Department of Medicine, University of Hong Kong, Hong Kong, China.
State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong, China.
Endocrinol Metab (Seoul). 2021 Feb;36(1):134-145. doi: 10.3803/EnM.2020.887. Epub 2021 Feb 24.
In non-alcoholic fatty liver disease (NAFLD), transient elastography (TE) is an accurate non-invasive method to identify patients at risk of advanced fibrosis (AF). We developed a diabetes-specific, non-invasive liver fibrosis score based on TE to facilitate AF risk stratification, especially for use in diabetes clinics where TE is not readily available.
Seven hundred sixty-six adults with type 2 diabetes and NAFLD were recruited and randomly divided into a training set (n=534) for the development of diabetes fibrosis score (DFS), and a testing set (n=232) for internal validation. DFS identified patients with AF on TE, defined as liver stiffness (LS) ≥9.6 kPa, based on a clinical model comprising significant determinants of LS with the lowest Akaike information criteria. The performance of DFS was compared with conventional liver fibrosis scores (NFS, FIB-4, and APRI), using area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive and negative predictive values (NPV).
DFS comprised body mass index, platelet, aspartate aminotransferase, high-density lipoprotein cholesterol, and albuminuria, five routine measurements in standard diabetes care. Derived low and high DFS cut-offs were 0.1 and 0.3, with 90% sensitivity and 90% specificity, respectively. Both cut-offs provided better NPVs of >90% than conventional fibrosis scores. The AUROC of DFS for AF on TE was also higher (P<0.01) than the conventional fibrosis scores, being 0.85 and 0.81 in the training and testing sets, respectively.
Compared to conventional fibrosis scores, DFS, with a high NPV, more accurately identified diabetes patients at-risk of AF, who need further evaluation by hepatologists.
在非酒精性脂肪性肝病（NAFLD）中，瞬时弹性成像（TE）是一种准确的非侵入性方法，可用于识别有进展性肝纤维化（AF）风险的患者。我们开发了一种基于 TE 的糖尿病特异性、非侵入性肝纤维化评分，以方便进行 AF 风险分层，特别是在 TE 不易获得的糖尿病诊所中使用。
招募了 766 名患有 2 型糖尿病和 NAFLD 的成年人，并将其随机分为训练集（n=534）和测试集（n=232），用于开发糖尿病纤维化评分（DFS）。DFS 基于包含 TE 中 LS 最低 Akaike 信息准则的显著决定因素的临床模型，根据 TE 上的 AF 确定患者（定义为 LS≥9.6kPa）。使用接受者操作特征曲线（AUROC）下面积、敏感性、特异性、阳性和阴性预测值（NPV）比较 DFS 与常规肝纤维化评分（NFS、FIB-4 和 APRI）的性能。
DFS 包括体重指数、血小板、天冬氨酸氨基转移酶、高密度脂蛋白胆固醇和蛋白尿，这是标准糖尿病护理中的五项常规测量值。衍生的低和高 DFS 截止值分别为 0.1 和 0.3，具有 90%的敏感性和 90%的特异性。两种截止值的 NPV 均>90%，优于常规纤维化评分。DFS 对 TE 上 AF 的 AUROC 也高于（P<0.01）常规纤维化评分，在训练组和测试组中分别为 0.85 和 0.81。
与常规纤维化评分相比，DFS 具有较高的 NPV，更准确地识别出有进展性肝纤维化风险的糖尿病患者，这些患者需要肝病专家进一步评估。
