非酒精性脂肪性肝病特异性或非特异性肝纤维化血液检测的比较
Comparison of blood tests for liver fibrosis specific or not to NAFLD.
作者信息
Calès Paul, Lainé Fabrice, Boursier Jérôme, Deugnier Yves, Moal Valérie, Oberti Frédéric, Hunault Gilles, Rousselet Marie Christine, Hubert Isabelle, Laafi Jihane, Ducluzeaux Pierre Henri, Lunel Françoise
机构信息
Service d'Hépato-Gastroentérologie, CHU, 49933 Angers Cedex 09, France.
出版信息
J Hepatol. 2009 Jan;50(1):165-73. doi: 10.1016/j.jhep.2008.07.035. Epub 2008 Oct 7.
BACKGROUND/AIMS: To compare blood tests of liver fibrosis specific for NAFLD: the FibroMeter NAFLD and the NAFLD fibrosis score (NFSA) with a non-specific test, APRI.
METHODS
Two hundred and thirty-five NAFLD patients with liver Metavir staging and blood markers from two independent centres were randomly assigned to a test (n=121) or a validation population (n=114).
RESULTS
The highest accuracy--91%--for significant fibrosis was obtained with the FibroMeter whose (i) AUROC (0.943) was significantly higher than those of NFSA (0.884, p=0.008) and APRI (0.866, p<10(-3); p=0.309 vs NFSA) in the whole population, and (ii) misclassification rate (9%) was significantly lower than those of NFSA (14%, p=0.04) and APRI (16%, p=0.002) and did not vary according to centre (14 vs 7%, p=0.07), unlike those of NFSA (25 vs 9%, p=0.001) and APRI (29 vs 11%, p<10(-3)). By using thresholds of 90% predictive values, liver biopsy could have been avoided in most patients: FibroMeter: 97.4% vs NFSA: 86.8% (p<10(-3)) and APRI: 80.0% (p<10(-3)). A new classification provided three reliable diagnosis intervals: F0/1, F0/1/2, F2/3/4 with 91.4% accuracy for FibroMeter, avoiding biopsy in all patients.
CONCLUSIONS
FibroMeter NAFLD had high performance and provided reliable diagnosis for significant fibrosis, significantly outperforming NFSA and APRI.
背景/目的：比较非酒精性脂肪性肝病（NAFLD）特异性的肝纤维化血液检测指标：FibroMeter NAFLD和NAFLD纤维化评分（NFSA）与非特异性检测指标APRI。
方法
将来自两个独立中心的235例有肝脏Metavir分期及血液标志物的NAFLD患者随机分为测试组（n = 121）和验证组（n = 114）。
结果
FibroMeter对显著纤维化的准确率最高，达91%，其（i）在总体人群中，受试者工作特征曲线下面积（AUROC）（0.943）显著高于NFSA（0.884，p = 0.008）和APRI（0.866，p < 10⁻³；与NFSA相比p = 0.309）；（ii）误分类率（9%）显著低于NFSA（14%，p = 0.04）和APRI（16%，p = 0.002），且不像NFSA（25%对9%，p = 0.001）和APRI（29%对11%，p < 10⁻³）那样因中心而异（14%对7%，p = 0.07）。通过使用90%预测值的阈值，大多数患者可避免肝活检：FibroMeter为97.4%，而NFSA为86.8%（p < 10⁻³），APRI为80.0%（p < 此文档中未提及具体数值，可能有误，推测为10⁻³）。一种新的分类提供了三个可靠的诊断区间：F0/1、F0/1/2、F2/3/4，FibroMeter的准确率为91.4%，可避免所有患者进行活检。
结论
FibroMeter NAFLD性能良好，能为显著纤维化提供可靠诊断，显著优于NFSA和APRI。
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