单纯性肝纤维化评分在非酒精性脂肪性肝病伴或不伴 2 型糖尿病中的表现。
Performance of Simple Fibrosis Score in Non-Alcoholic Fatty Liver Disease with and without Type 2 Diabetes.
机构信息
Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
Division of Gastroenterology and Hepatology, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea.
出版信息
Endocrinol Metab (Seoul). 2023 Apr;38(2):277-281. doi: 10.3803/EnM.2022.1635. Epub 2023 Mar 13.
This cross-sectional study enrolled 267 patients with metabolic risk factors and established non-alcoholic fatty liver disease in the prospective cohort. The performance of fibrosis-4 (FIB-4) score (≥1.3) to diagnose advanced fibrosis using transient elastography (liver stiffness measurement [LSM] ≥8 kPa) was analyzed. Comparing patients with type 2 diabetes (T2D, n=87) and without (n=180), not FIB-4, but LSM was significantly higher in T2D (P=0.026). The prevalence of advanced fibrosis was 17.2% in T2D and 12.8% in non-T2D. FIB-4 exhibited higher proportion of false negatives in T2D patients (10.9%) than those without (5.2%). The diagnostic performance of FIB-4 was suboptimal in T2D (area under curve [AUC], 0.653; 95% confidence interval [CI], 0.462 to 0.844) compared to that in non-T2D (AUC, 0.826; 95% CI, 0.724 to 0.927). In conclusion, patients with T2D might be beneficial to conduct transient elastography without screening to avoid missing advanced fibrosis.
这项横断面研究纳入了前瞻性队列中 267 例存在代谢危险因素和非酒精性脂肪性肝病的患者。分析了纤维化-4 （FIB-4）评分（≥1.3）结合瞬时弹性成像（肝脏硬度测量[LSM]≥8kPa）诊断晚期纤维化的性能。比较有 2 型糖尿病（T2D，n=87）和无 2 型糖尿病（n=180）的患者，T2D 患者的 LSM 明显高于非 T2D 患者（P=0.026），而非 FIB-4。T2D 患者的晚期纤维化患病率为 17.2%，而非 T2D 患者为 12.8%。FIB-4 在 T2D 患者中假阴性的比例更高（10.9%），而非 T2D 患者为 5.2%（P=0.026）。与非 T2D 患者相比（AUC，0.826；95%置信区间[CI]，0.724 至 0.927），T2D 患者的 FIB-4 诊断性能较差（AUC，0.653；95%CI，0.462 至 0.844）。总之，T2D 患者可能受益于进行瞬时弹性成像而无需筛查，以避免漏诊晚期纤维化。
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