Department of Gastroenterology and Hepatology, Musashino Red Cross Hospital, Tokyo, Japan.
J Gastroenterol Hepatol. 2022 Sep;37(9):1726-1731. doi: 10.1111/jgh.15893. Epub 2022 Jun 3.
MEFIB (the combination of magnetic resonance elastography [MRE] ≥ 3.3 kPa and fibrosis-4 (FIB-4) ≥ 1.6) is useful for detecting patients with significant fibrosis (fibrosis stage ≥ 2) having nonalcoholic fatty liver disease (NAFLD). However, age-dependent thresholds of FIB-4 have been proposed, and it remains unclear whether MEFIB could be applied with the same FIB-4 threshold in a different cohort. Therefore, in this study, we examined the best threshold of FIB-4 and validated the utility of MEFIB.
This study included 105 biopsy-proven NAFLD patients with contemporaneous MRE assessment. The primary outcome was a diagnostic accuracy for significant fibrosis.
The median (interquartile range) age was 65 (58-72) years, and significant fibrosis was 76.2% (80/105). FIB-4 of 2.1 was defined as the best threshold for significant fibrosis in the cohort. The area under the receiver operating characteristics curves (AUROCs) of the combination of MRE and FIB-4 (MRE ≥ 3.3 kPa + FIB-4 ≥ 1.6: 0.80, MRE ≥ 3.3 kPa + FIB-4 ≥ 2.1: 0.84) were higher than those of each index alone (MRE ≥ 3.3 kPa: 0.76, FIB-4 ≥ 1.6: 0.72, and FIB-4 ≥ 2.1: 0.77), but AUROCs of MRE ≥ 3.3 kPa + FIB-4 ≥ 1.6 and MRE ≥ 3.3 kPa + FIB-4 ≥ 2.1 were equivalent (P = 0.3).
MEFIB is useful for detecting patients with significant fibrosis and could be utilized in a different cohort without changing the threshold of FIB-4, and it may then be used as a two-step screening strategy.
MEFIB（磁共振弹性成像[MRE]≥3.3kPa 和纤维化-4[FIB-4]≥1.6）可用于检测患有非酒精性脂肪性肝病（NAFLD）且具有显著纤维化（纤维化分期≥2）的患者。然而，已经提出了 FIB-4 的年龄依赖性阈值，并且尚不清楚 MEFIB 是否可以在不同的队列中使用相同的 FIB-4 阈值。因此，在本研究中，我们检查了 FIB-4 的最佳阈值，并验证了 MEFIB 的实用性。
本研究纳入了 105 例经活检证实的 NAFLD 患者，并同时进行了 MRE 评估。主要结局是显著纤维化的诊断准确性。
中位（四分位距）年龄为 65（58-72）岁，有 76.2%（80/105）的患者存在显著纤维化。FIB-4 为 2.1 被定义为该队列中显著纤维化的最佳阈值。MRE 和 FIB-4 联合（MRE≥3.3kPa+FIB-4≥1.6：0.80，MRE≥3.3kPa+FIB-4≥2.1：0.84）的受试者工作特征曲线下面积（AUROCs）高于各单项指标（MRE≥3.3kPa：0.76，FIB-4≥1.6：0.72，和 FIB-4≥2.1：0.77），但 MRE≥3.3kPa+FIB-4≥1.6 和 MRE≥3.3kPa+FIB-4≥2.1 的 AUROCs 等效（P=0.3）。
MEFIB 可用于检测患有显著纤维化的患者，且无需更改 FIB-4 的阈值即可用于不同的队列，因此可作为两步筛查策略使用。
