Patel Preya J, Banh Xuan, Horsfall Leigh U, Hayward Kelly L, Hossain Fabrina, Johnson Tracey, Stuart Katherine A, Brown Nigel N, Saad Nivene, Clouston Andrew, Irvine Katharine M, Russell Anthony W, Valery Patricia C, Williams Suzanne, Powell Elizabeth E
Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine and Biomedical Science, The University of Queensland, Brisbane, Queensland, Australia.
Intern Med J. 2018 Feb;48(2):144-151. doi: 10.1111/imj.13667.
Non-alcoholic fatty liver disease (NAFLD) is a common cause of incidental liver test abnormalities. General practitioners (GP) have a key role in identifying people with NAFLD at risk of significant liver disease. Recent specialist guidelines emphasise the use of fibrosis algorithms or serum biomarkers rather than routine liver tests, to assess advanced fibrosis.
To evaluate primary care clinicians' current approach to diagnosis, management and referral of NAFLD.
A cross-sectional survey of primary care clinicians was undertaken through a structured questionnaire about NAFLD. A convenience sample of general practice clinics and general practice conferences in Metropolitan Brisbane and regional south east Queensland was selected.
A total of 108 primary care clinicians completed the survey (participation rate 100%). Fifty-one percent of respondents considered the prevalence of NAFLD in the general population to be ≤10%. Twenty-four percent of respondents felt that liver enzymes were sufficiently sensitive to detect underlying NAFLD. Most respondents were unsure whether the Fibrosis 4 score (62.7% unsure) or Enhanced Liver Fibrosis score (63.7% unsure) could help to identify advanced fibrosis or cirrhosis. Although 47% of respondents said they would refer a patient to a Gastroenterologist/Hepatologist if they suspect the patient has NAFLD, 44.1% do not make any referrals. Of concern, 70.6% of clinicians said they were unlikely to refer a patient to Hepatology unless liver function tests are abnormal.
Our findings demonstrate that many primary care clinicians underestimate the prevalence of NAFLD and under-recognise the clinical spectrum of NAFLD and how this is assessed.
非酒精性脂肪性肝病（NAFLD）是偶然发现的肝功能检查异常的常见原因。全科医生（GP）在识别有严重肝病风险的NAFLD患者方面起着关键作用。最近的专家指南强调使用纤维化算法或血清生物标志物而非常规肝功能检查来评估肝纤维化进展。
评估基层医疗临床医生目前对NAFLD的诊断、管理和转诊方法。
通过一份关于NAFLD的结构化问卷对基层医疗临床医生进行横断面调查。选取了布里斯班都会区和昆士兰州东南部地区的全科诊所和全科医学会议作为便利样本。
共有108名基层医疗临床医生完成了调查（参与率100%）。51%的受访者认为普通人群中NAFLD的患病率≤10%。24%的受访者认为肝酶对检测潜在的NAFLD足够敏感。大多数受访者不确定纤维化4评分（62.7%不确定）或增强肝纤维化评分（63.7%不确定）是否有助于识别肝纤维化进展或肝硬化。尽管47%的受访者表示，如果怀疑患者患有NAFLD，他们会将患者转诊给胃肠病学家/肝病学家，但44.1%的人不会进行任何转诊。令人担忧的是，70.6%的临床医生表示，除非肝功能检查异常，否则他们不太可能将患者转诊至肝病科。
我们的研究结果表明，许多基层医疗临床医生低估了NAFLD的患病率，未充分认识到NAFLD的临床谱及其评估方法。
