Family Practice Department, State Hospital, Üsküdar, Istanbul, Turkey.
Eur Rev Med Pharmacol Sci. 2023 Jul;27(14):6530-6538. doi: 10.26355/eurrev_202307_33123.
Efficacies of the noninvasive scoring tools in screening and diagnosing nonalcoholic fatty liver disease (NAFLD) remain controversial. Aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, AST-to-platelet ratio index (APRI), and fibrosis-4 (FIB-4) index are the most frequently used parameters for differentiating moderate and severe steatohepatitis. In this context, the objective of this study is to evaluate the diagnostic accuracy of noninvasive tools in predicting moderate-to-severe steatohepatitis via ultrasonography in asymptomatic healthy subjects admitted to family medicine outpatient clinics.
The population of this retrospective study consisted of healthy individuals tested within the scope of a medical check-up program between January and July 2021. All participants included in the study underwent relevant laboratory tests and liver ultrasonography (US). Steatohepatitis was graded using the US images as normal (grade 0), mild (grade 1), moderate (grade 2), and severe (grade 3). The participants with grade 0 and 1 steatohepatitis were categorized as Group 1, whereas those with grade 2 and 3 steatohepatitis (NAFLD) were categorized as Group 2. Any relationship between the aminotransferase/alanine aminotransferase (AST/ALT), AST-to-platelet ratio index (APRI), and fibrosis-4 index (FIB-4) parameters and the diagnostic powers thereof were analyzed based on the collected data.
The mean age of the study sample (n=408) was 46.1±12.7 years. There were 352 (86.3%) and 56 individuals in Groups 1 and 2, respectively. Platelet-to-lymphocyte ratio (PLR) and AST/ALT values were significantly higher, whereas APRI values were significantly lower in Group 1 than in Group 2 (p=0.004, p<0.001, and p<0.001, respectively). There were significant correlations between the presence of NAFLD and PLR values of ≤90.78 [area under the curve (AUC)=0.619, 95% confidence interval (CI): 0.570-0.666, p=0.007], AST/ALT values of ≤0.91 (AUC=0.802, 95% CI: 0.760-0.840, p<0.001), and APRI values of >0.22 (AUC=0.687, 95% CI: 0.640-0.732, p<0.001).
The composite noninvasive indices, including PLR, AST/ALT, and APRI, can be beneficial in predicting NAFLD in healthy individuals.
非侵入性评分工具在筛查和诊断非酒精性脂肪性肝病（NAFLD）方面的疗效仍存在争议。天门冬氨酸氨基转移酶/丙氨酸氨基转移酶（AST/ALT）比值、天冬氨酸氨基转移酶/血小板比值指数（APRI）和纤维化-4（FIB-4）指数是区分中重度脂肪性肝炎最常用的参数。在这种情况下，本研究的目的是评估在接受家庭医学门诊治疗的无症状健康受试者中，通过超声检查预测非侵入性工具在预测中重度脂肪性肝炎方面的诊断准确性。
本回顾性研究的人群由 2021 年 1 月至 7 月期间在体检计划中接受测试的健康个体组成。所有纳入研究的参与者均接受了相关的实验室检查和肝脏超声（US）检查。脂肪性肝炎的分级采用 US 图像，分为正常（0 级）、轻度（1 级）、中度（2 级）和重度（3 级）。将脂肪性肝炎 0 级和 1 级的患者归入第 1 组，而脂肪性肝炎 2 级和 3 级（NAFLD）的患者归入第 2 组。分析了收集到的数据中 AST/ALT、AST-血小板比值指数（APRI）和纤维化-4 指数（FIB-4）参数与诊断能力之间的任何关系。
研究样本（n=408）的平均年龄为 46.1±12.7 岁。第 1 组和第 2 组分别有 352（86.3%）和 56 名患者。第 1 组的血小板与淋巴细胞比值（PLR）和 AST/ALT 值显著较高，而 APRI 值显著较低（p=0.004、p<0.001 和 p<0.001）。NAFLD 的存在与 PLR 值≤90.78 [曲线下面积（AUC）=0.619，95%置信区间（CI）：0.570-0.666，p=0.007]、AST/ALT 值≤0.91（AUC=0.802，95%CI：0.760-0.840，p<0.001）和 APRI 值>0.22（AUC=0.687，95%CI：0.640-0.732，p<0.001）之间存在显著相关性。
包括 PLR、AST/ALT 和 APRI 在内的复合非侵入性指数可有助于预测健康个体中的 NAFLD。
