临床纤维化标志物、Hepascore 和 Fibroscan®对非酒精性脂肪性肝病患者诊断肝纤维化的准确性比较。

Comparative Accuracy of Clinical Fibrosis Markers, Hepascore and Fibroscan® to Detect Advanced Fibrosis in Patients with Nonalcoholic Fatty Liver Disease.

机构信息

Medical School, University of Western Australia, QEII Medical Campus, Verdun St, Nedlands, WA, 6009, Australia.

Department of Hepatology, Sir Charles Gairdner Hospital, QEII Medical Campus, Verdun St, Nedlands, WA, 6009, Australia.

出版信息

Dig Dis Sci. 2023 Jun;68(6):2757-2767. doi: 10.1007/s10620-023-07896-3. Epub 2023 Mar 22.

BACKGROUND

Non-invasive tests are widely used to diagnose fibrosis in patients with non-alcoholic fatty liver disease (NAFLD), however, the optimal method remains unclear. We compared the accuracy of simple serum models, a serum model incorporating direct measures of fibrogenesis (Hepascore), and Fibroscan®, for detecting fibrosis in NAFLD.

METHODS

NAFLD patients undergoing liver biopsy were evaluated with Hepascore, NAFLD Fibrosis Score (NFS), FIB-4 and AST-platelet ratio index (APRI), with a subset (n = 131) undergoing Fibroscan®. Fibrosis on liver biopsy was categorized as advanced (F3-4) or cirrhosis (F4). Accuracy was determined by area under receiving operating characteristic curves (AUC). Indeterminate ranges were calculated using published cut-offs.

RESULTS

In 271 NAFLD patients, 83 (31%) had F3-4 and 47 (17%) cirrhosis. 6/131 (4%) had an unreliable Fibroscan®. For the detection of advanced fibrosis, the accuracy of Hepascore (AUC 0.88) was higher than FIB-4 (0.73), NFS (0.72) and APRI (0.69) (p < 0.001 for all). Hepascore had similar accuracy to Fibroscan® (0.80) overall, but higher accuracy in obese individuals (0.91 vs 0.80, p = 0.001). Hepascore more accurately identified patients with cirrhosis than APRI (AUC 0.85 vs 0.71, p = 0.01) and NFS (AUC 0.73, p = 0.01) but performed similar to FIB-4 and Fibroscan®. For the determination of F3-4, the proportion of patients in indeterminate area was lower for Hepascore (4.8%), compared to FIB-4 (42%), NFS (36%) and APRI (44%) (p < 0.001 for all).

CONCLUSIONS

Hepascore has greater accuracy and a lower indeterminate range than simple serum fibrosis tests for advanced fibrosis in NAFLD, and greater accuracy than Fibroscan® in obese individuals.

背景

非侵入性检测广泛用于诊断非酒精性脂肪性肝病（NAFLD）患者的纤维化，但最佳方法仍不清楚。我们比较了简单的血清模型、包含直接纤维化指标的血清模型（Hepascore）和 Fibroscan®在诊断 NAFLD 纤维化方面的准确性。

方法

对接受肝活检的 NAFLD 患者进行 Hepascore、NAFLD 纤维化评分（NFS）、FIB-4 和天冬氨酸转氨酶血小板比值指数（APRI）评估，其中一部分（n=131）进行 Fibroscan®检测。肝活检纤维化分为晚期（F3-4）或肝硬化（F4）。通过接受者操作特征曲线下面积（AUC）确定准确性。不确定范围使用发表的截止值计算。

结果

在 271 例 NAFLD 患者中，83 例（31%）有 F3-4，47 例（17%）有肝硬化。131 例中有 6 例（4%）Fibroscan®不可靠。对于晚期纤维化的检测，Hepascore（AUC 0.88）的准确性高于 FIB-4（0.73）、NFS（0.72）和 APRI（0.69）（p<0.001）。Hepascore 的总体准确性与 Fibroscan®相似（0.80），但在肥胖患者中准确性更高（0.91 比 0.80，p=0.001）。Hepascore 比 APRI（AUC 0.85 比 0.71，p=0.01）和 NFS（AUC 0.73，p=0.01）更准确地识别肝硬化患者，但与 FIB-4 和 Fibroscan®的表现相似。对于 F3-4 的确定，Hepascore 的不确定范围低于 FIB-4（42%）、NFS（36%）和 APRI（44%）（p<0.001）。