非酒精性脂肪性肝病患者通过血液检查诊断不同的肝纤维化特征。
Diagnosis of different liver fibrosis characteristics by blood tests in non-alcoholic fatty liver disease.
机构信息
Service d'Hépato-Gastroentérologie, CHU, Angers, France.
出版信息
Liver Int. 2010 Oct;30(9):1346-54. doi: 10.1111/j.1478-3231.2010.02314.x.
AIMS
Our aim was to develop an accurate, non-invasive, blood-test-based method for identifying the main characteristics of liver fibrosis in non-alcoholic fatty liver disease (NAFLD).
METHODS
Fibrosis was staged according to NASH-CRN and Metavir systems in 226 patients with NAFLD. A fully automated algorithm measured the fractal dimension (FD) and the area of fibrosis (AOF). Independent predictors of diagnostic targets were determined using bootstrap methods.
RESULTS
(i) Development. Significant fibrosis defined by NASH-CRN F ≥2 was diagnosed by weight, glycaemia, aspartate aminotransferase (AST), alanine aminotransferase (ALT) and prothrombin index [area under the receiver operating characteristic (AUROC)=0.867]; significant fibrosis defined by Metavir F ≥2 was diagnosed by weight, age, glycaemia, AST, ALT, ferritin and platelets (FibroMeter AUROC=0.941, P<0.005). AOF was estimated by the combination of hyaluronic acid, glycaemia, AST, ALT, platelets and prothrombin index ((a) R(2) =0.530), while FD was estimated by hyaluronic acid, glycaemia, AST/ALT, weight and platelets ((a) R(2) =0.529). (ii) Evaluation. Although NASH-CRN was a better system for fibrosis staging, Metavir staging was a better reference for blood test. Thus, the patient rate with predictive values ≥90% by tests was 97.3% with Metavir reference vs. 66.5% with NASH-CRN reference (P<10(-3)). FibroMeter showed a significantly higher AUROC than the NAFLD fibrosis score for significant fibrosis, but not for severe fibrosis or cirrhosis, with both staging systems. Relationships between fibrosis lesions were well reflected by blood tests, e.g., the correlation between histological area and FD of fibrosis (r(s) =0.971, P<10(-3)) was well reflected by the relationship between respective blood tests (r(s) =0.852, P<10(-3)).
CONCLUSIONS
Different characteristics of fibrosis in NAFLD can be diagnosed and quantified by blood tests with excellent accuracy.
目的
我们旨在开发一种准确、无创、基于血液检测的方法，用于识别非酒精性脂肪性肝病（NAFLD）中肝纤维化的主要特征。
方法
根据 NASH-CRN 和 Metavir 系统对 226 例 NAFLD 患者进行纤维化分期。使用全自动算法测量分形维数（FD）和纤维化面积（AOF）。使用自举方法确定诊断目标的独立预测因子。
结果
（i）发展。根据 NASH-CRN F≥2 定义的显著纤维化通过体重、血糖、天冬氨酸转氨酶（AST）、丙氨酸转氨酶（ALT）和凝血酶原指数诊断[受试者工作特征曲线（ROC）下面积（AUROC）=0.867]；根据 Metavir F≥2 定义的显著纤维化通过体重、年龄、血糖、AST、ALT、铁蛋白和血小板（FibroMeter AUROC=0.941，P<0.005）诊断。AOF 由透明质酸、血糖、AST、ALT、血小板和凝血酶原指数的组合估算（a）R²=0.530），而 FD 由透明质酸、血糖、AST/ALT、体重和血小板估算（a）R²=0.529）。（ii）评估。虽然 NASH-CRN 是一种更好的纤维化分期系统，但 Metavir 分期是血液检测的更好参考。因此，在以 Metavir 为参考时，预测值≥90%的患者比例为 97.3%，而以 NASH-CRN 为参考时为 66.5%（P<10(-3)）。与两种分期系统相比，FibroMeter 对显著纤维化的 AUROC 显著高于 NAFLD 纤维化评分，但对严重纤维化或肝硬化则不然。血液检测能很好地反映纤维化病变之间的关系，例如，组织学面积与纤维化 FD（r(s)=0.971，P<10(-3))之间的相关性很好地反映了各自血液检测（r(s)=0.852，P<10(-3))之间的关系。
结论
基于血液检测的方法可以准确地诊断和定量 NAFLD 中不同的纤维化特征。
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