简单的非侵入性纤维化评分系统可以可靠地排除非酒精性脂肪性肝病患者的晚期纤维化。

Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease.

机构信息

Liver Unit, Level 6, Freeman Hospital, Freeman Road, Newcastle upon Tyne, UK.

出版信息

Gut. 2010 Sep;59(9):1265-9. doi: 10.1136/gut.2010.216077.

DOI:10.1136/gut.2010.216077

PMID:20801772

Abstract

BACKGROUND

Accurate evaluation of liver fibrosis in patients with non-alcoholic fatty liver disease (NAFLD) is important to identify patients who may develop complications. The aim of this study was to compare the diagnostic performance of simple non-invasive tests in identifying advanced fibrosis among patients with biopsy-proven NAFLD.

METHODS

Consecutive patients with biopsy proven NAFLD were recruited from the Newcastle Hospitals Fatty Liver Clinic from 2003 to 2009. The AST/ALT ratio, AST to platelet ratio index, BARD (weighted sum of BMI>28=1 point, AST/ALT ratio>0.8=2 points, diabetes=1 point), FIB-4 (agexAST (IU/l)/platelet count (x10(9)/litre)x radicalALT (IU/l)) and NAFLD fibrosis scores were calculated from blood tests taken at time of biopsy.

RESULTS

145 patients (82 male (61%), mean age 51+ or -12 years) were included. The mean body mass index was 35+ or -5 kg/m(2). 73 subjects (50%) had diabetes. 93 patients (64%) had non-alcoholic steatohepatitis. 27 (19%) had advanced fibrosis (Kleiner stage 3-4). The FIB-4 score had the best diagnostic accuracy for advanced fibrosis (area under receiver operator characteristic curve (AUROC) 0.86), followed by AST/ALT ratio (AUROC 0.83), NAFLD fibrosis score (AUROC 0.81), BARD (AUROC 0.77) and AST to platelet ratio index (AUROC 0.67). The AST/ALT ratio, BARD score, FIB-4 and NAFLD fibrosis scores had negative predictive values greater than 90% (93%, 95%, 95% and 92% respectively). Positive predictive values were modest. In order to exclude advanced fibrosis liver biopsy could potentially be avoided in 69% with AST/ALT ratio, 62% with FIB-4, 52% with NAFLD fibrosis score and 38% with BARD.

CONCLUSIONS

The ALT/AST ratio, FIB-4 and NAFLD fibrosis scores can reliably exclude advanced fibrosis in a high proportion of patients with NAFLD, allowing liver biopsy to be used in a more directed manner.

摘要

背景

准确评估非酒精性脂肪性肝病（NAFLD）患者的肝纤维化程度对于识别可能发生并发症的患者很重要。本研究旨在比较简单的非侵入性检测在识别经活检证实的 NAFLD 患者中晚期纤维化的诊断性能。

方法

从 2003 年至 2009 年，从纽卡斯尔医院脂肪肝诊所连续招募经活检证实的 NAFLD 患者。在进行活检时，从血液检查中计算 AST/ALT 比值、AST 血小板比值指数、BARD（BMI>28 为 1 分，AST/ALT 比值>0.8 为 2 分，糖尿病为 1 分）、FIB-4（年龄 xAST（IU/l）/血小板计数（x10^9/升）x 碱性 ALT（IU/l））和 NAFLD 纤维化评分。

结果

共纳入 145 例患者（82 例男性（61%），平均年龄 51+或-12 岁）。平均体重指数为 35+或-5kg/m^2。73 例患者（50%）患有糖尿病。93 例患者（64%）患有非酒精性脂肪性肝炎。27 例（19%）患有晚期纤维化（Kleiner 分期 3-4）。FIB-4 评分对晚期纤维化的诊断准确性最高（ROC 曲线下面积（AUROC）为 0.86），其次是 AST/ALT 比值（AUROC 为 0.83）、NAFLD 纤维化评分（AUROC 为 0.81）、BARD（AUROC 为 0.77）和 AST 血小板比值指数（AUROC 为 0.67）。AST/ALT 比值、BARD 评分、FIB-4 和 NAFLD 纤维化评分的阴性预测值均大于 90%（分别为 93%、95%、95%和 92%）。阳性预测值适中。为了排除晚期纤维化，AST/ALT 比值可使 69%的患者、FIB-4 可使 62%的患者、NAFLD 纤维化评分可使 52%的患者、BARD 可使 38%的患者无需进行肝活检。