Li Qiang, Huang Chenlu, Xu Wei, Hu Qiankun, Chen Liang
Department of Liver Disease, Shanghai Public Health Clinical Center, Fudan University, Shanghai, China.
Medicine (Baltimore). 2020 Jun 5;99(23):e20616. doi: 10.1097/MD.0000000000020616.
Liver steatosis could affect the accuracy of FibroScan in patients with chronic hepatitis B (CHB) and nonalcoholic fatty liver disease (NAFLD). This study aimed to assess the accuracy and cut-off values of FibroScan for diagnosing liver fibrosis and cirrhosis in patients with concomitant CHB and NAFLD.A total of 116 patients with concomitant CHB and NAFLD who underwent FibroScan test and liver biopsy were retrospectively enrolled. Liver fibrosis was staged according to the METAVIR scoring system. Calculations of the areas under receiver-operating characteristic curves (AUROC) were performed and compared for the staging of liver fibrosis.The AUROCs for FibroScan, gamma-glutamyl transpeptidase to platelet ratio (GPR), aspartate aminotransferase to platelet ratio index (APRI), fibrosis index based on 4 factors (FIB-4), and NAFLD Fibrosis Score (NFS) were 0.87, 0.73, 0.69, 0.57, and 0.57 for the diagnosis of significant liver fibrosis (METAVIR ≥ F2); 0.89, 0.77, 0.75, 0.68, and 0.60 for severe liver fibrosis (METAVIR ≥ F3); and 0.94, 0.86, 0.80, 0.74, and 0.63 for cirrhosis (F4), respectively. The cutoff values of FibroScan for staging liver fibrosis with sensitivity at least 90% were: 8.0 kPa for significant liver fibrosis, and 10.5 kPa for cirrhosis. The cutoff values of FibroScan for staging liver fibrosis with specificity at least 90% were: 10.8 kPa for significant liver fibrosis, and 17.8 kPa for cirrhosis.FibroScan provides high value for the diagnosis of liver fibrosis and cirrhosis in patients with concomitant CHB and NAFLD.
肝脂肪变性可能会影响FibroScan对慢性乙型肝炎（CHB）和非酒精性脂肪性肝病（NAFLD）患者的检测准确性。本研究旨在评估FibroScan诊断合并CHB和NAFLD患者肝纤维化和肝硬化的准确性及临界值。
本研究回顾性纳入了116例接受FibroScan检测和肝活检的CHB合并NAFLD患者。根据METAVIR评分系统对肝纤维化进行分期。计算受试者工作特征曲线下面积（AUROC）并比较肝纤维化分期情况。
FibroScan、γ-谷氨酰转肽酶与血小板比值（GPR）、天冬氨酸氨基转移酶与血小板比值指数（APRI）、基于4项指标的纤维化指数（FIB-4）及NAFLD纤维化评分（NFS）诊断显著肝纤维化（METAVIR≥F2）的AUROC分别为0.87、0.73、0.69、0.57和0.57；诊断重度肝纤维化（METAVIR≥F3）的AUROC分别为0.89、0.77、0.75、0.68和0.60；诊断肝硬化（F4）的AUROC分别为0.94、0.86、0.80、0.74和0.63。FibroScan诊断肝纤维化分期且灵敏度至少为90%时的临界值为：显著肝纤维化为8.0 kPa，肝硬化为10.5 kPa。FibroScan诊断肝纤维化分期且特异度至少为90%时的临界值为：显著肝纤维化为10.8 kPa，肝硬化为17.8 kPa。
FibroScan对诊断合并CHB和NAFLD患者的肝纤维化和肝硬化具有较高价值。
