Shieh Christine, Halegoua-De Marzio Dina L, Hung Matthew L, Fenkel Jonathan M, Herrine Steven K
Division of Gastroenterology and Hepatology Thomas Jefferson University Hospital Philadelphia Pennsylvania USA.
Department of Radiology Hospital of the University of Pennsylvania Philadelphia Pennsylvania USA.
JGH Open. 2020 Jun 29;4(5):1002-1006. doi: 10.1002/jgh3.12385. eCollection 2020 Oct.
There is no standardized guideline to screen, image, or refer patients with non-alcoholic fatty liver disease (NAFLD) to a specialist. In this study, we used transient elastography (TE) to examine the fibrosis stages at which patients are first diagnosed with NAFLD. Subsequently, we analyzed metabolic markers to establish cut-offs beyond which noninvasive imaging should be considered to confirm NAFLD/non-alcoholic steatohepatitis fibrosis in patients.
Charts spanning July 2015-April 2018 for 116 NAFLD patients who had TE performed were reviewed. Univariate and multivariate analysis of metabolic markers was conducted.
At the first hepatology visit, TE showed 73% F0-F2 and 27% F3-F4. Univariate analysis showed that high-density lipoproteins (HDL), hemoglobin A1c (A1c), aspartate transaminase (AST), and alanine transaminase (ALT) were significantly different between the F0-F2 and F3-F4 groups. Multivariate analysis showed that AST ( = 0.01) and A1c ( = 0.05) were significantly different. Optimal cut-offs for these markers to detect liver fibrosis on TE were AST >43 U/L and A1c >6.6%. The logistic regression function combining these two variables to reflect the probability () of the patient having advanced fibrosis (F3-F4) on TE yielded the formula: = /(1 + ), where = -8.56 + 0.052 * AST + 0.89 * A1c.
Our study suggested that >25% of patients presenting to a specialist for NAFLD may have advanced fibrosis (F3-F4). Diabetes (A1c >6.6%) and AST >43 U/L were the most predictive in identifying NAFLD patients with advanced fibrosis on imaging. We proposed a formula that may be used to prioritize NAFLD patients at higher risk of having advanced fibrosis for specialist referral and imaging follow-up.
目前尚无用于筛查、成像或转诊非酒精性脂肪性肝病（NAFLD）患者至专科医生的标准化指南。在本研究中，我们使用瞬时弹性成像（TE）来检查患者首次被诊断为NAFLD时的纤维化阶段。随后，我们分析代谢标志物以确定临界值，超过该临界值时应考虑采用非侵入性成像来确认NAFLD/非酒精性脂肪性肝炎患者的纤维化情况。
回顾了2015年7月至2018年4月期间116例行TE检查的NAFLD患者的病历。对代谢标志物进行了单因素和多因素分析。
在首次肝病门诊就诊时，TE显示73%为F0 - F2期，27%为F3 - F4期。单因素分析显示，F0 - F2组和F3 - F4组之间的高密度脂蛋白（HDL）、糖化血红蛋白（A1c）、天冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）存在显著差异。多因素分析显示，AST（=0.01）和A1c（=0.05）存在显著差异。这些标志物在TE上检测肝纤维化的最佳临界值为AST>43 U/L和A1c>6.6%。结合这两个变量以反映患者在TE上出现晚期纤维化（F3 - F4）概率（）的逻辑回归函数得出公式：= /(1 + )，其中=-8.56 + 0.052 * AST + 0.89 * A1c。
我们的研究表明，因NAFLD就诊于专科医生的患者中，超过25%可能存在晚期纤维化（F3 - F4）。糖尿病（A1c>6.6%）和AST>43 U/L在通过成像识别有晚期纤维化的NAFLD患者方面最具预测性。我们提出了一个公式，可用于对有晚期纤维化高风险的NAFLD患者进行优先排序，以便转诊至专科医生并进行成像随访。
