六项国际指南使用Fibrosis-4和FibroScan对2型糖尿病中代谢功能障碍相关脂肪性肝病进行风险分层的有效性

Effectiveness of Six International Guidelines Using Fibrosis-4 and FibroScan for Risk Stratification of Metabolic Dysfunction-associated Steatotic Liver Disease in Type 2 Diabetes.

作者信息

Vidal-Trécan Tiphaine, Julla Jean-Baptiste, El Khoury Tania, Venteclef Nicolas, Riveline Jean-Pierre, Paradis Valérie, Valla Dominique, Gautier Jean-François, Castera Laurent

机构信息

Centre Universitaire du Diabète et de ses Complications, AP-HP, Hôpital Lariboisière, Paris, France.

Centre Universitaire du Diabète et de ses Complications, AP-HP, Hôpital Lariboisière, Paris, France; INSERM UMR-S1151, CNRS UMR-S8253, Immediab Lab, Institut Necker-Enfants Malades, Université Paris Cité, Paris, France.

出版信息

Clin Gastroenterol Hepatol. 2025 May 8. doi: 10.1016/j.cgh.2025.02.018.

DOI:10.1016/j.cgh.2025.02.018

PMID:40348110

Abstract

BACKGROUND & AIMS: Screening of patients with type 2 diabetes (T2D) and metabolic dysfunction-associated steatotic liver disease (MASLD), who are at high risk for significant (F2F4) or advanced fibrosis (F3F4), is an unmet need. Recently, several pathways have been proposed to screen patients at risk for MASLD and fibrosis. We aimed to compare their performance in a large cohort of outpatients with T2D.

METHODS

A total of 1572 participants with T2D (60% male; median age, 61 years) attending a diabetes clinic were prospectively screened for MASLD (steatosis and/or elevated alanine aminotransferase) of whom 163 underwent liver biopsy. The European Association for the Study of the Liver (EASL) 2021, 2024, American Association for the Study of Liver Diseases (AASLD), American Gastroenterological Association (AGA), American Association of Clinical Endocrinology (AACE), and American Diabetes Association (ADA) pathways were applied using Fibrosis-4 followed by vibration-controlled transient elastography (VCTE). Outcomes were the percent requiring hepatology referral and the false negative and positive rates in patients according to liver biopsy (F3F4 for EASL, AGA and AASLD and F2F4 for AACE and ADA).

RESULTS

In the 1572 patients, the 6 pathways performed similarly, identifying 12% of patients requiring hepatology referral. In the 163 patients, the false positive rates (36%-39%) were higher than the false negative rates (15%-18%) for F3F4 (EASL, AGA, and AASLD), whereas the opposite was true for F2F4 (AACE and ADA) (17% and 44%, respectively). Using VCTE as the first line, resulted in a higher percentage of hepatology referrals (19%) and a low false negative rate (3%) for F3F4.

CONCLUSION

The percentage of patients with T2D in diabetes clinics requiring referral to hepatology (12%) was similar across the 6 pathways, but higher (19%) when VCTE was used as the first line, with a low false negative rate (3%) for advanced fibrosis.

摘要

背景与目的

对2型糖尿病（T2D）和代谢功能障碍相关脂肪性肝病（MASLD）患者进行筛查，这些患者存在显著（F2 - F4）或晚期纤维化（F3 - F4）的高风险，这是一项尚未满足的需求。最近，已经提出了几种途径来筛查有MASLD和纤维化风险的患者。我们旨在比较它们在一大群T2D门诊患者中的表现。

方法

共有1572名就诊于糖尿病诊所的T2D参与者（60%为男性；中位年龄61岁）接受了MASLD（脂肪变性和/或丙氨酸转氨酶升高）的前瞻性筛查，其中163人接受了肝活检。应用欧洲肝脏研究协会（EASL）2021年、2024年、美国肝脏病研究协会（AASLD）、美国胃肠病学会（AGA）、美国临床内分泌学会（AACE）和美国糖尿病协会（ADA）的途径，先使用Fibrosis - 4，然后进行振动控制瞬时弹性成像（VCTE）。结果是需要转诊至肝病科的患者百分比以及根据肝活检（EASL、AGA和AASLD为F3 - F4，AACE和ADA为F2 - F4）得出的患者假阴性和假阳性率。

结果

在1572名患者中，6种途径的表现相似，识别出12%需要转诊至肝病科的患者。在163名患者中，F3 - F4（EASL、AGA和AASLD）的假阳性率（36% - 39%）高于假阴性率（15% - 18%），而F2 - F4（AACE和ADA）则相反（分别为17%和44%）。以VCTE作为一线检查，导致更高比例的患者转诊至肝病科（19%），且F3 - F4的假阴性率较低（3%）。