Ismaiel Abdulrahman, Leucuta Daniel-Corneliu, Popa Stefan-Lucian, Fagoonee Sharmila, Pellicano Rinaldo, Abenavoli Ludovico, Dumitrascu Dan L
Second Department of Internal Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Department of Medical Informatics and Biostatistics, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania -
Panminerva Med. 2021 Dec;63(4):508-518. doi: 10.23736/S0031-0808.20.04171-3. Epub 2020 Nov 9.
Nonalcoholic steatohepatitis (NASH) is characterized by hepatic steatosis with inflammation, ballooned hepatocytes and possible fibrosis, which may progress to liver cirrhosis. Although liver biopsy, remains the diagnostic gold standard of NASH, several noninvasive biomarkers have been studied, to avoid the need for this invasive procedure. We performed a systematic review with meta-analysis to evaluate the accuracy of several noninvasive biomarkers in predicting NASH and assessing liver fibrosis in NASH patients.
An electronic search on PubMed and Embase was systematically performed. The principal summary outcome was the area under the curve (AUC), assessing the accuracy of NashTest, BARD (Body Mass Index, AST/ALT ratio, diabetes) score, NAFLD fibrosis score (NFS), APRI (aspartate aminotransferase-to-Platelet Ratio Index), and Fibrosis-4 (FIB-4) Index in predicting NASH and assessing liver fibrosis.
Thirteen studies involving 6557 adult patients were included in the qualitative assessment of this review, out of which, six studies were included in the quantitative assessment. Prediction of NASH was evaluated better using NFS (AUC of 0.687) and FIB-4 (AUC of 0.729). Fibrosis stages 0 vs. 1-4 was diagnosed better using NFS (AUC of 0.718) and FIB-4 (AUC of 0.723). Advanced fibrosis was assessed better by BARD (AUC of 0.673), APRI (AUC of 0.762), NFS (AUC of 0.787) and FIB-4 (AUC of 0.821).
FIB-4 predicted NASH and quantified liver fibrosis, stages 0 vs. 1-4 more precisely compared to NFS, APRI, and BARD. However, considering that methodological quality of the assessed studies is limited, the results should be considered with caution.
非酒精性脂肪性肝炎（NASH）的特征是肝脏脂肪变性伴有炎症、肝细胞气球样变以及可能的纤维化，其可能进展为肝硬化。尽管肝活检仍是NASH的诊断金标准，但已对多种非侵入性生物标志物进行了研究，以避免这种侵入性检查。我们进行了一项系统评价并荟萃分析，以评估多种非侵入性生物标志物在预测NASH以及评估NASH患者肝纤维化方面的准确性。
对PubMed和Embase进行了系统的电子检索。主要汇总结果是曲线下面积（AUC），用于评估NashTest、BARD（体重指数、AST/ALT比值、糖尿病）评分、非酒精性脂肪性肝病纤维化评分（NFS）、天冬氨酸转氨酶与血小板比值指数（APRI）以及纤维化-4（FIB-4）指数在预测NASH和评估肝纤维化方面的准确性。
本评价的定性评估纳入了13项涉及6557例成年患者的研究，其中6项研究纳入了定量评估。使用NFS（AUC为0.687）和FIB-4（AUC为0.729）对NASH的预测评估效果更好。使用NFS（AUC为0.718）和FIB-4（AUC为0.723）对纤维化0期与1-4期的诊断效果更好。通过BARD（AUC为0.673）、APRI（AUC为0.762）、NFS（AUC为0.787）和FIB-4（AUC为0.821）对重度纤维化的评估效果更好。
与NFS、APRI和BARD相比，FIB-4在预测NASH以及更精确地量化纤维化0期与1-4期方面表现更佳。然而，鉴于所评估研究方法学质量有限，对结果应谨慎看待。
