Drolz Andreas, Wehmeyer Malte, Diedrich Tom, Piecha Felix, Schulze Zur Wiesch Julian, Kluwe Johannes
1. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Deutschland.
Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Deutschland.
Z Gastroenterol. 2018 Jan;56(1):43-50. doi: 10.1055/s-0043-124956. Epub 2018 Jan 9.
Non-alcoholic fatty liver disease (NAFLD) has become one of the most frequent causes of chronic liver disease. Currently, therapeutic options for NAFLD patients are limited, but new pharmacologic agents are being investigated in the course of clinical trials. Because most of these studies are focusing on patients with fibrosis stages II and III (according to Kleiner), non-invasive identification of patients with intermediate fibrosis stages (II and III) is of increasing interest.
Evaluation of NAFLD Fibrosis Score (NFS) and liver stiffness measurement (LSM) for prediction of fibrosis stages II/III.
Patients with histologically confirmed NAFLD diagnosis were included in the study. All patients underwent a clinical and laboratory examination as well as a LSM prior to liver biopsy. Predictive value of NFS and LSM with respect to identification of fibrosis stages II/III was assessed.
134 NAFLD patients were included and analyzed. Median age was 53 (IQR 36 - 60) years, 55 patients (41 %) were female. 82 % of our patients were overweight/obese with typical aspects of metabolic syndrome. 84 patients (66 %) had liver fibrosis, 42 (50 %) advanced fibrosis. LSM and NFS correlated with fibrosis stage (r = 0.696 and r = 0.685, respectively; p < 0.01 for both). NFS values between -2.0 and + 0.5, and LSM values between 8 and 22kPa were associated with fibrosis stages II/III. If both criteria were met, probability of fibrosis stage II/III was 61 %. If none of the two criteria was met, chance for fibrosis stage II/III was only 6 % (negative predictive value 94 %).
Combination of LSM and NFS enables identification of patients with significant probability of fibrosis stage II/III. Accordingly, these tests, especially in combination, may be a suitable screening tool for fibrosis stages II/III in NAFLD. The use of these non-invasive methods might also help to avoid unnecessary biopsies.
非酒精性脂肪性肝病（NAFLD）已成为慢性肝病最常见的病因之一。目前，NAFLD患者的治疗选择有限，但新的药物正在临床试验过程中进行研究。由于这些研究大多集中在纤维化II期和III期（根据克莱纳分类）的患者，因此对处于中等纤维化阶段（II期和III期）患者的非侵入性识别越来越受到关注。
评估NAFLD纤维化评分（NFS）和肝脏硬度测量（LSM）对纤维化II/III期的预测价值。
组织学确诊为NAFLD的患者纳入本研究。所有患者在肝活检前均接受了临床和实验室检查以及LSM检查。评估NFS和LSM对识别纤维化II/III期的预测价值。
纳入并分析了134例NAFLD患者。中位年龄为53岁（四分位间距36 - 60岁），55例患者（41%）为女性。82%的患者超重/肥胖，具有代谢综合征的典型特征。84例患者（66%）有肝纤维化，42例（50%）有进展性纤维化。LSM和NFS与纤维化阶段相关（分别为r = 0.696和r = 0.685；两者p < 0.01）。NFS值在-2.0至+0.5之间，LSM值在8至22kPa之间与纤维化II/III期相关。如果两个标准都满足，纤维化II/III期的概率为61%。如果两个标准都不满足，纤维化II/III期的可能性仅为6%（阴性预测值94%）。
LSM和NFS联合使用能够识别具有显著纤维化II/III期可能性的患者。因此，这些检查，尤其是联合使用时，可以作为NAFLD患者纤维化II/III期的合适筛查工具。使用这些非侵入性方法也可能有助于避免不必要的活检。
