Kawata Nozomi, Takahashi Hirokazu, Iwane Shinji, Inoue Kanako, Kojima Motoyasu, Kohno Michiko, Tanaka Kenichi, Mori Hitoe, Isoda Hiroshi, Oeda Satoshi, Matsuda Yayoi, Egashira Yoshiaki, Nojiri Jyunichi, Irie Hiroyuki, Eguchi Yuichiro, Anzai Keizo
Division of Metabolism and Endocrinology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga Japan.
Liver Center, Saga University, Saga, Japan.
Diabetol Int. 2020 Jul 9;12(1):118-125. doi: 10.1007/s13340-020-00453-7. eCollection 2021 Jan.
Liver fibrosis is associated with lifestyle-related diseases, including diabetes. The identification of diabetic patients with severe liver fibrosis is important, but a simple and reliable diagnostic procedure remains to be determined. We conducted an observational study to evaluate the performance of a FIB-4 index-based screening strategy for the diagnosis of advanced liver fibrosis in patients with diabetes or prediabetes. Two hundred and forty-two patients underwent abdominal imaging in our Study. According to the abdominal imaging findings, fatty liver, liver cirrhosis, and hepatocellular carcinoma were defined, and their association with FIB-4 index evaluated. The prevalences of liver cirrhosis and hepatocellular carcinoma in patients with a high (≥ 2.67; liver cirrhosis: 42.9%, hepatocellular carcinoma: 14.3%) FIB-4 index were significantly higher than in those with an intermediate (1.3 ≤ FIB-4 < 2.67; liver cirrhosis: 1.6%, hepatocellular carcinoma: 0.8%) or low FIB-4 index (< 1.3; liver cirrhosis: 1.2%, hepatocellular carcinoma: 0%). The diagnostic accuracy, specificity, and sensitivity of the FIB-4 index for the diagnosis of liver cirrhosis or hepatocellular carcinoma were 84.3%, 85.5%, and 89.3%, respectively, with an optimized cut-off value of 2.96 (sensitivity = 0.86, specificity = 0.98). Using an optimized cut-off value, FIB-4 index might be useful to identify liver cirrhosis or hepatocellular carcinoma in diabetes patients with high diagnostic accuracy.
肝纤维化与包括糖尿病在内的生活方式相关疾病有关。识别患有严重肝纤维化的糖尿病患者很重要，但仍有待确定一种简单可靠的诊断方法。我们进行了一项观察性研究，以评估基于FIB-4指数的筛查策略对糖尿病或糖尿病前期患者晚期肝纤维化的诊断性能。在我们的研究中，242名患者接受了腹部成像检查。根据腹部成像结果，定义了脂肪肝、肝硬化和肝细胞癌，并评估了它们与FIB-4指数的相关性。FIB-4指数高（≥2.67；肝硬化：42.9%，肝细胞癌：14.3%）的患者中肝硬化和肝细胞癌的患病率显著高于FIB-4指数中等（1.3≤FIB-4＜2.67；肝硬化：1.6%，肝细胞癌：0.8%）或低（＜1.3；肝硬化：1.2%，肝细胞癌：0%）的患者。FIB-4指数诊断肝硬化或肝细胞癌的诊断准确性、特异性和敏感性分别为84.3%、85.5%和89.3%，优化的临界值为2.96（敏感性=0.86，特异性=0.98）。使用优化的临界值，FIB-4指数可能有助于以高诊断准确性识别糖尿病患者中的肝硬化或肝细胞癌。
