诊断准确性的 FibroScan-AST (FAST) 评分、非酒精性脂肪性肝纤维化评分 (NFS)、FibroScan 和肝纤维化指数 (FIB-4) 在识别代谢相关脂肪性肝病合并慢性乙型肝炎患者的纤维化非酒精性脂肪性肝炎。
Diagnostic accuracy of FibroScan-AST (FAST) score, non-alcoholic fatty liver fibrosis score (NFS), FibroScan, and liver fibrosis index (FIB-4) for identifying fibrotic non-alcoholic steatohepatitis in patients with chronic hepatitis B with metabolic dysfunction-associated fatty liver disease.
机构信息
Department of Hepatology, The Third Hospital of Zhenjiang Affiliated Jiangsu University, Zhenjiang, China.
出版信息
Ann Med. 2024 Dec;56(1):2420858. doi: 10.1080/07853890.2024.2420858. Epub 2024 Oct 26.
OBJECTIVE
To evaluate the diagnostic value of the FibroScan-AST (FAST) score, non-alcoholic fatty liver fibrosis score (NFS), FibroScan, and liver fibrosis index (FIB-4) for identifying fibrotic non-alcoholic steatohepatitis (NASH) in patients with chronic hepatitis B (CHB) with metabolic dysfunction-associated fatty liver disease (MAFLD).
METHODS
All patients with CHB and MAFLD who underwent liver biopsy at the Zhenjiang Third Hospital affiliated with Jiangsu University between August 2010 and December 2022 were included in the analysis. The diagnostic accuracy of FAST, NFS, FibroScan, and FIB-4 for diagnosing NASH and liver fibrosis were evaluated based on the area under the receiver-operating characteristic curve (AUC).
RESULTS
A total of 156 patients with CHB combined with MAFLD were included, including 69 with NASH and fibrosis stage 2 or higher (NASH+ ≥ 2), and 16 with NASH and cirrhosis (NASH+F4). The AUC of FAST, NFS, liver stiffness measurement (LSM), and FIB-4 for diagnosing NASH+ ≥ 2 was 0.739 ( < 0.001), 0.643 ( = 0.006), 0.754 ( < 0.001), and 0.665 ( = 0.003), respectively. The specificity of FAST, NFS, LSM, and FIB-4 was 67%, 51.8%, 78.6% and 76.8%, respectively, and the sensitivity was 75%, 78.6%, 67.9%, and 53.6%, respectively. No significant differences were found between groups. The AUC of FAST, NFS, LSM, and FIB-4 for diagnosing NASH+F4 was 0.650 ( = 0.038), 0.725 ( = 0.001), 0.851 ( < 0.001), and 0.560 ( = 0.533), respectively. The specificity of the FAST, NFS, LSM, and FIB-4 was 55.9%, 50.0%, 71.6%, and 75.5%, respectively and the sensitivity was 80.0%, 100%, 100%, and 50.0%, respectively. The differences between AUCs of FIB-4 and FAST compared with LSM were 0.291 and 0.201, respectively ( < 0.05).
CONCLUSION
In patients with CHB combined with MAFLD, FAST did not have better accuracy than NFS and FIB-4 for predicting fibrotic NASH, whereas LSM had better accuracy than FAST and FIB-4.
目的
评估 FibroScan-AST（FAST）评分、非酒精性脂肪性肝病纤维化评分（NFS）、FibroScan 和肝纤维化指数（FIB-4）在诊断代谢相关脂肪性肝病合并慢性乙型肝炎（MAFLD）患者纤维化非酒精性脂肪性肝炎（NASH）中的诊断价值。
方法
选取 2010 年 8 月至 2022 年 12 月在江苏大学附属镇江第三医院行肝活检的 MAFLD 合并 CHB 患者，评估 FAST、NFS、FibroScan 和 FIB-4 对诊断 NASH 和肝纤维化的诊断准确性，采用受试者工作特征曲线（ROC）下面积（AUC）进行评价。
结果
共纳入 156 例 MAFLD 合并 CHB 患者，其中 NASH 且纤维化分期≥2 期（NASH+≥2）69 例，NASH 合并肝硬化（NASH+F4）16 例。FAST、NFS、肝脏硬度测量（LSM）和 FIB-4 诊断 NASH+≥2 的 AUC 分别为 0.739（<0.001）、0.643（=0.006）、0.754（<0.001）和 0.665（=0.003）。FAST、NFS、LSM 和 FIB-4 的特异度分别为 67%、51.8%、78.6%和 76.8%，敏感度分别为 75%、78.6%、67.9%和 53.6%。组间无显著差异。FAST、NFS、LSM 和 FIB-4 诊断 NASH+F4 的 AUC 分别为 0.650（=0.038）、0.725（=0.001）、0.851（<0.001）和 0.560（=0.533）。FAST、NFS、LSM 和 FIB-4 的特异度分别为 55.9%、50.0%、71.6%和 75.5%，敏感度分别为 80.0%、100%、100%和 50.0%。FIB-4 与 FAST 相比，LSM 的 AUC 差异为 0.291（<0.05）。
结论
在 MAFLD 合并 CHB 患者中，FAST 预测纤维化 NASH 的准确性并不优于 NFS 和 FIB-4，而 LSM 的准确性优于 FAST 和 FIB-4。
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