Département d'Hépato-Gastroentérologie, Institut Arnault Tzanck, 06700, Saint-Laurent-du-Var, France.
Réseau ville hôpital hépatite C Cote d'Azur (RHeCCA), Nice, France.
Sci Rep. 2024 May 28;14(1):12198. doi: 10.1038/s41598-024-62549-3.
The objective of our work was to evaluate the screening of hepatic fibrosis in primary care using the FIB-4 score, automatically calculated. When the FIB-4 was ≥ 1.3, it was defined as positive, and ELF Test was performed. FIB-4 positivity was confirmed when ELF Test was ≥ 9.8 indicating an advanced fibrosis. Among the 3427 patients included, 869 (25%) had a positive FIB-4 score, 784 (22.5%) at intermediate (FIB-4: 1.3-2.67), and 85 (2.5%) at high risk of fibrosis (FIB-4 > 2.67). 509 (59%) of the FIB-4 positive were confirmed by the ELF Test. The percentage of confirmation was significantly higher in patients over 65 years (83 vs. 57%), with FIB-4 > 2.67 (80 vs. 56%), BMI > 25 (47 vs. 37%), and diabetes (24 vs. 14%), p = 0.001). In patients without known liver disease (92%), the practitioner identified a cause of disease in 27% of cases: mainly NAFLD and alcohol. Liver fibrosis was suspected on FIB-4 in 25% of patients in primary care. The ELF Test, performed as a second-line, improves the screening of liver fibrosis, particularly for FIB-4 intermediate results. A positive FIB-4 test allows physicians to recognize a liver disease, providing an opportunity for timely intervention.Clinical trial registration: Comité de protection des personnes du sud-ouest et outre-mer SI18.00832.201865-MS04-IDRCB 2018-A01571-54.
我们的工作目的是评估在初级保健中使用自动计算的 FIB-4 评分筛查肝纤维化。当 FIB-4≥1.3 时，定义为阳性，并进行 ELF 测试。当 ELF 测试≥9.8 时，FIB-4 阳性被确认，表明存在晚期纤维化。在纳入的 3427 名患者中，869 名（25%）FIB-4 评分阳性，784 名（22.5%）为中等（FIB-4：1.3-2.67），85 名（2.5%）为高风险纤维化（FIB-4>2.67）。FIB-4 阳性的 509 例（59%）通过 ELF 测试得到确认。在年龄超过 65 岁的患者中，FIB-4 阳性的确认率显著更高（83% vs. 57%），FIB-4>2.67（80% vs. 56%），BMI>25（47% vs. 37%），以及糖尿病（24% vs. 14%），p=0.001）。在没有已知肝病的患者（92%）中，医生在 27%的病例中确定了病因：主要是非酒精性脂肪性肝病和酒精。在初级保健中，25%的患者因 FIB-4 而怀疑存在肝纤维化。ELF 测试作为二线检查，可提高肝纤维化的筛查率，特别是对于 FIB-4 中等结果。FIB-4 检测阳性可使医生识别出肝脏疾病，为及时干预提供机会。临床试验注册：南西南和海外保护委员会 SI18.00832.201865-MS04-IDRCB 2018-A01571-54。
