J Hepatol. 2014 Feb;60(2):384-91. doi: 10.1016/j.jhep.2013.10.017. Epub 2013 Oct 26.
BACKGROUND & AIMS: It is difficult to determine the different stages of non-alcoholic fatty liver disease without the use of invasive liver biopsy. In this study we investigated five non-invasive biomarkers used previously to detect hepatic fibrosis and determined the level of agreement between them in order to inform future research.
In the Edinburgh Type 2 Diabetes Study, a population-based cohort aged 60-74 years with type 2 diabetes, 831 participants underwent ultrasound assessment for fatty liver and had serum aspartate aminotransferase to alanine aminotransferase ratio (AST/ALT), aspartate to platelet ratio index (APRI), European Liver Fibrosis panel (ELF), Fibrosis-4 Score (FIB4) and liver stiffness measurement (LSM) measured.
Literature based cut-offs yielded marked differences in the proportions of the cohort with probable liver fibrosis in the full cohort. Agreement between the top 5% of the distribution for each biomarker pair was poor. APRI and FIB4 had the best positive agreement at 76.4%, but agreement for all of the other serum biomarker pairs was between 18% and 34%. Agreement with LSM was poor (9-16%).
We found poor correlation between the five biomarkers of liver fibrosis studied. Using the top 5% of each biomarker resulted in good agreement on the absence of advanced liver disease but poor agreement on the presence of advanced disease. Further work is required to validate these markers against liver biopsy and to determine their predictive value for clinical liver-related endpoints, in a range of different low and high risk population groups.
如果不使用侵入性肝活检，很难确定非酒精性脂肪性肝病的不同阶段。在这项研究中，我们研究了以前用于检测肝纤维化的五种非侵入性生物标志物，并确定了它们之间的一致性程度，以便为未来的研究提供信息。
在爱丁堡 2 型糖尿病研究中，我们对年龄在 60-74 岁、患有 2 型糖尿病的人群进行了超声检查以评估脂肪肝，并测量了血清天门冬氨酸氨基转移酶与丙氨酸氨基转移酶比值（AST/ALT）、天冬氨酸与血小板比值指数（APRI）、欧洲肝纤维化小组（ELF）、纤维化-4 评分（FIB4）和肝硬度测量（LSM）。
基于文献的截止值导致在整个队列中可能患有肝纤维化的患者比例存在显著差异。每个生物标志物对中最高 5%的分布之间的一致性较差。APRI 和 FIB4 的阳性一致性最佳，为 76.4%，但所有其他血清生物标志物对之间的一致性在 18%至 34%之间。与 LSM 的一致性较差（9-16%）。
我们发现研究的五种肝纤维化生物标志物之间相关性较差。使用每个生物标志物的前 5%可以很好地一致地确定不存在晚期肝病，但在存在晚期疾病时一致性较差。需要进一步工作来验证这些标志物与肝活检的相关性，并确定它们在一系列不同的低风险和高风险人群中对临床相关肝脏终点的预测价值。
