Loong Thomson Chi-Wang, Wei Jeremy Lok, Leung Jonathan Chung-Fai, Wong Grace Lai-Hung, Shu Sally She-Ting, Chim Angel Mei-Ling, Chan Anthony Wing-Hung, Choi Paul Cheung-Lung, Tse Yee-Kit, Chan Henry Lik-Yuen, Wong Vincent Wai-Sun
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong.
State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong.
J Gastroenterol Hepatol. 2017 Jul;32(7):1363-1369. doi: 10.1111/jgh.13671.
The FibroMeter vibration-controlled transient elastography (FM VCTE) is a new formula combining the serum test FM and liver stiffness measurement (LSM) by VCTE. We tested the accuracy and utility of FM VCTE for fibrosis staging in patients with non-alcoholic fatty liver disease (NAFLD).
Two hundred fifteen NAFLD patients with LSM, FM NAFLD, FM VCTE, and other serum tests (aspartate aminotransferase-to-platelet ratio index, fibrosis-4 index, BARD score, NAFLD fibrosis score, and aspartate aminotransferase-to-alanine aminotransferase ratio) performed 1 day before liver biopsy were evaluated.
Sixty-nine (32.1%) and 43 (20.0%) patients had F2-4 and F3-4, respectively. LSM had higher diagnostic accuracy (area under receiver-operating characteristics curves [AUROC] 0.851 for F2-4, 0.940 for F3-4; Obuchowski index 0.937 ± 0.007) than all evaluated serum tests, while FM NAFLD was the most accurate serum test (AUROC 0.775 and 0.774; Obuchowski index 0.891 ± 0.013). FM VCTE had similar accuracy to LSM (AUROC 0.855 and 0.901; Obuchowski index 0.927 ± 0.009). LSM had excellent negative predictive values of 92.4% and 99.2% to exclude F2-4 and F3-4, but the positive predictive values (PPV) were only 71.4% and 61.0%, respectively. In patients with high LSM, the use of FM VCTE improved the PPV from 71.4% to 84.4% for F2-4 and from 61.0% to 88.9% for F3-4. Liver biopsy could be spared in around 50-65% of patients.
Liver stiffness measurement alone can confidently exclude significant and advanced fibrosis in NAFLD patients. Using FM VCTE in patients with high liver stiffness can increase the positive predictive value to rule in F2-4 and F3-4.
FibroMeter振动控制瞬时弹性成像（FM VCTE）是一种将血清检测指标FM与通过VCTE进行的肝脏硬度测量（LSM）相结合的新公式。我们测试了FM VCTE在非酒精性脂肪性肝病（NAFLD）患者纤维化分期中的准确性和实用性。
对215例在肝活检前1天进行了LSM、FM NAFLD、FM VCTE及其他血清检测（天冬氨酸转氨酶与血小板比值指数、纤维化-4指数、BARD评分、NAFLD纤维化评分以及天冬氨酸转氨酶与丙氨酸转氨酶比值）的NAFLD患者进行了评估。
分别有69例（32.1%）和43例（20.0%）患者存在F2-4和F3-4纤维化。LSM的诊断准确性高于所有评估的血清检测指标（F2-4的受试者操作特征曲线下面积[AUROC]为0.851，F3-4为0.940；Obuchowski指数为0.937±0.007），而FM NAFLD是最准确的血清检测指标（AUROC分别为0.775和0.774；Obuchowski指数为0.891±0.013）。FM VCTE的准确性与LSM相似（AUROC分别为0.855和0.901；Obuchowski指数为0.927±0.009）。LSM在排除F2-4和F3-4纤维化方面具有出色的阴性预测值，分别为92.4%和99.2%，但阳性预测值（PPV）分别仅为71.4%和61.0%。在LSM值较高的患者中，使用FM VCTE可将F2-4的PPV从71.4%提高至84.4%，将F3-4的PPV从61.0%提高至88.9%。约50%-65%的患者可避免进行肝活检。
单独的肝脏硬度测量能够可靠地排除NAFLD患者的显著和晚期纤维化。在肝脏硬度较高的患者中使用FM VCTE可提高诊断F2-4和F3-4纤维化的阳性预测值。
