Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea.
Department of Internal Medicine, Kyungpook National University Hospital, School of Medicine, Kyungpook National University, Daegu, Korea.
Gut Liver. 2024 Mar 15;18(2):283-293. doi: 10.5009/gnl230128. Epub 2023 Aug 14.
BACKGROUND/AIMS: Noninvasive methods have become increasingly critical in the diagnosis of fibrosis in chronic liver diseases. Herein, we compared the diagnostic performance of serum Mac2 binding protein glycosylation isomer (M2BPGi) and other serological panels for fibrosis in patients with nonalcoholic fatty liver disease (NAFLD) and proposed an improved two-step diagnostic algorithm for advanced fibrosis.
We enrolled 231 patients diagnosed with NAFLD who underwent a liver biopsy. We subsequently evaluated the diagnostic performance of serological panels, including serum M2BPGi, a fibrosis index based on four factors (FIB-4), aspartate aminotransferase-to-platelet ratio index (APRI), and NAFLD fibrosis score (NFS), in predicting the stage of liver fibrosis. We then constructed a two-step algorithm to better differentiate advanced fibrosis.
The areas under the receiver operating characteristic curves of serum M2BPGi, FIB-4, APRI, and NFS for advanced fibrosis (≥F3) were 0.823, 0.858, 0.779, and 0.827, respectively. To reduce the performance of unnecessary liver biopsy, we propose a two-step algorithm using FIB-4 as an initial diagnostic tool and serum M2BPGi (≥0.6) as an additional diagnostic method for patients classified as intermediate (23%). Using the proposed algorithm, the sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 0.812, 0.814, 0.814, 0.600, and 0.927, respectively.
Serum M2BPGi is a simple and effective test for advanced fibrosis in patients with NAFLD. Application of the two-step algorithm based on FIB-4 and M2BPGi proposed here can improve diagnostic performance and reduce unnecessary tests, making diagnosis easily accessible, especially in primary medical centers.
背景/目的：非侵入性方法在慢性肝病纤维化的诊断中变得越来越重要。在此，我们比较了血清 Mac2 结合蛋白糖基化异构体（M2BPGi）和其他几种用于诊断非酒精性脂肪性肝病（NAFLD）患者纤维化的血清学指标的诊断性能，并提出了一种用于诊断晚期纤维化的两步改进诊断算法。
我们纳入了 231 例经肝活检诊断为 NAFLD 的患者。随后，我们评估了包括血清 M2BPGi、基于四个因素的纤维化指数（FIB-4）、天冬氨酸氨基转移酶与血小板比值指数（APRI）和非酒精性脂肪性肝病纤维化评分（NFS）在内的血清学指标对预测肝纤维化分期的诊断性能。然后，我们构建了一个两步算法，以更好地区分晚期纤维化。
血清 M2BPGi、FIB-4、APRI 和 NFS 对晚期纤维化（≥F3）的受试者工作特征曲线下面积分别为 0.823、0.858、0.779 和 0.827。为了降低不必要的肝活检的性能，我们提出了一种两步算法，将 FIB-4 作为初始诊断工具，将血清 M2BPGi（≥0.6）作为分类为中等程度（23%）患者的附加诊断方法。使用该算法，其灵敏度、特异度、准确度、阳性预测值和阴性预测值分别为 0.812、0.814、0.814、0.600 和 0.927。
血清 M2BPGi 是一种简单有效的用于诊断 NAFLD 患者晚期纤维化的检测方法。应用我们提出的基于 FIB-4 和 M2BPGi 的两步算法可以提高诊断性能，减少不必要的检查，使诊断更易于进行，特别是在基层医疗中心。
