评价和比较六种非侵入性检测用于预测非酒精性脂肪性肝病中显著或晚期纤维化。
Evaluation and comparison of six noninvasive tests for prediction of significant or advanced fibrosis in nonalcoholic fatty liver disease.
机构信息
Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
Department of Visceral Surgery and Medicine, University Hospital Bern, Bern, Switzerland.
出版信息
United European Gastroenterol J. 2019 Oct;7(8):1113-1123. doi: 10.1177/2050640619865133. Epub 2019 Jul 12.
BACKGROUND
In nonalcoholic fatty liver disease (NAFLD), advanced fibrosis has been identified as an important prognostic factor with increased liver-related mortality and treatment need. Due to the high prevalence of NAFLD, noninvasive risk stratification is needed to select patients for liver biopsy and treatment.
OBJECTIVE
To compare the diagnostic accuracy of several widely available noninvasive tests for assessment of fibrosis among patients with NAFLD with or without nonalcoholic steatohepatitis (NASH).
METHODS
We enrolled consecutive patients with NAFLD admitted to two Austrian referral centers who underwent liver biopsy. Liver stiffness measurement (LSM) was obtained by vibration-controlled transient elastography (VCTE, FibroScan) and blood samples were collected for determination of enhanced liver fibrosis (ELF) test, FibroMeter, FibroMeter, NAFLD fibrosis score (NFS), and fibrosis-4 index (FIB-4).
RESULTS
Our study cohort contained 186 patients with histologically confirmed NAFLD. On liver histology, NASH was present in 92 patients (50%), significant fibrosis (F ≥ 2) in 71 patients (38%), advanced fibrosis (F ≥ 3) in 49 patients (26%), and F ≥ 3 plus NASH in 35 patients (19%). For diagnosis of F ≥ 2, F ≥ 3, and F ≥ 3 plus NASH, respectively, receiver operating characteristic (ROC) analysis revealed superior diagnostic accuracy of ELF score (area under ROC curve (AUROC) 0.85, 0.90, 0.90), FibroMeter (AUROC 0.86, 0.88, 0.89), FibroMeter (AUROC 0.84, 0.88, 0.88), and LSM per protocol (AUROC 0.87, 0.95, 0.91) versus FIB-4 (AUROC 0.80, 0.82, 0.81) or NFS (AUROC 0.78, 0.80, 0.79).
CONCLUSION
Proprietary fibrosis panels and VCTE show superior diagnostic accuracy for noninvasive diagnosis of fibrosis stage in NAFLD as compared to FIB-4 and NFS.
背景
在非酒精性脂肪性肝病（NAFLD）中，已确定晚期纤维化是一个重要的预后因素，与肝脏相关死亡率和治疗需求增加有关。由于 NAFLD 的高患病率，需要进行非侵入性风险分层，以选择接受肝活检和治疗的患者。
目的
比较几种广泛应用的非侵入性检测方法在评估伴有或不伴有非酒精性脂肪性肝炎（NASH）的 NAFLD 患者纤维化程度方面的诊断准确性。
方法
我们纳入了在奥地利两个转诊中心就诊的连续确诊为 NAFLD 的患者，这些患者均接受了肝活检。采用振动控制瞬时弹性成像（VCTE，FibroScan）获得肝脏硬度值（LSM），并采集血样以确定增强型肝纤维化（ELF）检测、FibroMeter、FibroMeter、NAFLD 纤维化评分（NFS）和纤维化-4 指数（FIB-4）。
结果
我们的研究队列包含 186 例经组织学证实的 NAFLD 患者。在肝组织学上，92 例（50%）患者存在 NASH，71 例（38%）患者存在显著纤维化（F≥2），49 例（26%）患者存在晚期纤维化（F≥3），35 例（19%）患者存在 F≥3 且伴有 NASH。对于 F≥2、F≥3 和 F≥3 且伴有 NASH 的诊断，分别进行了受试者工作特征（ROC）分析，结果显示 ELF 评分（ROC 曲线下面积（AUROC）为 0.85、0.90、0.90）、FibroMeter（AUROC 为 0.86、0.88、0.89）、FibroMeter（AUROC 为 0.84、0.88、0.88）和按方案的 LSM（AUROC 为 0.87、0.95、0.91）的诊断准确性优于 FIB-4（AUROC 为 0.80、0.82、0.81）或 NFS（AUROC 为 0.78、0.80、0.79）。
结论
与 FIB-4 和 NFS 相比，专用纤维化检测面板和 VCTE 显示出在诊断 NAFLD 纤维化分期方面具有更高的诊断准确性。
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