Department of Hepatology, Institute of Liver and Biliary Sciences (ILBS), Sector D1, Vasant Kunj, New Delhi, 110070, India.
Dig Dis Sci. 2013 Jan;58(1):265-74. doi: 10.1007/s10620-012-2306-1. Epub 2012 Jul 12.
The present study evaluated performance characteristics of liver stiffness measurement (LSM) by FibroScan in patients with different stages of nonalcoholic fatty liver disease (NAFLD).
A total of 307 subjects (120 NAFLD, 85 NAFLD related cirrhosis, and 102 healthy controls) were studied.
In NAFLD patients, LSM had significant correlation with fibrosis (r = 0.68, p < 0.001), and increased progressively with increasing fibrosis (p < 0.001). However, the difference between stage 1 and stage 2 fibrosis was not significant (p = 0.07). The LSM in NAFLD without fibrosis and healthy controls was similar (p = 0.37). The areas under receiver-operating characteristics (AUROC) curve of LSM for stages ≥1, ≥2, ≥3, and 4 were 0.82, 0.85, 0.94, and 0.96, respectively. The best LSM (kPa) cut-offs for fibrosis stages ≥1, ≥2, ≥3 and 4 were 6.1, 7.0, 9.0, and 11.8, respectively. The negative predictive value of LSM for excluding advanced fibrosis was 95%. For advanced fibrosis, the AUROC curve of LSM was 0.94, followed by FIB-4 (0.75), BARD score (0.68), NAFLD fibrosis score (0.66), and aspartate platelet ratio index (0.60). In multivariate analysis, LSM was the only independent predictor of advanced fibrosis (odds ratio 1.47). In patients with NAFLD cirrhosis, LSM correlated significantly with Child-Pugh score (r = 0.40, p < 0.001), serum bilirubin (r = 0.34, p = 0.02), and grades of esophageal varices (r = 0.23, p = 0.04).
LSM is a useful tool for evaluation of patients with NAFLD, and is the best among other non-invasive predictors of liver fibrosis.
本研究评估了 FibroScan 检测肝硬度（LSM）在不同阶段非酒精性脂肪性肝病（NAFLD）患者中的性能特征。
共研究了 307 名受试者（120 名 NAFLD、85 名 NAFLD 相关肝硬化和 102 名健康对照者）。
在 NAFLD 患者中，LSM 与纤维化具有显著相关性（r = 0.68，p < 0.001），并随纤维化程度的增加而逐渐升高（p < 0.001）。然而，1 期和 2 期纤维化之间的差异无统计学意义（p = 0.07）。无纤维化的 NAFLD 和健康对照者的 LSM 相似（p = 0.37）。LSM 对≥1 期、≥2 期、≥3 期和 4 期的受试者工作特征（ROC）曲线下面积（AUROC）分别为 0.82、0.85、0.94 和 0.96。LSM 用于纤维化≥1 期、≥2 期、≥3 期和 4 期的最佳截断值（kPa）分别为 6.1、7.0、9.0 和 11.8。LSM 排除晚期纤维化的阴性预测值为 95%。对于晚期纤维化，LSM 的 ROC 曲线为 0.94，其次是 FIB-4（0.75）、BARD 评分（0.68）、NAFLD 纤维化评分（0.66）和天冬氨酸血小板比值指数（0.60）。多变量分析显示，LSM 是晚期纤维化的唯一独立预测因素（优势比 1.47）。在 NAFLD 肝硬化患者中，LSM 与 Child-Pugh 评分（r = 0.40，p < 0.001）、血清胆红素（r = 0.34，p = 0.02）和食管静脉曲张程度（r = 0.23，p = 0.04）显著相关。
LSM 是评估 NAFLD 患者的有用工具，并且是其他非侵入性肝纤维化预测指标中最好的。
