Hepatology Division San Giuseppe Hospital, MultiMedica IRCCS, Università degli Studi di Milano, Via San Vittore 12, 20123 Milan, Italy.
Division of Internal Medicine and Hepatology, Department of Gastroenterology, IRCCS Humanitas Research Hospital, 20089 Rozzano, Italy.
Int J Mol Sci. 2022 Oct 18;23(20):12489. doi: 10.3390/ijms232012489.
The identification of advanced fibrosis by applying noninvasive tests is still a key component of the diagnostic algorithm of NAFLD. The aim of this study is to assess the concordance between the FIB-4 and liver stiffness measurement (LSM) in patients referred to two liver centers for the ultrasound-based diagnosis of NAFLD. Fibrosis 4 Index for Liver Fibrosis (FIB-4) and LSM were assessed in 1338 patients. A total of 428 (32%) had an LSM ≥ 8 kPa, whereas 699 (52%) and 113 (9%) patients had an FIB-4 < 1.3 and >3.25, respectively. Among 699 patients with an FIB-4 < 1.3, 118 (17%) had an LSM ≥ 8 kPa (false-negative FIB-4). This proportion was higher in patients ≥60 years, with diabetes mellitus (DM), arterial hypertension or a body mass index (BMI) ≥ 27 kg/m2. In multiple adjusted models, age ≥ 60 years (odds ratio (OR) = 1.96, 95% confidence interval (CI) 1.19−3.23)), DM (OR = 2.59, 95% CI 1.63−4.13), body mass index (BMI) ≥ 27 kg/m2 (OR = 2.17, 95% CI 1.33−3.56) and gamma-glutamyltransferase ≥ 25 UI/L (OR = 2.68, 95% CI 1.49−4.84) were associated with false-negative FIB-4. The proportion of false-negative FIB-4 was 6% in patients with none or one of these risk factors and increased to 16, 31 and 46% among those with two, three and four concomitant risk factors, respectively. FIB-4 is suboptimal to identify patients to refer to liver centers, because about one-fifth may be false negative at FIB-4, having instead an LSM ≥ 8 KPa.
应用非侵入性检测方法来识别肝纤维化仍然是 NAFLD 诊断算法的关键组成部分。本研究旨在评估在因超声检查诊断为非酒精性脂肪性肝病而被转诊至两个肝脏中心的患者中，FIB-4 和肝硬度测量（LSM）之间的一致性。在 1338 例患者中评估了 Fibrosis 4 Index for Liver Fibrosis（FIB-4）和 LSM。共有 428 例（32%）的 LSM≥8kPa，而 699 例（52%）和 113 例（9%）患者的 FIB-4<1.3 和>3.25。在 699 例 FIB-4<1.3 的患者中，有 118 例（17%）的 LSM≥8kPa（FIB-4 假阴性）。在年龄≥60 岁、患有糖尿病（DM）、动脉高血压或 BMI≥27kg/m2 的患者中，这一比例更高。在多因素调整模型中，年龄≥60 岁（比值比（OR）=1.96，95%置信区间（CI）1.19−3.23））、DM（OR=2.59，95%CI 1.63−4.13）、BMI≥27kg/m2（OR=2.17，95%CI 1.33−3.56）和γ-谷氨酰转移酶≥25UI/L（OR=2.68，95%CI 1.49−4.84）与 FIB-4 假阴性相关。在无或仅存在一个这些危险因素的患者中，FIB-4 假阴性的比例为 6%，而在存在两个、三个和四个同时存在的危险因素的患者中，该比例分别增加至 16%、31%和 46%。FIB-4 不能很好地识别需要转诊至肝脏中心的患者，因为大约五分之一的患者在 FIB-4 时可能为假阴性，而 LSM≥8kPa。
