Shi Yi-Wen, He Fang-Ping, Chen Jin-Jun, Deng Hong, Shi Jun-Ping, Zhao Cai-Yan, Mi Yu-Qiang, Zou Zheng-Sheng, Zhou Yong-Jian, Di Fu-Sheng, Zheng Rui-Dan, Du Qin, Shang Jia, Yang Rui-Xu, Popovic Branko, Zhong Bi-Hui, Fan Jian-Gao
Center for Fatty Liver, Department of Gastroenterology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai Key Lab of Pediatric Gastroenterology and Nutrition, Shanghai, China.
Department of Gastroenterology II, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang Uygur Autonomous Regions, Ürümqi, China.
J Clin Transl Hepatol. 2021 Oct 28;9(5):607-614. doi: 10.14218/JCTH.2021.00058. Epub 2021 Apr 23.
Nonalcoholic fatty liver disease (NAFLD) is associated with metabolic disorders. This study aimed to explore the role of metabolic disorders in screening advanced fibrosis in NAFLD patients.
A total of 246 histologically-proven NAFLD patients were enrolled across 14 centers. We compared the severity of fibrosis in patients with different components of metabolic disorders. Based on standard noninvasive tests and metabolic disorders, we developed new algorithms to identify advanced fibrosis.
Metabolic syndrome (MetS) was frequent in NAFLD patients (133/246, 54%). Patients with MetS had a higher proportion of significant fibrosis (=0.014) and higher LSM values (9.2 kPa, vs. 7.4 kPa, =0.002) than those without MetS. Patients with more metabolic disorders had higher fibrosis stages (=0.017). Reduced high-density lipoprotein cholesterol (odds ratio [OR]: 2.241, 95% confidence interval [CI]: 1.004-5.002, =0.049) and raised fasting glucose (OR: 4.500, 95% CI: 2.083-9.725, <0.001) were significantly associated with advanced fibrosis. Using these two metabolic disorders as a screening tool, a sensitivity, specificity and accuracy of 92%, 81% and 83% was achieved, respectively. With the new algorithms combining metabolic disorders with noninvasive measurements, the number of patients requiring liver biopsy was reduced, especially in combination with the Fibrosis-4 score and metabolic disorders (36% to 17%, <0.001). In addition, this stepwise algorithm could achieve a high accuracy (85%) and high negative predictive value (93%).
Metabolic disorders should be taken into consideration in the diagnosis of advanced fibrosis. With further validation and investigation, new algorithms could be recommended in primary care units to spare patients from unnecessary referral and liver biopsies.
非酒精性脂肪性肝病（NAFLD）与代谢紊乱相关。本研究旨在探讨代谢紊乱在非酒精性脂肪性肝病患者晚期纤维化筛查中的作用。
共有246例经组织学证实的非酒精性脂肪性肝病患者在14个中心入组。我们比较了不同代谢紊乱组分患者的纤维化严重程度。基于标准的非侵入性检查和代谢紊乱情况，我们开发了新的算法来识别晚期纤维化。
代谢综合征（MetS）在非酒精性脂肪性肝病患者中很常见（133/246，54%）。与无代谢综合征的患者相比，代谢综合征患者显著纤维化的比例更高（P = 0.014），肝脏硬度值（LSM）更高（9.2 kPa对7.4 kPa，P = 0.002）。代谢紊乱更多的患者纤维化阶段更高（P = 0.017）。高密度脂蛋白胆固醇降低（比值比[OR]：2.241，95%置信区间[CI]：1.004 - 5.002，P = 0.049）和空腹血糖升高（OR：4.500，95% CI：2.083 - 9.725，P < 0.001）与晚期纤维化显著相关。将这两种代谢紊乱作为筛查工具，敏感性、特异性和准确性分别达到92%、81%和83%。通过将代谢紊乱与非侵入性测量相结合的新算法，需要进行肝活检的患者数量减少，尤其是与Fibrosis - 4评分和代谢紊乱相结合时（从36%降至17%，P < 0.001）。此外，这种逐步算法可实现高准确性（85%）和高阴性预测值（93%）。
在晚期纤维化的诊断中应考虑代谢紊乱情况。经过进一步验证和研究，新算法可在基层医疗单位推荐使用，以使患者避免不必要的转诊和肝活检。
