Liver Unit, Newcastle Upon Tyne Hospitals NHS Trust, Freeman Hospital, Newcastle University, Newcastle Upon Tyne, UK.
Eur J Gastroenterol Hepatol. 2013 Jun;25(6):652-8. doi: 10.1097/MEG.0b013e32835d72cf.
Nonalcoholic fatty liver disease (NAFLD) is common and many affected individuals have normal-range alanine aminotransferase (ALT) levels. There is a need for a robust screening tool to triage individuals with advanced fibrosis for specialist care.
The aim of this study was to assess the performance of noninvasive fibrosis tests in patients with biopsy-proven NAFLD and normal levels of ALT.
Patients presenting at a fatty liver clinic between 1999 and 2009 were included in the study. Liver biopsies were assessed using the Kleiner score. The aspartate aminotransferase (AST)/ALT ratio, BARD, FIB-4 and NAFLD fibrosis scores were calculated.
A total of 305 patients were included [70 with normal ALT levels (women: ALT≤30 IU/l, men: ALT≤45 IU/l) and 235 with elevated levels]. In total, 24% of patients with normal ALT levels and 17% of those with elevated ALT levels had advanced fibrosis (Kleiner stage 3-4). The FIB-4 performed best in identifying advanced fibrosis in patients with normal ALT (area under receiver operating characteristic curve=0.86, 82% sensitivity, 77% specificity and 92% negative predictive value). The sensitivity of the AST/ALT ratio and BARD and NAFLD fibrosis scores for advanced fibrosis was good in patients with normal ALT levels (94, 94 and 82%, respectively), but the specificity was low (44, 26 and 51%, respectively). The FIB-4 yielded best results in patients with elevated ALT levels. Using the FIB-4, 61% of patients with normal ALT levels and 63% of those with elevated ALT levels could avoid liver biopsy to exclude advanced fibrosis. In contrast, AST/ALT ratio and BARD and NAFLD scores would have led to a high proportion of patients with mild disease having to undergo a biopsy.
The FIB-4 yielded good results in patients with normal or elevated ALT levels, reliably excluding advanced fibrosis and reducing the need for liver biopsy.
非酒精性脂肪性肝病（NAFLD）很常见，许多受影响的个体丙氨酸氨基转移酶（ALT）水平在正常范围内。需要一种强大的筛查工具来对纤维化程度较高的患者进行分诊，以便接受专科治疗。
本研究旨在评估无创性纤维化检测在经活检证实的 NAFLD 且 ALT 水平正常的患者中的表现。
本研究纳入了 1999 年至 2009 年期间在脂肪肝诊所就诊的患者。使用 Kleiner 评分评估肝活检结果。计算天门冬氨酸氨基转移酶（AST）/丙氨酸氨基转移酶（ALT）比值、BARD、FIB-4 和 NAFLD 纤维化评分。
共纳入 305 例患者[70 例 ALT 水平正常（女性：ALT≤30IU/l，男性：ALT≤45IU/l），235 例 ALT 水平升高]。ALT 水平正常的患者中，共有 24%存在晚期纤维化（Kleiner 分期 3-4 期），而 ALT 水平升高的患者中，有 17%存在晚期纤维化。在 ALT 水平正常的患者中，FIB-4 对识别晚期纤维化的表现最佳（受试者工作特征曲线下面积为 0.86，灵敏度为 82%，特异性为 77%，阴性预测值为 92%）。在 ALT 水平正常的患者中，AST/ALT 比值、BARD 和 NAFLD 纤维化评分对晚期纤维化的诊断均具有良好的敏感性（分别为 94%、94%和 82%），但特异性较低（分别为 44%、26%和 51%）。在 ALT 水平升高的患者中，FIB-4 也取得了最佳结果。使用 FIB-4，61%的 ALT 水平正常的患者和 63%的 ALT 水平升高的患者可以避免肝活检来排除晚期纤维化。相比之下，AST/ALT 比值、BARD 和 NAFLD 评分将导致许多轻度疾病患者需要进行肝活检。
FIB-4 在 ALT 水平正常或升高的患者中表现良好，能够可靠地排除晚期纤维化，减少肝活检的需求。
