease

doi:10.3877/cma.j.issn.2095-2015.2026.04.007

Abstract

Abstract:

Objective

To explore the diagnostic value of two-dimensional shear wave elastography (2D-SWE) combined with the fibrosis-4 (FIB-4) score in diagnosing significant liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD).

Methods

This study was a retrospective study. A total of 150 patients with NAFLD from the First Hospital of Yulin City from January 2023 to January 2025 were selected as the research subjects. patients were classified into two groups according to the Metavir staging criteria for liver fibrosis: non-significant liver fibrosis (F0-F1 stage, n=88) and significant liver fibrosis (F2-F4 stage, n=62). All patients underwent 2D-SWE examination, recording Young's modulus and shear wave velocity (SWV), while serum markers were measured and the FIB-4 score was calculated. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic efficacy of individual and combined application of various indicators for significant fibrosis in NAFLD.

Results

The aspartate aminotransferase and alanine aminotransferase levels in the significant liver fibrosis group were significantly higher than those in the non-significant liver fibrosis group, while the platelet count was significantly lower (P<0.05); the Young's modulus, SWV, and FIB-4 scores in the significant liver fibrosis group were significantly higher than those in the non-significant liver fibrosis group (P<0.05); ROC curve analysis showed that the area under the curve (AUC) for the combined diagnosis of significant liver fibrosis in NAFLD using Young's modulus value, SWV, and FIB-4 score was 0.934, with sensitivity and specificity of 90.70% and 85.94%. The AUC for each single indicator diagnosis was 0.890, 0.858, and 0.823; the Delong test showed that the AUC of the combined diagnosis was significantly higher than that of each single indicator (P<0.05).

Conclusion

The 2D-SWE parameter, including Young's modulus value and SWV combined with FIB-4 score, can effectively improve the diagnostic sensitivity and specificity. They can be used as a preferred non-invasive clinical assessment of the degree of liver fibrosis in patients with NAFLD.

Key words: Non-alcoholic fatty liver disease, Liver fibrosis, Two-dimensional ultrasound shear wave elastography, Fibrosis-4 index, Diagnostic value

Hui Li, Ying Nie, Jia Li, Juan Fan. Diagnostic value of two-dimensional ultrasound shear wave elastography combined with FIB-4 score for significant fibrosis in non-alcoholic fatty liver disease[J]. Chinese Journal of Digestion and Medical Imageology(Electronic Edition), 2026, 16(04): 325-330.

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References 21

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临床资料	非显著性纤维化组(n=88)	显著性纤维化组(n=62)	t/χ²值	P值
男/女[例(%)]	48(54.55)/40(45.45)	33(52.23)/29(46.77)	0.026	0.873
年龄(岁,±s)	46.78±8.71	46.51±8.45	0.189	0.85
天冬氨酸氨基转移酶(U/L,±s)	45.32±12.45	68.45±15.67	10.059	<0.001
丙氨酸氨基转移酶(U/L,±s)	52.43±14.67	75.68±18.92	8.47	<0.001
血小板计数(×10⁹/L,±s)	225.89±42.15	168.76±35.42	8.719	<0.001
血红蛋白(g/L,±s)	138.65±12.34	125.32±11.89	6.613	<0.001
红细胞计数(×10¹²/L,±s)	4.87±0.56	4.32±0.48	6.276	<0.001
白细胞计数(×10⁹/L,±s)	6.78±1.23	5.89±1.15	4.482	<0.001
总胆红素(μmol/L,±s)	18.76±5.43	25.74±6.78	6.989	<0.001
体重指数(kg/m²,±s)	25.34±3.21	28.76±3.56	6.141	<0.001
空腹血糖(mmol/L,±s)	5.67±1.02	6.89±1.23	6.621	<0.001
总胆固醇(mmol/L,±s)	5.23±0.87	6.54±1.02	8.452	<0.001
甘油三酯(mmol/L,±s)	1.78±0.65	2.89±0.75	9.661	<0.001
低密度脂蛋白(mmol/L,±s)	3.34±0.76	4.56±0.89	9.016	<0.001
高密度脂蛋白(mmol/L,±s)	1.23±0.21	0.98±0.18	7.608	<0.001
2型糖尿病[例(%)]	12(13.64)	23(37.10)	11.191	<0.001
高血压[例(%)]	15(17.05)	25(40.32)	10.078	0.015
肝穿刺脂肪含量(%)	23.45±6.78	35.67±8.90	9.541	<0.001

临床资料	非显著性纤维化组(n=88)	显著性纤维化组(n=62)	t/χ²值	P值
男/女[例(%)]	48(54.55)/40(45.45)	33(52.23)/29(46.77)	0.026	0.873
年龄(岁,±s)	46.78±8.71	46.51±8.45	0.189	0.85
天冬氨酸氨基转移酶(U/L,±s)	45.32±12.45	68.45±15.67	10.059	<0.001
丙氨酸氨基转移酶(U/L,±s)	52.43±14.67	75.68±18.92	8.47	<0.001
血小板计数(×10⁹/L,±s)	225.89±42.15	168.76±35.42	8.719	<0.001
血红蛋白(g/L,±s)	138.65±12.34	125.32±11.89	6.613	<0.001
红细胞计数(×10¹²/L,±s)	4.87±0.56	4.32±0.48	6.276	<0.001
白细胞计数(×10⁹/L,±s)	6.78±1.23	5.89±1.15	4.482	<0.001
总胆红素(μmol/L,±s)	18.76±5.43	25.74±6.78	6.989	<0.001
体重指数(kg/m²,±s)	25.34±3.21	28.76±3.56	6.141	<0.001
空腹血糖(mmol/L,±s)	5.67±1.02	6.89±1.23	6.621	<0.001
总胆固醇(mmol/L,±s)	5.23±0.87	6.54±1.02	8.452	<0.001
甘油三酯(mmol/L,±s)	1.78±0.65	2.89±0.75	9.661	<0.001
低密度脂蛋白(mmol/L,±s)	3.34±0.76	4.56±0.89	9.016	<0.001
高密度脂蛋白(mmol/L,±s)	1.23±0.21	0.98±0.18	7.608	<0.001
2型糖尿病[例(%)]	12(13.64)	23(37.10)	11.191	<0.001
高血压[例(%)]	15(17.05)	25(40.32)	10.078	0.015
肝穿刺脂肪含量(%)	23.45±6.78	35.67±8.90	9.541	<0.001

组别	例数	杨氏模量值(kPa)	SWV(m/s)	FIB-4评分
非显著性纤维化组	88	6.12±1.35	1.25±0.24	1.51±0.42
显著性纤维化组	62	15.78±2.61	3.21±0.67	2.35±0.78
t值		29.581	25.267	8.509
P值		<0.001	<0.001	<0.001

组别	例数	杨氏模量值(kPa)	SWV(m/s)	FIB-4评分
非显著性纤维化组	88	6.12±1.35	1.25±0.24	1.51±0.42
显著性纤维化组	62	15.78±2.61	3.21±0.67	2.35±0.78
t值		29.581	25.267	8.509
P值		<0.001	<0.001	<0.001

变量	最佳截断值	AUC	95% CI	敏感度(%)	特异性(%)	Z值	P值
杨氏模量值	14.26 kPa	0.890	0.835~0.945	81.40	78.13	3.86	<0.001
SWV	2.18 m/s	0.858	0.800~0.916	83.72	81.25	2.94	<0.001
FIB-4评分	1.92	0.823	0.759~0.887	76.74	81.25	4.52	<0.001
联合检测	0.476	0.934	0.892~0.976	90.70	85.94	-	<0.001

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