Department of Medicine and Rehabilitation, Policlinico Di Monza, Via Modigliani 10, 20900, Monza, MB, Italy.
Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Milan, Italy.
J Endocrinol Invest. 2020 Jul;43(7):1019-1026. doi: 10.1007/s40618-020-01188-7. Epub 2020 Feb 1.
The purpose of this study was to estimate how many individuals with severe obesity and NAFLD should be referred to hepatologists according to the EASL-EASD-EASO guidelines and whether the choice of specific indicators of liver fibrosis would significantly impact the number of referrals.
This was a single-center retrospective study of 495 individuals with severe obesity screened at our institution between 2012 and 2018 for a bariatric surgery intervention. The guidelines were applied using the NAFLD Liver Fat Score (NLFS) to assess the presence of steatosis and the NAFLD fibrosis score (NFS), Fibrosis-4 (FIB-4) and Hepamet Fibrosis Score (HFS) to assess the risk of advanced fibrosis.
Three hundred and seventy-nine patients (76.6%) had evidence of liver steatosis. The application of the guidelines would lead to referral of 66.3% of patients using NFS, 31.7% using FIB-4 and 34.2% using HFS. When referrals due to abnormal liver function tests were excluded, these percentages dropped to 55.8%, 7.3% and 12.1%, respectively. The strongest inter-biomarker agreement was found between FIB-4 and HFS (κ = 0.86, 95% CI 0.815-0.910).
Strict application of the guidelines in individuals with severe obesity would probably lead to over-referral, although a great variability exists among the different scores.
本研究旨在根据 EASL-EASD-EASO 指南估计应将多少名严重肥胖和非酒精性脂肪性肝病（NAFLD）患者转介给肝病专家，以及选择特定的肝纤维化指标是否会显著影响转介人数。
这是一项单中心回顾性研究，纳入了 2012 年至 2018 年在我院接受减重手术干预的 495 名严重肥胖患者。使用非酒精性脂肪性肝病肝脂肪评分（NLFS）评估脂肪变性的存在，使用 NAFLD 纤维化评分（NFS）、纤维化-4 指数（FIB-4）和 Hepamet 纤维化评分（HFS）评估进展性纤维化的风险。
379 例（76.6%）患者有肝脂肪变性的证据。应用指南将导致 66.3%的患者使用 NFS、31.7%的患者使用 FIB-4 和 34.2%的患者使用 HFS 转介。排除肝功能异常的转介后，这些百分比分别降至 55.8%、7.3%和 12.1%。FIB-4 和 HFS 之间的一致性最强（κ=0.86，95%CI 0.815-0.910）。
在严重肥胖患者中严格应用指南可能会导致过度转介，尽管不同评分之间存在很大差异。
