Laboratory of Epidemiology and Biostatistics, National Institute of Gastroenterology, "Saverio de Bellis" Research Hospital, Castellana Grotte, Bari, Italy.
Scientific and Ethical Committee, University Hospital Policlinico, Bari, Italy.
Liver Int. 2019 Jan;39(1):187-196. doi: 10.1111/liv.13970. Epub 2018 Oct 22.
BACKGROUND & AIMS: The use of ultrasound scan (US) in non-alcoholic fatty liver disease (NAFLD) screening overloads US waiting lists. We hypothesized and tested a hybrid two-step method, consisting of applying a formula, to exclude subjects at low risk, before US.
The sample included 2970 males and females (937 with NAFLD) diagnosed by US. We selected eight formulas: Fatty Liver Index (FLI), Hepatic Steatosis Index (HIS), body mass index (BMI), waist circumference (WC), Abdominal Volume Index (AVI), waist-to-height ratio (WHtR), waist/height (WHT.5R) and Body Roundness Index (BRI), and calculated their performance in the two-step method evaluating percentage reduction of the number of liver US (US reduction percentage), percentage of false negative and percentage of NAFLD identified.
The US reductions percentage were 52.2% (WHtR), 52.1% (HIS), 51.8% (FLI), 50.8% (BRI), 50.7% (BMI and WHt_5R), 46.5% (WC) and 45.2% (AVI). The false negative percentage were 8.5% (WHtR), 7.9% (BRI), 7.3% (WHt_5R), 7.2% (BMI), 6.7% (HIS), 6.6% (FLI), 5.6% (WC) and 5.2% (AVI). The best percentage of NALFD identified was obtained using AVI (83.6%) before US, then WC (82.2%), FLI (79%), HIS (78.9%), BMI (77.3%), WHt_5R (76.9%), BRI (74.8%) and WHtR (73%).
The best formula to use in two-step diagnostic NAFLD screening was AVI, which showed a low false negative rate and a higher percentage of identified NAFLD. Other studies evaluating the economic advantages of this screening method are warranted.
在非酒精性脂肪性肝病（NAFLD）筛查中使用超声扫描（US）会使 US 候补名单过载。我们假设并测试了一种混合两步法，该方法包括应用公式，在 US 之前排除低风险的受试者。
该样本包括 2970 名男性和女性（937 名患有 NAFLD），这些患者均通过 US 诊断。我们选择了八个公式：脂肪肝指数（FLI）、肝脂肪变性指数（HIS）、体重指数（BMI）、腰围（WC）、腹部体积指数（AVI）、腰高比（WHtR）、腰围/身高（WHT.5R）和体圆度指数（BRI），并计算了它们在两步法中的性能，评估了肝 US 数量减少的百分比（US 减少百分比）、假阴性百分比和识别的 NAFLD 百分比。
US 减少百分比分别为 52.2%（WHtR）、52.1%（HIS）、51.8%（FLI）、50.8%（BRI）、50.7%（BMI 和 WHt_5R）、46.5%（WC）和 45.2%（AVI）。假阴性百分比分别为 8.5%（WHtR）、7.9%（BRI）、7.3%（WHt_5R）、7.2%（BMI）、6.7%（HIS）、6.6%（FLI）、5.6%（WC）和 5.2%（AVI）。在 US 之前，使用 AVI（83.6%）可以获得最佳的 NAFLD 识别百分比，然后是 WC（82.2%）、FLI（79%）、HIS（78.9%）、BMI（77.3%）、WHt_5R（76.9%）、BRI（74.8%）和 WHtR（73%）。
用于两步诊断 NAFLD 筛查的最佳公式是 AVI，它显示出较低的假阴性率和较高的 NAFLD 识别百分比。需要进行其他研究来评估这种筛查方法的经济优势。
