Sachar Moniyka, Pan Jason J, Park James
Department of Medicine at NYU Grossman School of Medicine, New York, New York.
Division of Gastroenterology & Hepatology at NYU Langone Health, New York, New York.
Gastro Hep Adv. 2022 Jul 3;1(6):1006-1013. doi: 10.1016/j.gastha.2022.06.011. eCollection 2022.
Metabolic dysfunction-associated fatty liver disease (MAFLD) is diagnosed in patients with hepatic steatosis who meet at least one of the following criteria: body mass index >25, diabetes mellitus type 2, and metabolic dysfunction. Given about one-third of Americans meet the criteria for MAFLD, there is an unmet need for a score to noninvasively triage patients who need transient elastography and possible biopsy. We determined the risk factors for advanced fibrosis (F3+ on transient elastography) in a cohort of 2671 MAFLD patients and developed the MAFLD fibrosis-4 (FIB-4) score to help clinicians predict the risk of advanced fibrosis.
Multivariate logistic regression analysis and independent t-tests were used to evaluate the relationship between physical exam parameters, lab values, and interview responses and risk of advanced fibrosis. The most significant risk factors were used to build the MAFLD FIB-4 score, equivalent to -46.55 + (7.89∗log[waist circumference]) + (1.25∗log[fasting plasma glucose]) + (0.85∗FIB-4 score).
Risk factors for advanced fibrosis in MAFLD patients are elevated body mass index (odds ratio [OR] = 5.90; < .01), waist circumference (OR = 3.53; < .01), high fasting plasma glucose (OR = 2.45; < .01), high homeostasis model assessment-estimated insulin resistance score (OR = 2.18; = .02), high triglycerides (OR = 1.94; = .03), positive hepatitis C RNA (OR = 14.92; = .02), high ferritin (OR = 1.58; = .05), and alanine transaminase > aspartate aminotransferase (OR = 1.54; = .04). The MAFLD FIB-4 score has a specificity of 80%, sensitivity of 97%, and receiver operating characteristic of 0.85 (compared to the receiver operating characteristic of 0.60 for FIB-4 and 0.68 for nonalcoholic fatty liver disease existing scores) for the detection of advanced fibrosis in MAFLD patients.
Clinicians can utilize the MAFLD FIB-4 score to noninvasively identify patients with advanced fibrosis risk for further evaluation and management.
代谢功能障碍相关脂肪性肝病（MAFLD）在符合以下至少一项标准的肝脂肪变性患者中被诊断：体重指数>25、2型糖尿病和代谢功能障碍。鉴于约三分之一的美国人符合MAFLD标准，对于一种用于对需要瞬时弹性成像检查及可能进行活检的患者进行无创分类的评分存在未满足的需求。我们在2671例MAFLD患者队列中确定了进展期肝纤维化（瞬时弹性成像检查为F3+）的危险因素，并开发了MAFLD纤维化-4（FIB-4）评分，以帮助临床医生预测进展期肝纤维化的风险。
采用多因素logistic回归分析和独立t检验来评估体格检查参数、实验室检查值及访谈回答与进展期肝纤维化风险之间的关系。使用最显著的危险因素构建MAFLD FIB-4评分，该评分等于-46.55 +（7.89×log[腰围]）+（1.25×log[空腹血糖]）+（0.85×FIB-4评分）。
MAFLD患者进展期肝纤维化的危险因素包括体重指数升高（比值比[OR]=5.90；P<.01）、腰围（OR=3.53；P<.01）、空腹血糖升高（OR=2.45；P<.01）、高稳态模型评估-估计胰岛素抵抗评分（OR=2.18；P=.02）、高甘油三酯（OR=1.94；P=.03）、丙型肝炎RNA阳性（OR=14.92；P=.02）、高铁蛋白（OR=1.58；P=.05）以及丙氨酸转氨酶>天冬氨酸转氨酶（OR=1.54；P=.04）。MAFLD FIB-4评分在检测MAFLD患者进展期肝纤维化时，特异性为80%，敏感性为97%，受试者工作特征曲线下面积为0.85（相比之下，FIB-4的受试者工作特征曲线下面积为0.60，非酒精性脂肪性肝病现有评分的受试者工作特征曲线下面积为0.68）。
临床医生可利用MAFLD FIB-4评分无创识别有进展期肝纤维化风险的患者，以便进行进一步评估和管理。
