用于诊断纤维化性MASH及预测肝脏相关事件的acFibroMASH指数：一项国际多中心研究
acFibroMASH Index for the Diagnosis of Fibrotic MASH and Prediction of Liver-related Events: An International Multicenter Study.
作者信息
Feng Gong, Mózes Ferenc E, Ji Dong, Treeprasertsuk Sombat, Okanoue Takeshi, Shima Toshihide, Liang Huiqing, Tsochatzis Emmanuel, Chen Jinjun, Schattenberg Jörn M, Labenz Christian, Mahadeva Sanjiv, Chan Wah Kheong, Chi Xiaoling, Delamarre Adèle, de Lédinghen Victor, Petta Salvatore, Bugianesi Elisabetta, Hagström Hannes, Boursier Jérôme, Calleja José Luis, Goh George Boon-Bee, Gallego-Durán Rocio, Sanyal Arun J, Fan Jian-Gao, Castéra Laurent, Lai Michelle, Harrison Stephen A, Romero-Gomez Manuel, Kim Seung Up, Zhu Yongfen, Ooi Geraldine, Shi Junping, Yoneda Masato, Nakajima Atsushi, Zhang Jing, Lupsor-Platon Monica, Zhong Bihui, Cobbold Jeremy F L, Ye Chun-Yan, Eddowes Peter J, Newsome Philip, Li Jie, George Jacob, He Fangping, Song Myeong Jun, Tang Hong, Fan Yuchen, Jia Jidong, Xu Liang, Lin Su, Li Yiling, Lu Zhonghua, Nan Yuemin, Niu Junqi, Yan Xuebing, Zhou Yongjian, Liu Chenghai, Deng Hong, Ye Qing, Zeng Qing-Lei, Li Lei, Wang Jing, Yang Song, Lin Huapeng, Lee Hye Won, Yip Terry Cheuk-Fung, Fournier-Poizat Céline, Wong Grace Lai-Hung, Pennisi Grazia, Armandi Angelo, Liu Wen-Yue, Shang Ying, de Saint-Loup Marc, Llop Elba, Teh Kevin Kim Jun, Lara-Romero Carmen, Asgharpour Amon, Mahgoub Sara, Chan Mandy Sau-Wai, Canivet Clemence M, Ji Fanpu, Xin Yongning, Chai Jin, Dong Zhiyong, Targher Giovanni, Byrne Christopher D, He Na, Mi Man, Ye Feng, Wong Vincent Wai-Sun, Pavlides Michael, Zheng Ming-Hua
机构信息
Xi'an Medical University, Xi'an, China; Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.
出版信息
Clin Gastroenterol Hepatol. 2025 Apr;23(5):785-796. doi: 10.1016/j.cgh.2024.07.045. Epub 2024 Oct 2.
BACKGROUND & AIMS: Metabolic dysfunction-associated steatohepatitis (MASH) and fibrotic MASH are significant health challenges. This multi-national study aimed to validate the acMASH index (including serum creatinine and aspartate aminotransferase concentrations) for MASH diagnosis and develop a new index (acFibroMASH) for non-invasively identifying fibrotic MASH and exploring its predictive value for liver-related events (LREs).
METHODS
We analyzed data from 3004 individuals with biopsy-proven metabolic dysfunction-associated steatotic liver disease (MASLD) across 29 Chinese and 9 international cohorts to validate the acMASH index and develop the acFibroMASH index. Additionally, we utilized the independent external data from a multi-national cohort of 9034 patients with MASLD to examine associations between the acFibroMASH index and the risk of LREs.
RESULTS
In the pooled global cohort, the acMASH index identified MASH with an area under the receiver operating characteristic curve (AUROC) of 0.802 (95% confidence interval [CI], 0.786-0.818). The acFibroMASH index (including the acMASH index plus liver stiffness measurement) accurately identified fibrotic MASH with an AUROC of 0.808 in the derivation cohort and 0.800 in the validation cohort. Notably, the AUROC for the acFibroMASH index was 0.835 (95% CI, 0.786-0.882), superior to that of the FAST score at 0.750 (95% CI, 0.693-0.800; P < .01) in predicting the 5-year risk of LREs. Patients with acFibroMASH >0.39 had a higher risk of LREs than those with acFibroMASH <0.15 (adjusted hazard ratio, 11.23; 95% CI, 3.98-31.66).
CONCLUSIONS
This multi-ethnic study validates the acMASH index as a reliable, noninvasive test for identifying MASH. The newly proposed acFibroMASH index is a reliable test for identifying fibrotic MASH and predicting the risk of LREs.
背景与目的
代谢功能障碍相关脂肪性肝炎（MASH）和纤维化MASH是重大的健康挑战。这项多国研究旨在验证用于MASH诊断的acMASH指数（包括血清肌酐和天冬氨酸转氨酶浓度），并开发一种新的指数（acFibroMASH），用于非侵入性识别纤维化MASH并探索其对肝脏相关事件（LRE）的预测价值。
方法
我们分析了来自29个中国队列和9个国际队列的3004例经活检证实的代谢功能障碍相关脂肪性肝病（MASLD）患者的数据，以验证acMASH指数并开发acFibroMASH指数。此外，我们利用来自9034例MASLD患者的多国队列的独立外部数据，研究acFibroMASH指数与LRE风险之间的关联。
结果
在汇总的全球队列中，acMASH指数识别MASH的受试者工作特征曲线下面积（AUROC）为0.802（95%置信区间[CI]，0.786-0.818）。acFibroMASH指数（包括acMASH指数加肝脏硬度测量）在推导队列中以AUROC 0.808、在验证队列中以AUROC 0.800准确识别纤维化MASH。值得注意的是，在预测LRE的5年风险方面，acFibroMASH指数的AUROC为0.835（95%CI，0.786-0.882），优于FAST评分的AUROC 0.750（95%CI，0.693-0.800；P<.01）。acFibroMASH>0.39的患者发生LRE的风险高于acFibroMASH<0.15的患者（调整后风险比，11.23；95%CI，3.98-31.66）。
结论
这项多民族研究验证了acMASH指数是一种可靠的、用于识别MASH的非侵入性检测方法。新提出的acFibroMASH指数是一种可靠的检测方法，用于识别纤维化MASH并预测LRE的风险。
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