Itoh Yoshito, Seko Yuya, Shima Toshihide, Nakajima Tomoaki, Mizuno Kei, Kawamura Yusuke, Akuta Norio, Ito Kiyoaki, Kawanaka Miwa, Hiramatsu Akira, Sakamoto Michiie, Harada Kenichi, Goto Yoshihito, Nakayama Takeo, Kumada Hiromitsu, Okanoue Takeshi
Department of Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
Department of Gastroenterology and Hepatology, Saiseikai Suita Hospital, Suita, Japan.
Hepatol Res. 2018 Dec;48(13):1099-1107. doi: 10.1111/hepr.13226. Epub 2018 Aug 6.
Hepatic fibrosis is the most important factor for estimating the prognosis of patients with non-alcoholic fatty liver disease (NAFLD). A novel non-invasive scoring system, the FM-fibro index, showed high accuracy in a pilot study. The purpose of this study was to validate the efficacy of the FM-fibro index in a multicenter cohort.
Among 18 institutions, we analyzed 400 Japanese patients with biopsy-proven NAFLD. We evaluated the accuracies of the FM-fibro index, CA-fibro index, and European Liver Fibrosis (ELF) panel by area under the receiver operator characteristics curves (AUROC). The FM-fibro index includes three formulas for type IV collagen 7S, hyaluronic acid, and vascular cell adhesion molecule-1.
Among 400 patients, 205 were women, and the median age was 56 years. The histological distribution of Matteoni types 1, 2, 3, and 4 was 11, 40, 15, and 334, and the distribution of hepatic fibrosis stages 0 to 4 was 67, 183, 55, 63, and 32, respectively. The AUROCs of the FM-fibro index, CA-fibro index, and ELF panel for non-alcoholic steatohepatitis (NASH)-related fibrosis were 0.7178/0.7095/0.7065, 0.7093, and 0.7245, respectively. The sensitivity and specificity of the FM-fibro index for predicting NASH-related fibrosis was 0.5359/0.5210/0.4641 and 0.8333/0.8182/0.8788, respectively. The accuracy of the FM-fibro index was not significantly different from that of the CA-fibro index or the ELF panel.
The FM-fibro index can predict NASH-related fibrosis with sufficient accuracy compared with previous scoring systems. Further analyses that verify the accuracy of the FM-fibro index to distinguish significant or advanced fibrosis in patients with NAFLD are awaited. (UMIN-CTR: UMIN000018158).
肝纤维化是评估非酒精性脂肪性肝病（NAFLD）患者预后的最重要因素。一种新型非侵入性评分系统，即FM-纤维化指数，在一项初步研究中显示出较高的准确性。本研究的目的是在多中心队列中验证FM-纤维化指数的有效性。
在18家机构中，我们分析了400例经活检证实为NAFLD的日本患者。我们通过受试者操作特征曲线下面积（AUROC）评估了FM-纤维化指数、CA-纤维化指数和欧洲肝纤维化（ELF）检测板的准确性。FM-纤维化指数包括针对IV型胶原7S、透明质酸和血管细胞粘附分子-1的三个公式。
400例患者中，205例为女性，中位年龄为56岁。Matteoni 1、2、3和4型的组织学分布分别为11、40、15和334例，肝纤维化0至4期的分布分别为67、183、55、63和32例。FM-纤维化指数、CA-纤维化指数和ELF检测板用于非酒精性脂肪性肝炎（NASH）相关纤维化的AUROC分别为0.7178/0.7095/0.7065、0.7093和0.7245。FM-纤维化指数预测NASH相关纤维化的敏感性和特异性分别为0.5359/0.5210/0.4641和0.8333/0.8182/0.8788。FM-纤维化指数的准确性与CA-纤维化指数或ELF检测板的准确性无显著差异。
与先前的评分系统相比，FM-纤维化指数能够以足够的准确性预测NASH相关纤维化。期待进一步分析以验证FM-纤维化指数在区分NAFLD患者显著或重度纤维化方面的准确性。（UMIN-CTR：UMIN000018158）
