All India Institute of Medical Sciences(AIIMS), Bhopal.
J Assoc Physicians India. 2022 Apr;70(4):11-12.
Despite its rising prevalence, and its potential to lead to life threatening complications, there are no recommendations in the current guidelines for screening individuals with diabetes mellitus or high BMI for NAFLD(non-alcoholic fatty liver disease)/NASH (non alcoholic steatohepatitis),mainly due to the uncertain performance and feasibility of currently available screening tools. This research was carried out to assess the diagnostic accuracy of non-invasive screening tools in predicting liver fibrosis in individuals with diabetes mellitus and metabolic syndrome.
140 patients with diabetes mellitus and metabolic syndrome, identified between March 2020 and October 2021 were studied. Liver stiffness measurement by point shear wave elastography was considered the gold standard. 5 non-invasive scores, AST/ALT (aspartate aminotransferase/alanine aminotransferase) Ratio, Aspartate aminotransferase/platelet ratio (APRI)Score, FIB-4 Index, BARD Score and NAFLD Fibrosis Score were determined in all of the study participants. Using receiver operator characteristic (ROC) curve analysis, sensitivity, specificity, negative predictive value (NPV) and positive predictive value (PPV) were calculated for each of these scores. The area under the ROC curve (AUROC) was used to calculate the diagnostic accuracy of these scores.
Out of the140 participants in the study, (83 males (59.29%)), 30 (21.43%) had liver fibrosis as per liver stiffness measurement by point shear wave elastography. The mean age and mean BMI were 54.53±12.42 and 27.37±2.73 respectively in the 'Fibrosis' group and 56.20 ±11.76 and 27.10±4.22 in the 'No fibrosis' group. The major finding of our study was that all these scores had relatively high NPV (>85 %) for predicting liver fibrosis in our cohort. The AST/ALT Ratio had the highest negative predictive value (90.28 %) followed by APRI Score (88.94 %). The AUROC (for FIB-4 Score, NAFLD-Fibrosis Score, APRI Score, AST/ALT Ratio, BARD Score were 0.6669, 0.657, 0.655, 0.637 and 0.599 respectively. FIB-4 Index(p = 0.005) had the highest AUROC, followed by NAFLD-Fibrosis Score(p =0.009) .But, all the scores had relatively low specificity(<60 %), PPV(<35 %) and accuracy(<63 %).
FIB- 4 Index and NAFLD-Fibrosis Score can be used to reliably exclude liver fibrosis in individuals with diabetes mellitus and metabolic syndrome in the Indian population, but may not be useful in accurately diagnosing liver fibrosis. Utilization of these non-invasive and cost-effective screening tools in routine practice, may have promising results in predicting liver fibrosis in 'at risk' populations.
评估非侵入性筛查工具在预测糖尿病和代谢综合征个体肝纤维化中的诊断准确性。
研究纳入了 2020 年 3 月至 2021 年 10 月间确诊的 140 例糖尿病和代谢综合征患者。采用瞬时弹性成像测量肝脏硬度作为金标准。在所有研究对象中均测定了 5 种非侵入性评分，包括天冬氨酸氨基转移酶/丙氨酸氨基转移酶（AST/ALT）比值、天门冬氨酸氨基转移酶/血小板比值（APRI）评分、FIB-4 指数、BARD 评分和非酒精性脂肪性肝病纤维化评分。通过受试者工作特征（ROC）曲线分析，计算了这些评分的灵敏度、特异性、阴性预测值（NPV）和阳性预测值（PPV）。ROC 曲线下面积（AUROC）用于计算这些评分的诊断准确性。
在 140 名研究参与者中（男性 83 名（59.29%）），30 名（21.43%）根据瞬时弹性成像测量的肝脏硬度存在肝纤维化。在“纤维化”组中，平均年龄和平均 BMI 分别为 54.53±12.42 和 27.37±2.73，在“无纤维化”组中分别为 56.20±11.76 和 27.10±4.22。我们研究的主要发现是，在我们的队列中，所有这些评分对于预测肝纤维化均具有较高的 NPV（>85%）。AST/ALT 比值的阴性预测值最高（90.28%），其次是 APRI 评分（88.94%）。FIB-4 指数、非酒精性脂肪性肝病纤维化评分、APRI 评分、AST/ALT 比值和 BARD 评分的 AUROC 分别为 0.6669、0.657、0.655、0.637 和 0.599。FIB-4 指数（p=0.005）的 AUROC 最高，其次是非酒精性脂肪性肝病纤维化评分（p=0.009）。但是，所有评分的特异性均较低（<60%），PPV（<35%）和准确性（<63%）均较低。
FIB-4 指数和非酒精性脂肪性肝病纤维化评分可用于可靠地排除印度人群中糖尿病和代谢综合征个体的肝纤维化，但可能无法准确诊断肝纤维化。在常规实践中使用这些非侵入性和具有成本效益的筛查工具可能在预测“高危”人群的肝纤维化方面具有良好的效果。
