University Hospital of Cologne, Cologne, Germany.
J Clin Gastroenterol. 2013 Sep;47(8):719-26. doi: 10.1097/MCG.0b013e3182819a89.
Nonalcoholic fatty liver disease (NAFLD) is a common chronic liver disease ranging from simple fatty liver to steatohepatitis, fibrosis, and cirrhosis. We aimed to analyze the diagnostic performance and clinical utility of simple noninvasive tests alone or in combination for the detection of advanced fibrosis in patients with NAFLD.
Data from 323 patients with biopsy-proven NAFLD/NASH who presented to the Clinic for Gastroenterology and Hepatology, University Hospital of Cologne between July 1998 and November 2009, were analyzed retrospectively. Sensitivity, specificity, positive predictive values, and negative predictive values were determined along with the area under receiver operating characteristic curves (AUROC) using published formulas for NAFLD, FIB-4, and BARD fibrosis scores.
The area under receiver operating characteristic curves were as follows: NAFLD fibrosis score 0.96 [95% confidence interval (CI), 0.92-0.99], FIB-4 0.95 (95% CI, 0.91-1.00), BARD 0.82 (95% CI, 0.71-0.92) with negative predictive values for advanced fibrosis of 96%, 98%, and 96%, respectively. When applying the NAFLD, FIB-4, or BARD scoring systems 25%, 15%, or 26% of cases with advanced fibrosis would have been missed. Combining FIB-4 and BARD in a stepwise fashion, patients would have been correctly classified without biopsy in 67% of cases without missing a single case of advanced fibrosis.
The FIB-4 and NAFLD fibrosis scores perform better than the BARD scoring system. Liver biopsy can securely be replaced only with a stepwise combination of simple noninvasive tests, otherwise the assessment of risk due to advanced fibrosis may be misleading in a clinically meaningful proportion of patients.
非酒精性脂肪性肝病（NAFLD）是一种常见的慢性肝病，其病变范围从单纯性脂肪肝到脂肪性肝炎、肝纤维化和肝硬化。本研究旨在分析单独或联合使用简单的非侵入性检查对诊断 NAFLD 患者肝纤维化的诊断性能和临床应用。
回顾性分析了 1998 年 7 月至 2009 年 11 月期间在科隆大学医院消化内科和肝病科就诊的经活检证实的 323 例 NAFLD/NASH 患者的数据。使用 NAFLD、FIB-4 和 BARD 纤维化评分的公式计算了灵敏度、特异度、阳性预测值和阴性预测值，并绘制了受试者工作特征曲线下面积（AUROC）。
受试者工作特征曲线下面积如下：NAFLD 纤维化评分 0.96（95%置信区间，0.92-0.99），FIB-4 0.95（95%置信区间，0.91-1.00），BARD 0.82（95%置信区间，0.71-0.92），其诊断晚期纤维化的阴性预测值分别为 96%、98%和 96%。当应用 NAFLD、FIB-4 或 BARD 评分系统时，分别有 25%、15%或 26%的晚期纤维化病例会被遗漏。逐步联合使用 FIB-4 和 BARD，67%的病例无需进行肝活检即可正确分类，且不会遗漏任何一例晚期纤维化病例。
FIB-4 和 NAFLD 纤维化评分优于 BARD 评分系统。只有逐步联合使用简单的非侵入性检查才能可靠地替代肝活检，否则在临床上有意义的一部分患者中，对晚期纤维化风险的评估可能会产生误导。
