School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
Division of Molecular and Clinical Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK; Directorate of Public Health, Kings Cross Hospital, NHS Tayside, Dundee, UK.
Ann Hepatol. 2024 Mar-Apr;29(2):101280. doi: 10.1016/j.aohep.2023.101280. Epub 2024 Jan 14.
Early diagnosis of metabolic dysfunction-associated steatotic liver disease (MASLD), especially with advanced fibrosis, is crucial due to the increased risk of complications and mortality. Serum alanine aminotransferase (ALT) is commonly used; however, many patients have normal ranges (<55 U/L) who may remain undetected. We investigated the clinical implications of a lower ALT cut-off (>30 U/L) using intelligent liver function testing (iLFT) to identify MASLD patients with and without advanced fibrosis in primary care.
All patients entering the iLFT diagnostic pathway had liver aetiological screening investigations if ALT >30 U/L. In those with MASLD the proportions with and without advanced fibrosis at different ALT thresholds: 31-41 U/L, 42-54 U/L and ≥55 U/L were compared.
16,373 patients underwent iLFT between March 2016 to April 2022. 762 (5 %) patients had MASLD with abnormal fibrosis scores, while 908 (6 %) had MASLD with normal fibrosis scores. 428 (56 %) patients were assessed in liver clinics, where 169 (39 %) had evidence of fibrosis. Of these, 22 (13 %) had ALT 31-41 U/L, 31 (18 %) had ALT 42-54 U/L and 116 (69 %) had ALT ≥55 U/L. 145 (86 %) patients had advanced fibrosis or cirrhosis, where 20 (14 %) had ALT 31-41 U/L, 28 (19 %) had ALT 42-54 U/L and 97 (67 %) had ALT ≥55 U/L.
33 % of MASLD patients with advanced fibrosis or cirrhosis had ALT 31-54 U/L, who would have been missed using the conventional ALT range. This suggests that lowering the ALT cut-off improves diagnosis of MASLD with advanced fibrosis in primary care.
代谢相关脂肪性肝病（MASLD）的早期诊断，尤其是晚期纤维化的诊断，至关重要，因为这会增加并发症和死亡率的风险。血清丙氨酸氨基转移酶（ALT）通常用于此目的；然而，许多患者的 ALT 值在正常范围内（<55 U/L），可能会被漏诊。我们使用智能肝功能检测（iLFT）研究了较低的 ALT 截止值（>30 U/L）的临床意义，以确定初级保健中是否存在伴有或不伴有晚期纤维化的 MASLD 患者。
所有 ALT >30 U/L 的进入 iLFT 诊断途径的患者均进行肝脏病因筛查检查。在 MASLD 患者中，比较了不同 ALT 阈值（31-41 U/L、42-54 U/L 和≥55 U/L）下伴有和不伴有晚期纤维化的患者比例。
2016 年 3 月至 2022 年 4 月期间，共有 16373 名患者接受了 iLFT。762 名（5%）患者患有 MASLD，伴有异常纤维化评分，908 名（6%）患者患有 MASLD，伴有正常纤维化评分。428 名（56%）患者在肝脏诊所进行了评估，其中 169 名（39%）有纤维化证据。在这些患者中，22 名（13%）的 ALT 值为 31-41 U/L，31 名（18%）的 ALT 值为 42-54 U/L，116 名（69%）的 ALT 值≥55 U/L。145 名（86%）患者有晚期纤维化或肝硬化，其中 20 名（14%）的 ALT 值为 31-41 U/L，28 名（19%）的 ALT 值为 42-54 U/L，97 名（67%）的 ALT 值≥55 U/L。
33%的伴有晚期纤维化或肝硬化的 MASLD 患者的 ALT 值为 31-54 U/L，使用常规 ALT 范围可能会漏诊这些患者。这表明降低 ALT 截止值可提高初级保健中 MASLD 伴有晚期纤维化的诊断率。
