Eguchi Yuichiro, Wong Gabriel, Akhtar Omar, Sumida Yoshio
Liver Center, Saga University Hospital, Saga, Japan.
Gilead Sciences, Foster City, California, USA.
Hepatol Res. 2020 Jun;50(6):645-655. doi: 10.1111/hepr.13502. Epub 2020 May 15.
Despite the invasive nature of liver biopsy, it remains the current standard for diagnosing non-alcoholic steatohepatitis (NASH) and fibrosis staging. Given the rising prevalence of non-alcoholic fatty liver disease (NAFLD) in Japan, there is a need for reliable non-invasive tests to accurately and efficiently identify NASH and advanced (F3/F4) fibrosis. A review of published works from English and Japanese sources was undertaken in PubMed, Embase, and Ichushi Web to identify studies reporting diagnostic characteristics of NITs in biopsy-proven Japanese NAFLD/NASH patients including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and area under the receiver operating characteristic curve. The performance of non-invasive tests for two diagnostic questions were assessed, namely: (i) identifying NASH cases among NAFLD; and (ii) distinguishing advanced fibrosis (F3-4) from milder fibrosis (F0-2). Twenty-five studies reported outcomes for serum biomarkers, imaging, scoring systems, and novel complex techniques (based on multivariable regression models) for both diagnostic questions. Serum biomarkers were the most commonly assessed method for NASH identification, whereas scoring systems and imaging techniques were most commonly studied for fibrosis staging. In general, tests for NASH identification showed higher PPVs than NPVs, suggesting their usefulness in identifying probable NASH cases. The reverse was observed for fibrosis staging, with higher NPVs than PPVs, suggesting their use in excluding patients at low risk of F3/F4 disease rather than identifying definite F3/F4 fibrosis. In Japanese studies, simple scoring systems and imaging techniques showed particular usefulness in prediction of fibrosis staging, and combinations of serum biomarkers showed diagnostic potential for NASH screening.
尽管肝活检具有侵入性，但它仍是目前诊断非酒精性脂肪性肝炎（NASH）和纤维化分期的标准方法。鉴于日本非酒精性脂肪性肝病（NAFLD）的患病率不断上升，需要可靠的非侵入性检测方法来准确、高效地识别NASH和晚期（F3/F4）纤维化。我们在PubMed、Embase和Ichushi Web上对英文和日文来源的已发表文献进行了综述，以确定报告活检证实的日本NAFLD/NASH患者中非侵入性检测（NITs）诊断特征的研究，包括敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）以及受试者操作特征曲线下面积。评估了非侵入性检测针对两个诊断问题的性能，即：（i）在NAFLD中识别NASH病例；（ii）区分晚期纤维化（F3 - 4）和轻度纤维化（F0 - 2）。25项研究报告了血清生物标志物、影像学、评分系统和新型复杂技术（基于多变量回归模型）针对这两个诊断问题的结果。血清生物标志物是识别NASH最常用的评估方法，而评分系统和影像学技术是纤维化分期研究最常用的方法。总体而言，识别NASH的检测方法显示出的PPV高于NPV，表明它们在识别可能的NASH病例方面有用。纤维化分期则相反，NPV高于PPV，表明它们用于排除F3/F4疾病低风险患者，而非识别明确的F3/F4纤维化。在日本的研究中，简单的评分系统和影像学技术在预测纤维化分期方面显示出特别的有用性，血清生物标志物组合在NASH筛查中显示出诊断潜力。
