Servicio de Aparato Digestivo, Hospital de Medina del Campo, Valladolid, Spain.
Servicio de Aparato Digestivo, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.
Endocrinol Diabetes Nutr (Engl Ed). 2022 Jun-Jul;69(6):418-425. doi: 10.1016/j.endien.2022.06.009. Epub 2022 Jul 2.
Metabolic hepatic steatosis (metHS) is the most frequent cause of chronic liver disease in our environment. The "gold standard" for its diagnosis continues to be liver biopsy, but this is an invasive technique, is not risk-free, and has great interobserver variability, so noninvasive diagnostic methods are necessary.
To determine the diagnostic accuracy of non-invasive methods based on clinical and analytical data compared to liver biopsy, and to analyse their concordance with each other in the overall cohort and in subpopulations at risk of metHS.
Prospective observational study of 245 patients aged 19-80 years diagnosed with metHS by liver biopsy. Steatosis indices were calculated: FLI (Fatty Liver Index), LAP (Liver Accumulation Product), HSI-(Hepatitis Score Index) and fibrosis indices: Non-alcoholic fatty liver disease fibrosis score (NFS), fibrosis-4 index (FIB-4) and Hepamet Fibrosis Score (HFS).
The non-invasive steatosis indices showed high sensitivity, and those of fibrosis, high specificity. To assess steatosis, FLI was the most sensitive index in all subpopulations (89-97%), except in women. To assess fibrosis, HFS offers maximum sensitivity in diabetics (86.7%) and is the index with the highest negative predictive value overall. The COR curves for non-invasive indices in steatosis and fibrosis compared to liver biopsy showed greater areas under the curve for the fibrosis indices, with NFS and HFS offering greater diagnostic accuracy (area > 0.8, p < 0.05). HFS also offers high diagnostic sensitivity in the diabetic population.
Non-invasive indices of steatosis are more sensitive and those of fibrosis more specific than liver biopsy. NFS and HFS offer the highest diagnostic accuracy, with HFS having the highest negative predictive value.
代谢性肝脂肪变性（metHS）是我们环境中慢性肝病最常见的原因。其诊断的“金标准”仍然是肝活检，但这是一种有创技术，并非无风险，且观察者间差异较大，因此需要非侵入性诊断方法。
确定基于临床和分析数据的非侵入性方法与肝活检相比的诊断准确性，并分析它们在整个队列和代谢性肝脂肪变性高危亚群中的一致性。
对 245 名年龄在 19-80 岁之间通过肝活检诊断为代谢性肝脂肪变性的患者进行前瞻性观察研究。计算脂肪变性指数：FLI（脂肪肝指数）、LAP（肝脏蓄积产物）、HSI-（肝炎评分指数）和纤维化指数：非酒精性脂肪性肝病纤维化评分（NFS）、纤维化-4 指数（FIB-4）和 Hepamet 纤维化评分（HFS）。
非侵入性脂肪变性指数具有较高的敏感性，纤维化指数具有较高的特异性。评估脂肪变性时，除女性外，所有亚群中最敏感的指数都是 FLI。评估纤维化时，HFS 在糖尿病患者中具有最高的敏感性（86.7%），且总体上具有最高的阴性预测值。与肝活检相比，非侵入性指数在脂肪变性和纤维化中的 COR 曲线显示，纤维化指数的曲线下面积更大，NFS 和 HFS 具有更高的诊断准确性（面积>0.8，p<0.05）。HFS 在糖尿病患者中也具有较高的诊断敏感性。
非侵入性脂肪变性指数比肝活检更敏感，纤维化指数比肝活检更特异。NFS 和 HFS 具有最高的诊断准确性，HFS 具有最高的阴性预测值。
