Kim Mimi, Jun Dae Won, Park Huiyul, Kang Bo-Kyeong, Sumida Yoshio
Department of Radiology, Hanyang University College of Medicine, Seoul 04763, Korea.
Department of Internal Medicine, Hanyang University College of Medicine, Seoul 04763, Korea.
J Clin Med. 2020 Apr 14;9(4):1119. doi: 10.3390/jcm9041119.
The fibrosis-4 (FIB-4) index is the most widely used estimated formula to screen for advanced hepatic fibrosis; however, it has a considerable intermediate zone. Here, we propose an algorithm to reduce the intermediate zone and improve the diagnostic performance of screening for advanced liver fibrosis by incorporating Mac-2-binding protein glycan isomer (M2BPGi) into a FIB-4 based screening strategy in an average risk group. Four-hundred eighty-eight healthy and chronic liver disease subjects were analyzed using a 1:1 propensity score matched for age and sex. Advanced liver fibrosis (≥F3) was defined by magnetic resonance elastography (MRE, ≥3.6 kPa). Classification tree analysis was employed to improve diagnostic performance using a combination of the FIB-4 index and M2BPGi. The median serum M2BPGi levels of healthy subjects, patients without advanced fibrosis, and those with the condition were 0.48, 0.94, and 2.93, respectively. The area under the receiver operating characteristic (AUROC) curve of M2BPGi (0.918) for advanced fibrosis was the highest compared to those of the FIB-4 index (0.887), APRI (0.873), and AST/ALT ratio (0.794). When M2BPGi was incorporated following the FIB-4 index, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 87.1%, 82.5%, 54.0%, and 96.4%, respectively. Moreover, 74.3% (133/179) of cases in the intermediate zone of the FIB-4 index avoided unnecessary referrals. Two-step pathway (FIB-4 followed by M2BPGi) could reduce unnecessary referrals and/or liver biopsies in an average-risk population.
纤维化-4（FIB-4）指数是用于筛查晚期肝纤维化最广泛使用的估计公式；然而，它存在相当大的中间区域。在此，我们提出一种算法，通过将Mac-2结合蛋白聚糖异构体（M2BPGi）纳入基于FIB-4的平均风险组筛查策略中，以减少中间区域并提高晚期肝纤维化筛查的诊断性能。对488名健康和慢性肝病受试者进行年龄和性别1:1倾向评分匹配分析。晚期肝纤维化（≥F3）通过磁共振弹性成像（MRE，≥3.6 kPa）定义。采用分类树分析，结合FIB-4指数和M2BPGi来提高诊断性能。健康受试者、无晚期纤维化患者和有该病症患者的血清M2BPGi水平中位数分别为0.48、0.94和2.93。与FIB-4指数（0.887）、APRI（0.873）和AST/ALT比值（0.794）相比，M2BPGi用于晚期纤维化的受试者工作特征曲线下面积（AUROC）（0.918）最高。当在FIB-4指数之后纳入M2BPGi时，灵敏度、特异度、阳性预测值（PPV）和阴性预测值（NPV）分别为87.1%、82.5%、54.0%和96.4%。此外，FIB-4指数中间区域74.3%（133/179）的病例避免了不必要的转诊。两步法（先FIB-4再M2BPGi）可减少平均风险人群中不必要的转诊和/或肝活检。
