Yi He, Zhang Yan, Zhou Ziwei, Sun Weixia, Wang Yifan, Tao Wenxuan, Yu Hekai, Yao Liqin, Li Jia, Li Ling
Department of Endocrinology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China; Key Laboratory of Environmental Medicine Engineering of Ministry of Education, Southeast University, Nanjing, China.
Department of Endocrinology, The Affiliated People's Hospital of Jiangsu University, Zhenjiang, China.
Endocr Pract. 2025 Aug;31(8):995-1001. doi: 10.1016/j.eprac.2025.04.021. Epub 2025 May 5.
To assess the performance of fibrosis-4 index (FIB-4), nonalcoholic fatty liver disease fibrosis score (NFS) and aspartate aminotransferase to platelet ratio index (APRI) for advanced fibrosis in metabolic dysfunction-associated fatty liver disease (MAFLD) subgroups categorized by concomitant liver conditions.
We conducted a multicentered study comprising inpatients with type 2 diabetes mellitus and MAFLD. Participants were categorized into 2 groups: MAFLD with pure metabolic etiologies (MAFLD-P) and MAFLD with mixed etiologies (MAFLD-M). Diagnostic performance of FIB-4, NFS, and APRI was assessed by area under the curve (AUC), sensitivity, and specificity.
This study comprised a total of 1475 participants, with a mean (SD) age of 58.4 (13) years and 835 (56.6%) males. FIB-4 and APRI had higher AUCs for advanced fibrosis in the MAFLD-M group than in the MAFLD-P group (MAFLD-M vs MAFLD-P: FIB-4 0.680 vs 0.591, P = .0442; APRI 0.723 vs 0.631, P = .0363). No significant difference was observed in the AUC of NFS between the 2 subgroups (MAFLD-M 0.572 vs MAFLD-P 0.617; P = .3237). Besides, the sensitivity of FIB-4 (69.6% vs 54.0%; P = .019) and APRI (43.5% vs 26.1%; P = .005) was higher in the MAFLD-M group. However, no significant difference in sensitivity of NFS and specificity of FIB-4, NFS, and APRI was observed between subgroups.
In this diagnostic study of the type 2 diabetes mellitus population, FIB-4 and APRI showed better performance for identifying advanced fibrosis in MAFLD with mixed etiologies.
评估纤维化-4指数（FIB-4）、非酒精性脂肪性肝病纤维化评分（NFS）和天冬氨酸氨基转移酶与血小板比值指数（APRI）在按合并肝脏疾病分类的代谢功能障碍相关脂肪性肝病（MAFLD）亚组中对晚期纤维化的诊断效能。
我们开展了一项多中心研究，纳入2型糖尿病合并MAFLD的住院患者。参与者被分为两组：单纯代谢病因的MAFLD（MAFLD-P）和混合病因的MAFLD（MAFLD-M）。通过曲线下面积（AUC）、敏感性和特异性评估FIB-4、NFS和APRI的诊断效能。
本研究共纳入1475名参与者，平均（标准差）年龄为58.4（13）岁，男性835名（56.6%）。MAFLD-M组中FIB-4和APRI对晚期纤维化的AUC高于MAFLD-P组（MAFLD-M组 vs MAFLD-P组：FIB-4为0.680 vs 0.591，P = 0.0442；APRI为0.723 vs 0.631，P = 0.0363）。两组间NFS的AUC无显著差异（MAFLD-M组为0.572，MAFLD-P组为0.617；P = 0.3237）。此外，MAFLD-M组中FIB-4（69.6% vs 54.0%；P = 0.019）和APRI（43.5% vs 26.1%；P = 0.005）的敏感性更高。然而，亚组间NFS的敏感性以及FIB-4、NFS和APRI的特异性均无显著差异。
在这项针对2型糖尿病人群的诊断研究中，FIB-4和APRI在识别混合病因MAFLD中的晚期纤维化方面表现更佳。
