Department of Endocrinology and Metabolism, The Third Central Clinical College of Tianjin Medical University, Tianjin, China; Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, The Third Central Hospital of Tianjin, Tianjin, China.
Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Artificial Cell Engineering Technology Research Center, Tianjin Institute of Hepatobiliary Disease, The Third Central Hospital of Tianjin, Tianjin, China.
Ann Palliat Med. 2021 Sep;10(9):9702-9714. doi: 10.21037/apm-21-2339.
Metabolic-associated fatty liver disease (MAFLD) is highly prevalent in type 2 diabetes mellitus (T2DM) patients and can rapidly progress to steatohepatitis, liver fibrosis, and hepatocellular carcinoma (HCC). Accurate evaluation and proper management of MAFLD can help prevent adverse liver outcomes. Here we evaluated the precision of the FibroTouch (FT) in the staging of liver steatosis and fibrosis in patients with MAFLD combined with T2DM using two indicators: controlled attenuation parameter (CAP) and liver stiffness measurement (LSM).
Eighty-five adult MAFLD combined with T2DM patients were selected at our center from July 2016 to July 2019 and underwent liver puncture biopsy for histopathology and the FT assay simultaneously. Two blinded pathologists independently reviewed the samples. The severity of fatty liver was classified using two scoring systems: the nonalcoholic fatty liver disease activity score (NAS) and the fibrosis score. Scores were then assessed following the Pathology Working Group of the NASH Clinical Research Network of the National Institutes of Health. Similarly, the severity of nonalcoholic steatohepatitis (NASH) was classified using the European Steatosis Activity Fibrosis (SAF) system. The FT assay was applied to obtain the LSM and the CAP. FT accuracy in diagnosing steatosis and fibrosis was determined by the receiver operating characteristic (ROC) curve and the area under the ROC curve (AUROC).
Using biopsy analysis as the gold standard, the AUROCs and cutoff values of CAP in diagnosing liver steatosis were as follows: 0.84 (95% CI: 0.67-1.01) and 278 dB/m for S ≥ S1, 0.88 (95% CI: 0.81-0.95) and 305 dB/m for S ≥ S2, 0.89 (95% CI: 0.82-0.95) and 307 dB/m for S ≥ S3. The AUROCs and cutoff values of LSM in diagnosing liver fibrosis were as follows: 0.76 (95% CI: 0.66-0.86) for F ≥ F2, 0.81 (95% CI: 0.71-0.91) and 13.8 kPa for F ≥ F3, 0.92 (95% CI: 0.85-1.00) and 20.1 kPa for F ≥ F4.
In patients of MAFLD with T2DM, CAP and LSM obtained by FT are highly accurate in assess liver steatosis and fibrosis, respectively, with AUROC values ranging from 0.76 to 0.92.
代谢相关脂肪性肝病（MAFLD）在 2 型糖尿病（T2DM）患者中非常普遍，可迅速进展为肝炎、肝纤维化和肝细胞癌（HCC）。准确评估和适当管理 MAFLD 有助于预防不良的肝脏结局。在这里，我们使用受控衰减参数（CAP）和肝硬度测量（LSM）这两个指标评估 FibroTouch（FT）在 MAFLD 合并 T2DM 患者中对肝脂肪变性和纤维化分期的准确性。
我们从 2016 年 7 月至 2019 年 7 月在我院选择了 85 名 MAFLD 合并 T2DM 成年患者，同时进行肝穿刺活检和 FT 检测以获取组织病理学和 FT 检测结果。两名盲法病理学家独立审查了样本。使用两种评分系统评估脂肪肝的严重程度：非酒精性脂肪性肝病活动评分（NAS）和纤维化评分。然后按照美国国立卫生研究院 NASH 临床研究网络的病理学工作组的标准进行评估。同样，使用欧洲脂肪性肝炎活动纤维化（SAF）系统对非酒精性脂肪性肝炎（NASH）的严重程度进行分类。FT 检测用于获得 LSM 和 CAP。通过接收者操作特征（ROC）曲线和 ROC 曲线下面积（AUROC）来确定 CAP 诊断脂肪变性和纤维化的准确性。
以活检分析为金标准，CAP 诊断肝脂肪变性的 AUROC 和截断值如下：S≥S1 时为 0.84（95%CI：0.67-1.01）和 278 dB/m，S≥S2 时为 0.88（95%CI：0.81-0.95）和 305 dB/m，S≥S3 时为 0.89（95%CI：0.82-0.95）和 307 dB/m。LSM 诊断肝纤维化的 AUROC 和截断值如下：F≥F2 时为 0.76（95%CI：0.66-0.86），F≥F3 时为 0.81（95%CI：0.71-0.91）和 13.8 kPa，F≥F4 时为 0.92（95%CI：0.85-1.00）和 20.1 kPa。
在 MAFLD 合并 T2DM 患者中，FT 获得的 CAP 和 LSM 分别在评估肝脂肪变性和纤维化方面具有高度准确性，AUROC 值范围为 0.76 至 0.92。
