Department of Pediatric Gastroenterology, Nephrology and Metabolic Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität zu Berlin and Humboldt-Universität zu, Berlin, Germany.
Division of Pediatric Gastroenterology and Hepatology, Department of Pediatric Kidney, Liver, and Metabolic Diseases Hannover, Hannover Medical School, Hanover, Germany.
J Pediatr Gastroenterol Nutr. 2024 Jan;78(1):27-35. doi: 10.1002/jpn3.12068. Epub 2023 Dec 29.
Nonalcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children. Roughly a quarter of paediatric patients with NAFLD develop nonalcoholic steatohepatitis and fibrosis. Here, we evaluated the diagnostic accuracy of previously published noninvasive fibrosis scores to predict liver fibrosis in a large European cohort of paediatric patients with NAFLD.
The 457 patients with biopsy-proven NAFLD from 10 specialized centers were included. We assessed diagnostic accuracy for the prediction of any (F ≥ 1), moderate (F ≥ 2) or advanced (F ≥ 3) fibrosis for the AST/platelet ratio (APRI), Fibrosis 4 score (FIB-4), paediatric NAFLD fibrosis score (PNFS) and paediatric NAFLD fibrosis index (PNFI).
Patients covered the full spectrum of fibrosis (F0: n = 103; F1: n = 230; F2: n = 78; F3: n = 44; F4: n = 2). None of the scores were able to accurately distinguish the presence of any fibrosis from no fibrosis. For the detection of moderate fibrosis, area under the receiver operating characteristic curve (AUROC) were: APRI: 0.697, FIB-4: 0.663, PNFI: 0.515, PNFS: 0.665, while for detection of advanced fibrosis AUROCs were: APRI: 0.759, FIB-4: 0.611, PNFI: 0.521, PNFS: 0.712. Fibrosis scores showed no diagnostic benefit over using ALT ≤ 50/ > 50 IU/L as a cut-off.
Established fibrosis scores lack diagnostic accuracy to replace liver biopsy for staging of fibrosis, giving similar results as compared to using ALT alone. New diagnostic tools are needed for Noninvasive risk-stratification in paediatric NAFLD.
非酒精性脂肪性肝病（NAFLD）是儿童中最常见的慢性肝病。大约四分之一的患有 NAFLD 的儿科患者会发展为非酒精性脂肪性肝炎和纤维化。在这里，我们评估了以前发表的非侵入性纤维化评分在一个大型欧洲儿童 NAFLD 队列中预测肝纤维化的诊断准确性。
本研究纳入了来自 10 个专业中心的 457 名经活检证实为 NAFLD 的患者。我们评估了用于预测任何（F≥1）、中度（F≥2）或晚期（F≥3）纤维化的 AST/血小板比值（APRI）、纤维化 4 评分（FIB-4）、儿科非酒精性脂肪性肝病纤维化评分（PNFS）和儿科非酒精性脂肪性肝病纤维化指数（PNFI）的诊断准确性。
患者涵盖了纤维化的整个范围（F0：n=103；F1：n=230；F2：n=78；F3：n=44；F4：n=2）。没有任何评分能够准确地区分存在纤维化和没有纤维化。对于中度纤维化的检测，受试者工作特征曲线（ROC）下面积（AUROC）分别为：APRI：0.697、FIB-4：0.663、PNFI：0.515、PNFS：0.665，而对于晚期纤维化的检测 AUROCs 分别为：APRI：0.759、FIB-4：0.611、PNFI：0.521、PNFS：0.712。纤维化评分在区分纤维化分期方面并没有比 ALT≤50/>50IU/L 作为截断值更有诊断价值。
现有的纤维化评分缺乏诊断准确性，无法替代肝活检来分期纤维化，其结果与单独使用 ALT 相似。需要新的诊断工具来对儿科非酒精性脂肪性肝病进行非侵入性风险分层。
