非侵入性脂肪变性、NASH 和肝纤维化标志物在有非酒精性脂肪性肝病 (NAFLD) 风险的 HIV 单感染个体中的诊断准确性：ECHAM 研究结果。
Diagnostic Accuracy of Noninvasive Markers of Steatosis, NASH, and Liver Fibrosis in HIV-Monoinfected Individuals at Risk of Nonalcoholic Fatty Liver Disease (NAFLD): Results From the ECHAM Study.
机构信息
Liver Unit, Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, United Kingdom.
Institut Pierre Louis d'Épidémiologie et de Santé Publique (IPLESP), INSERM, Sorbonne Université, Paris, France.
出版信息
J Acquir Immune Defic Syndr. 2019 Apr 1;80(4):e86-e94. doi: 10.1097/QAI.0000000000001936.
BACKGROUND
HIV-monoinfected individuals are at high risk of nonalcoholic fatty liver disease. Noninvasive tests of steatosis, nonalcoholic steatohepatitis (NASH), and fibrosis have been poorly assessed in this population. Using liver biopsy (LB) as a reference, we assessed the accuracy of noninvasive methods for their respective diagnosis: magnetic resonance imaging proton-density-fat-fraction (MRI-PDFF), FibroScan/controlled attenuation parameter (CAP), and biochemical tests.
METHODS
We enrolled antiretroviral therapy-controlled participants with persistently elevated transaminases and/or metabolic syndrome, and/or lipodystrophy. All had hepatic MRI-PDFF, FibroScan/CAP, FibroTest/NashTest/SteatoTest, APRI, FIB-4, and nonalcoholic fatty liver disease-fibrosis score. A LB was indicated if suspected significant fibrosis (FibroScan ≥7.1 kPa and/or FibroTest ≥0.49). Performance was considered as good if area under a receiver operating characteristic curves (AUROCs) was >0.80.
RESULTS
Among the 140 patients with suspected significant fibrosis out of the 402 eligible patients, 49 had had a LB: median age of 54 years (53-65), body mass index: 26 kg/m (24-30), steatosis in 37 (76%), NASH in 23 (47%), and fibrosis in 31 (63%) patients [F2: 7 (14%); F3: 6 (12%); and F4: 2 (4%)]. Regarding steatosis, MRI-PDFF had excellent and CAP good performances with AUROCs at 0.98 (95% confidence interval: 0.96 to 1.00) and 0.88 (0.76 to 0.99), respectively, whereas the AUROCs of SteatoTest was 0.68 (0.51 to 0.85). Regarding fibrosis (≥F2), APRI and FIB-4 had good performance with AUROCs at 0.86 (0.74 to 0.98) and 0.81 (0.67 to 0.95). By contrast, FibroScan and FibroTest had poor AUROCs [0.61 (0.43 to 0.79) and 0.61 (0.44 to 0.78)], with very low specificity. Regarding NASH, alanine aminotransferase ≥36 IU/L had good performance with AUROCs of 0.83 (0.71 to 0.94), whereas the NashTest had an AUROC of 0.60 (0.44 to 0.76).
CONCLUSIONS
In HIV-monoinfected patients, MRI-PDFF and FibroScan/CAP are highly accurate for the diagnosis of steatosis. The alanine aminotransferase level and APRI should be considered for the detection of NASH and fibrosis.
背景
HIV 单一感染者患非酒精性脂肪性肝病的风险很高。这些人群中非侵入性的脂肪变性、非酒精性脂肪性肝炎（NASH）和纤维化检测效果不佳。本研究以肝活检（LB）作为参考，评估了非侵入性方法在各自诊断中的准确性：磁共振成像质子密度脂肪分数（MRI-PDFF）、FibroScan/受控衰减参数（CAP）和生化检测。
方法
我们招募了接受抗逆转录病毒治疗后持续转氨酶升高和/或代谢综合征和/或脂肪营养不良的患者。所有患者均进行了肝脏 MRI-PDFF、FibroScan/CAP、FibroTest/NashTest/SteatoTest、APRI、FIB-4 和非酒精性脂肪性肝病纤维化评分检测。如果怀疑有显著纤维化（FibroScan≥7.1 kPa 和/或 FibroTest≥0.49），则需要进行 LB。如果受试者工作特征曲线（AUROC）下面积（AUROCs）>0.80，则认为性能良好。
结果
在 402 名符合条件的患者中，有 140 名疑似存在显著纤维化，其中 49 名进行了 LB：中位年龄为 54 岁（53-65），体重指数为 26 kg/m（24-30），37 名患者存在脂肪变性（76%），23 名患者存在 NASH（47%），31 名患者存在纤维化（63%）[F2：7（14%）；F3：6（12%）；F4：2（4%）]。在评估脂肪变性时，MRI-PDFF 和 CAP 的表现均极佳，AUROCs 分别为 0.98（95%置信区间：0.96 至 1.00）和 0.88（0.76 至 0.99），而 SteatoTest 的 AUROC 为 0.68（0.51 至 0.85）。在评估纤维化（≥F2）时，APRI 和 FIB-4 的 AUROCs 分别为 0.86（0.74 至 0.98）和 0.81（0.67 至 0.95），表现良好。相比之下，FibroScan 和 FibroTest 的 AUROCs 较低[0.61（0.43 至 0.79）和 0.61（0.44 至 0.78）]，特异性很低。在评估 NASH 时，丙氨酸氨基转移酶（ALT）≥36 IU/L 时 AUROCs 为 0.83（0.71 至 0.94），而 NashTest 的 AUROC 为 0.60（0.44 至 0.76）。
结论
在 HIV 单一感染者中，MRI-PDFF 和 FibroScan/CAP 对脂肪变性的诊断具有高度准确性。ALT 水平和 APRI 应考虑用于检测 NASH 和纤维化。
Zotero 插件