Gaia Silvia, Campion Daniela, Evangelista Andrea, Spandre Maurizio, Cosso Loretta, Brunello Franco, Ciccone Giovannino, Bugianesi Elisabetta, Rizzetto Mario
Department of Gastroenterology, Città della Salute e della Scienza - University Hospital, Turin, Italy.
Department of Epidemiology, Città della Salute e della Scienza - University Hospital, Turin, Italy.
Liver Int. 2015 Aug;35(8):2027-35. doi: 10.1111/liv.12761. Epub 2015 Jan 21.
BACKGROUND & AIMS: We elaborate a non-invasive score system for liver fibrosis (NISF), exploring its diagnostic performance and comparing its accuracy to FibroScan in patients with chronic viral hepatitis (CH) and non-alcoholic fatty liver disease (NAFLD).
Clinical, biochemical, elastographic and ultrasound parameters derived from patients with CH (n = 83) or NAFLD (n = 58), undergoing liver biopsy for fibrosis assessment, were prospectively collected as potential predictors of fibrosis. Each parameter was evaluated for its correlation with the liver biopsy (Gold Standard). Candidate predictors with good interobserver agreement and correlation with histological stages were combined into two algorithms (NISF) to predict fibrosis in chronic viral hepatitis and NAFLD.
The CH-NISF included six parameters: bluntness of liver edges, irregularity of left lobe surface, diameter of segment 4, liver stiffness measurement, platelet count and ALT values. The ability of the model to discriminate F3-F4 vs F0-F1 stages and F2 vs F0-F1 was high (AUROC of 0.95 and 0.83 respectively) and better than FibroScan alone, especially in intermediate stages (F2 vs F0-F1), AUROC 0.83 vs 0.57 (P = 0.003). The resulting algorithm is available as mathematical formula, nomogram or free online link. [http://health.mafservizi.it/NISF_Calculator/liver.htm] The NAFLD-NISF included liver stiffness, platelet count and AST levels, had good ability to discriminate F0-F1 vs F2-F3-F4 stages (AUROC 0.86), however, not significantly higher than FibroScan.
CH-NISF can be proposed as preliminary and easily available staging tool, superior to FibroScan alone in predicting histological fibrosis, especially in intermediate stages. Further validations are needed to improve NISF accuracy in NAFLD.
我们精心制定了一种肝纤维化无创评分系统（NISF），探讨其诊断性能，并将其准确性与FibroScan在慢性病毒性肝炎（CH）和非酒精性脂肪性肝病（NAFLD）患者中的准确性进行比较。
前瞻性收集了因肝纤维化评估而接受肝活检的CH患者（n = 83）或NAFLD患者（n = 58）的临床、生化、弹性成像和超声参数，作为纤维化的潜在预测指标。评估每个参数与肝活检（金标准）的相关性。将具有良好观察者间一致性且与组织学分期相关的候选预测指标组合成两种算法（NISF），以预测慢性病毒性肝炎和NAFLD中的纤维化。
CH-NISF包括六个参数：肝边缘钝度、左叶表面不规则度、4段直径、肝脏硬度测量值、血小板计数和ALT值。该模型区分F3-F4与F0-F1期以及F2与F0-F1期的能力较高（AUC分别为0.95和0.83），且优于单独的FibroScan，尤其是在中期（F2与F0-F1），AUC为0.83对0.57（P = 0.003）。所得算法可作为数学公式、列线图或免费在线链接获取。[http://health.mafservizi.it/NISF_Calculator/liver.htm] NAFLD-NISF包括肝脏硬度、血小板计数和AST水平，具有良好的区分F0-F1与F2-F3-F4期的能力（AUC 0.86），然而，并不显著高于FibroScan。
CH-NISF可作为一种初步且易于获得的分期工具，在预测组织学纤维化方面优于单独的FibroScan，尤其是在中期。需要进一步验证以提高NISF在NAFLD中的准确性。
