Division of Gastroenterology, Yokohama City University Graduate School of Medicine, Yokohama, Japan.
J Gastroenterol. 2013 Sep;48(9):1051-60. doi: 10.1007/s00535-012-0704-y. Epub 2012 Nov 27.
The severity of liver fibrosis must be estimated to determine the prognosis, for surveillance, and for optimal treatment of nonalcoholic fatty liver disease (NAFLD). However, the severity of hepatic fibrosis tends to be underestimated in patients with normal ALT.
We investigated histological data and scoring systems (FIB-4 index, NAFLD fibrosis score, BARD score, and AST/ALT ratio) of 1,102 liver-biopsy-confirmed NAFLD patients.
A total of 235 NAFLD patients with normal ALT were estimated to exist. The ratio of advanced fibrosis (stage 3-4) was seen in 16.1 % of subjects with normal ALT. Scoring systems, especially the FIB-4 index and NAFLD fibrosis score, were clinically very useful (AUROC >0.8), even in patients with normal ALT. Furthermore, with resetting of the cutoff values, the FIB-4 index (>1.659) and NAFLD fibrosis score (>0.735) were found to have a higher sensitivity and higher specificity for the prediction of advanced fibrosis, and all of these scoring systems (FIB-4 index, NAFLD fibrosis score, BARD score, and AST/ALT ratio) had higher negative predictive values (>90.3 %). By using the resetting cutoff value, liver biopsy could have been avoided in 60.4 % (FIB-4), 66.4 % (NAFLD fibrosis score), 51.9 % (BARD score), and 62.1 % (AST/ALT ratio).
We reset the cutoff values of numerous non-invasive scoring systems to improve their clinical usefulness in the prediction of liver fibrosis in NAFLD patients with normal ALT, and these non-invasive scoring systems with the reset cutoff values could be of substantial benefit to reduce the number of liver biopsies performed.
为了评估非酒精性脂肪性肝病 (NAFLD) 的预后、监测和优化治疗,必须评估肝纤维化的严重程度。然而,在 ALT 正常的患者中,肝纤维化的严重程度往往被低估。
我们研究了 1102 例经肝活检证实的 NAFLD 患者的组织学数据和评分系统(FIB-4 指数、NAFLD 纤维化评分、BARD 评分和 AST/ALT 比值)。
共估计有 235 例 ALT 正常的 NAFLD 患者存在。在 ALT 正常的患者中,有 16.1%的患者存在晚期纤维化(3-4 期)。评分系统,特别是 FIB-4 指数和 NAFLD 纤维化评分,即使在 ALT 正常的患者中也具有非常重要的临床价值(AUROC >0.8)。此外,通过重置截断值,发现 FIB-4 指数(>1.659)和 NAFLD 纤维化评分(>0.735)对预测晚期纤维化具有更高的敏感性和特异性,所有这些评分系统(FIB-4 指数、NAFLD 纤维化评分、BARD 评分和 AST/ALT 比值)均具有更高的阴性预测值(>90.3%)。通过使用重置的截断值,可以避免进行肝活检的患者比例分别为:FIB-4 为 60.4%,NAFLD 纤维化评分为 66.4%,BARD 评分为 51.9%,AST/ALT 比值为 62.1%。
我们重置了多个非侵入性评分系统的截断值,以提高它们在预测 ALT 正常的 NAFLD 患者肝纤维化方面的临床实用性,并且这些具有重置截断值的非侵入性评分系统可以大大减少进行肝活检的数量。