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
Service d'Hépato-Gastroentérologie, CHU, 49933 Angers Cedex 09, France.
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.
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).
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.
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。
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）。
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。
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。
