School of Medicine, Marmara University, Istanbul, Turkey.
Institute of Gastroenterology, Marmara University, Istanbul, Turkey.
Acta Diabetol. 2020 May;57(5):613-618. doi: 10.1007/s00592-019-01467-7. Epub 2020 Jan 2.
BACKGROUND/AIM: Simple noninvasive fibrosis scores based on routine blood tests have been increasingly investigated as screening tools in different clinical settings. Here, we sought to examine whether the Fibrosis-4 Index (FIB-4) and the non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) could perform differently in diabetic versus non-diabetic patients with biopsy-proven NAFLD.
We examined 349 patients with biopsy-proven NAFLD (166 with type 2 diabetes and 183 without). Patients with FIB-4 scores < 1.3 and > 2.67 or NFS scores < - 1.455 and > 0.676 were considered at low and high risk of advanced fibrosis, respectively.
A FIB-4 cutoff value of 1.3-which denotes a low risk of advanced fibrosis-had a specificity of 67% in patients with diabetes and 69% in those without. Conversely, a FIB-4 cutoff value of 2.67-which denotes a high risk of advanced fibrosis-had a sensitivity of 22% in patients with diabetes and 0% in those without. NFS performed similar to FIB-4.
Both FIB-4 and NFS scores have an acceptable clinical utility in the exclusion of advanced fibrosis in patients with NAFLD, regardless of the presence of type 2 diabetes. However, their usefulness in identifying advanced fibrosis is limited-especially in the absence of diabetes.
背景/目的：基于常规血液检测的简单非侵入性纤维化评分已在不同临床环境中作为筛查工具得到越来越多的研究。在这里，我们试图研究纤维化-4 指数 (FIB-4) 和非酒精性脂肪性肝病 (NAFLD) 纤维化评分 (NFS) 是否在有活检证实的 NAFLD 的糖尿病与非糖尿病患者中表现不同。
我们检查了 349 名有活检证实的 NAFLD 患者（166 名 2 型糖尿病，183 名非糖尿病）。FIB-4 评分 < 1.3 和 > 2.67 或 NFS 评分 < -1.455 和 > 0.676 的患者分别被认为处于低危和高危进展性纤维化状态。
FIB-4 截断值为 1.3-表示进展性纤维化的低风险-在糖尿病患者中的特异性为 67%，在非糖尿病患者中的特异性为 69%。相反，FIB-4 截断值为 2.67-表示进展性纤维化的高风险-在糖尿病患者中的敏感性为 22%，在非糖尿病患者中的敏感性为 0%。NFS 的表现与 FIB-4 相似。
无论是否存在 2 型糖尿病，FIB-4 和 NFS 评分在排除 NAFLD 患者的进展性纤维化方面均具有可接受的临床实用性。然而，它们在识别进展性纤维化方面的作用有限-尤其是在没有糖尿病的情况下。
