Department of Gastroenterology, North Medical Center of Kyoto Prefectural University of Medicine, Yosanocho, Japan.
Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
J Gastroenterol. 2018 Nov;53(11):1216-1224. doi: 10.1007/s00535-018-1474-y. Epub 2018 May 9.
The FIB4 index is clinically useful, but because its formula includes age, the appropriate cutoff point may differ by age group. Here, new FIB4 index cutoff points were validated using cohort data from 14 hepatology centers in Japan.
The FIB4 index was determined in biopsy-confirmed NAFLD patients (n = 1050) who were divided into four groups: ≤ 49, 50-59, 60-69, and ≥ 70 years. ROC analysis predicted advanced fibrosis in each age group; low and high cutoff points were defined by a sensitivity and specificity of 90%. The new and conventional cutoffs were compared for detecting advanced fibrosis.
The modified low and high cutoff points were 1.05 and 1.21 in ≤ 49 years, 1.24 and 1.96 in 50-59 years, 1.88 and 3.24 in 60-69 years, and 1.95 and 4.56 in ≥ 70 years. In ≥ 60 years, the false-negative rate was increased using the modified high cutoff point, and the high cutoff point was better with the conventional cutoff point. The new proposed low and high cutoff points are 1.05 and 1.21 in ≤ 49 years, 1.24 and 1.96 in 50-59 years, 1.88 and 2.67 in 60-69 years, and 1.95 and 2.67 in ≥ 70 years; these cutoff points improved the accuracy of advanced fibrosis diagnosis.
FIB4 index cutoff points for predicting advanced fibrosis in NAFLD increased with age. Cutoff points modified by age improved the diagnostic accuracy of estimations of advanced liver fibrosis using the FIB4 index.
FIB4 指数具有临床应用价值，但因其公式中包含年龄因素，故不同年龄组的最佳截断点可能不同。本研究使用来自日本 14 个肝病中心的队列数据对新的 FIB4 指数截断点进行了验证。
对经肝活检证实的非酒精性脂肪性肝病（NAFLD）患者（n=1050）进行 FIB4 指数测定，并将其分为 4 组：≤49 岁、50-59 岁、60-69 岁和≥70 岁。在每个年龄组中，通过 ROC 分析预测进展性纤维化；低和高截断点的定义为敏感性和特异性分别为 90%。比较新和传统截断值检测进展性纤维化的能力。
≤49 岁、50-59 岁、60-69 岁和≥70 岁的改良低和高截断点分别为 1.05 和 1.21、1.24 和 1.96、1.88 和 3.24、1.95 和 4.56。在≥60 岁的患者中，使用改良的高截断点会增加假阴性率，而使用传统截断点则效果更好。新提出的低和高截断点分别为≤49 岁 1.05 和 1.21、50-59 岁 1.24 和 1.96、60-69 岁 1.88 和 2.67、≥70 岁 1.95 和 2.67；这些截断点提高了诊断进展性肝纤维化的准确性。
预测 NAFLD 患者进展性纤维化的 FIB4 指数截断点随年龄增加而增加。通过年龄修正的截断点可提高 FIB4 指数评估进展性肝纤维化的诊断准确性。
