Abstract: Objective To explore the value of serum acid sphingomyelinase (ASMase) combined with liver fibrosis index (FIB-4) in predicting early liver fibrosis in non-alcoholic fatty liver (NAFLD) patients with diabetes. Methods 126 patients with NAFLD complicated by diabetes who were admitted to the hospital from February 2018 to February 2021 were selected and divided into the early liver fibrosis group (n=74 cases) and the non-fibrosis group (n=52 cases) according to the pathological diagnosis. The serum ASMase level and FIB-4 index of the two groups of patients were compared, the clinical characteristics of the two groups of patients were compared, Logistic regression analysis was used to determine the factors affecting early liver fibrosis in patients with NAFLD complicated by diabetes, the receiver operating characteristic curve (ROC) was used to analyze the value of serum ASMase level and FIB-4 index in predicting early liver fibrosis in patients with NAFLD complicated by diabetes. Results Serum ASMase level and FIB-4 index [(58.49±9.15)nmol/L, (0.82±0.13)] of patients with liver fibrosis were higher than those without liver fibrosis [(44.06±7.63)nmol/L, (0.65±0.10)] (P<0.05). Univariate analysis showed that the gender, age, smoking history, drinking history, underlying disease composition, age, waist circumference, diabetes course, mean arterial pressure, serum blood glucose, urea nitrogen, uric acid, albumin, and total bilirubin of patients in the liver fibrosis group, Direct bilirubin, glutamyl aminotransferase, alanine aminotransferase, aspartate aminotransferase, total cholesterol, triglycerides, platelets, alkaline phosphatase composition ratio compared with the non-liver fibrosis group, the difference was not statistically significant (P>0.05). The body mass (BMI) and serum alkaline phosphatase levels of the liver fibrosis group were compared with those without liver fibrosis, and the differences were statistically significant (P<0.05), Logistic multivariate regression analysis showed that ASMase, FIB-4 index, and BMI were independent risk factors for early liver fibrosis in NAFLD patients with diabetes (OR=3.031, 3.501, 3.114, P<0.05). ROC analysis showed that the best cut-off points of serum ASMase level and FIB-4 index for predicting early liver fibrosis in NAFLD patients with diabetes were 50.73 nmol/L and 0.68, respectively, the sensitivity were 83.78% and 81.08%, and the specificity were 71.15% and 80.77%, respectively, and the area under the curve (AUC) were 0.854 and 0.838, respectively, the sensitivity, specificity and AUC of the combination of the two were 83.78%, 98.08% and 0.874, respectively. Conclusion The serum ASMase level and FIB-4 index of patients with early liver fibrosis for NAFLD complicated by diabetes are abnormally increased, both are independent risk factors for early liver fiber in NAFLD complicated by diabetes, dynamic monitoring of its level changes can be used as the sensitive indicator to predict early liver fiber in patients with NAFLD complicated by diabetes.

Key words: Non-alcoholic fatty liver, Diabetes, Liver fibrosis, Acid sphingomyelinase, FIB-4 index