Division of Gastroenterology (Liver Unit), University of Alberta, Edmonton, Alberta, Canada.
Family Medicine, University of Alberta, Edmonton, Alberta, Canada.
BMJ Open Gastroenterol. 2022 Jan;9(1). doi: 10.1136/bmjgast-2021-000798.
In non-alcoholic fatty liver disease (NAFLD), fibrosis determines the risk of liver complications. Non-invasive tests (NITs) such as FIB-4, NAFLD Fibrosis Score (NFS) and Hepamet, have been proposed as a tool to triage NAFLD patients in primary care (PC). These NITs include AST±ALT in their calculations. Many patients with NAFLD take statins, which can affect AST/ALT, but it is unknown if statin affects NITs fibrosis prediction.
We included 856 patients referred through a standardised pathway from PC with a final diagnosis of NAFLD. 832 had reliable vibration controlled transient elastography (VCTE) measurements. We assessed the effects of statins on the association between NITs and VCTE at different fibrosis thresholds.
129 out of 832 patients were taking a statin and 138 additional patients had indication for a statin. For any given FIB-4 value, patients on a statin had higher probabilities of high VCTE than patients not on a statin. Adjusting for body mass index, diabetes and age almost completely abrogated these differences, suggesting that these were related to patient's profile rather to a specific effect of statins. Negative predictive values (NPVs) of FIB-4 <1.3 for VCTE >8, 10, 12 and 16 were, respectively, 89, 94, 96% and 100% in patients on a statin and 92, 95, 98% and 99% in patients not on a statin. Statins had similar impact on Hepamet predictions but did not modify NFS predictions.
In patients with NAFLD referred from PC, those on statins had higher chances of a high VCTE for a given FIB-4 value, but this had a negligible impact on the NPV of the commonly used FIB-4 threshold (<1.3).
在非酒精性脂肪性肝病（NAFLD）中，纤维化决定了肝脏并发症的风险。非侵入性检测（NIT）如 FIB-4、NAFLD 纤维化评分（NFS）和 Hepamet 已被提出作为在初级保健（PC）中对 NAFLD 患者进行分诊的工具。这些 NIT 在其计算中包含 AST±ALT。许多患有 NAFLD 的患者服用他汀类药物，这可能会影响 AST/ALT，但尚不清楚他汀类药物是否会影响 NIT 纤维化预测。
我们纳入了通过标准化途径从 PC 转诊的 856 例最终诊断为 NAFLD 的患者。832 例患者有可靠的振动控制瞬态弹性成像（VCTE）测量值。我们评估了他汀类药物对 NIT 与不同纤维化阈值下 VCTE 之间关联的影响。
832 例患者中有 129 例正在服用他汀类药物，另有 138 例患者有服用他汀类药物的指征。对于任何给定的 FIB-4 值，服用他汀类药物的患者比未服用他汀类药物的患者更有可能出现高 VCTE。调整体重指数、糖尿病和年龄后，这些差异几乎完全消除，表明这与患者的特征有关，而不是他汀类药物的特定作用。在服用他汀类药物的患者中，FIB-4<1.3 对 VCTE>8、10、12 和 16 的阴性预测值（NPV）分别为 89、94、96%和 100%，而在未服用他汀类药物的患者中，NPV 分别为 92、95、98%和 99%。他汀类药物对 Hepamet 预测有类似的影响，但不改变 NFS 预测。
在从 PC 转诊的 NAFLD 患者中，对于给定的 FIB-4 值，服用他汀类药物的患者出现高 VCTE 的可能性更高，但这对常用的 FIB-4 阈值（<1.3）的 NPV 影响可以忽略不计。
