Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing Key Laboratory of Translational Medicine in Liver Cirrhosis, National Clinical Research Center of Digestive Diseases, Beijing, China.
J Dig Dis. 2020 May;21(5):279-286. doi: 10.1111/1751-2980.12868. Epub 2020 Jun 8.
We aimed to estimate the optimal cut-off values of liver stiffness measurement (LSM) for diagnosing and staging fibrosis in non-obese and obese patients with nonalcoholic fatty liver disease (NAFLD).
NAFLD patients diagnosed by liver biopsy according to the Nonalcoholic Steatohepatitis Clinical Research Network scoring system were enrolled in this study. Non-obesity was defined as a body mass index (BMI) less than 25 kg/m . LSM was performed by experienced physicians within 2 weeks before or after liver biopsy.
A total of 158 patients were included. Average BMI of the non-obese (n = 68) and obese (n = 90) groups was 23.2 ± 1.6 and 27.9 ± 2.5 kg/m , respectively. After adjusted for age, fibrosis stage, steatosis grade and type 2 diabetes mellitus, the obese group had a LSM of 3.522 kPa higher than the non-obese patients (P = 0.003). LSM values of the non-obese patients had a lower trend when stratified by fibrosis stage, especially in cirrhosis (F4; P = 0.021). Applying separate cut-off values for patients with NAFLD in individual fibrosis stage, 5.8 vs 7.5 kPa (≥ F1), 7.6 vs 8.5 kPa (≥ F2), 9.1 vs 11.2 kPa (≥ F3), and 12.5 vs 14.3 kPa (F4), improved their diagnostic odds ratios compared with overall cut-off values. In the non-obese NAFLD group, using a separate cut-off avoided underestimating 9.1% of patients with cirrhosis.
Non-obese NAFLD group had lower LSM than the obese group. Different cut-off values should be used to measure liver fibrosis stage in non-obese and obese NAFLD patients.
我们旨在评估肝硬度测量（LSM）在诊断和分期非肥胖和肥胖非酒精性脂肪性肝病（NAFLD）患者纤维化方面的最佳截断值。
本研究纳入了根据非酒精性脂肪性肝炎临床研究网络评分系统通过肝活检诊断的 NAFLD 患者。非肥胖定义为 BMI<25kg/m2。LSM 由经验丰富的医生在肝活检前或后 2 周内进行。
共纳入 158 例患者。非肥胖组（n=68）和肥胖组（n=90）的平均 BMI 分别为 23.2±1.6kg/m2和 27.9±2.5kg/m2。在调整年龄、纤维化分期、脂肪变性程度和 2 型糖尿病后，肥胖组的 LSM 比非肥胖组高 3.522kPa（P=0.003）。非肥胖患者的 LSM 值随着纤维化分期的分层而呈下降趋势，尤其是在肝硬化（F4；P=0.021）。在各纤维化分期的 NAFLD 患者中应用单独的截断值，5.8 vs 7.5kPa（≥F1）、7.6 vs 8.5kPa（≥F2）、9.1 vs 11.2kPa（≥F3）和 12.5 vs 14.3kPa（F4），与整体截断值相比，提高了诊断优势比。在非肥胖 NAFLD 组中，使用单独的截断值可避免低估 9.1%的肝硬化患者。
非肥胖 NAFLD 组的 LSM 低于肥胖组。非肥胖和肥胖 NAFLD 患者应使用不同的截断值来测量肝纤维化分期。
