Gupta Abhinav, Duggal Ranjana, Gupta Deepanjali, Gupta Anil K
Professor, Department of Medicine, Acharya Shri Chander College of Medical Sciences and Hospital, Jammu, Jammu and Kashmir, India, Orcid: https://orcid.org/0000-0003-3537-3723, Corresponding Author.
Senior Resident, Department of Physiology, Government Medical College, Jammu, Jammu and Kashmir, India.
J Assoc Physicians India. 2025 Sep;73(9):e1-e4. doi: 10.59556/japi.73.1114.
Liver fibrosis worsens prognosis in metabolic dysfunction-associated fatty liver disease (MAFLD). FibroScan® is the most widely used noninvasive tool for evaluating fibrosis, but performing this assessment requires specialized equipment and expertise. This study aimed to assess the potential of four additional noninvasive techniques for diagnosing liver fibrosis that rely on routine laboratory measurements, that is, fibrosis (FIB)-4 score, FIB-5 score, aspartate aminotransferase (AST)/alanine transaminase (ALT) ratio, and the aspartate aminotransferase to platelet ratio index (APRI).
This study was performed following a cross-sectional observational design at a tertiary care hospital in India. The study included adult patients who were observed to have elevated serum AST and ALT levels and fatty deposition on ultrasonography, as these indicate a risk for liver fibrosis, that is, MAFLD or metabolic dysfunction-associated steatohepatitis. The specificity and sensitivity of FIB-4, FIB-5, APRI, and AST/ALT ratio were compared with those of FibroScan® (FibroScan® 502, Echosens, Paris, France).
Among the alternative noninvasive methods, FIB-4 had the highest specificity (78%) and sensitivity (85%) that were closest to the specificity (88%) and sensitivity (92%) of FibroScan®. FIB-5 and APRI demonstrated moderate sensitivity (80% and 76%, respectively) and specificity (75 and 70%, respectively). The AST/ALT ratio had relatively poor diagnostic capability, with a specificity of 60% and sensitivity of 65%. The area under the curve (AUC) for the methods being compared was 0.82 (FIB-4), 0.79 (FIB-5), 0.74 (APRI), and 0.65 (AST/ALT ratio).
FibroScan® is the preferred option for evaluating liver fibrosis in patients with MAFLD. However, when unavailable, FIB-4 may be the next most reliable alternative for identifying or excluding advanced fibrosis. Other methods (FIB-5, APRI, and AST/ALT) are less accurate.
肝纤维化会使代谢功能障碍相关脂肪性肝病（MAFLD）的预后恶化。FibroScan®是评估纤维化最广泛使用的非侵入性工具，但进行此项评估需要专业设备和专业知识。本研究旨在评估另外四种依赖常规实验室检测来诊断肝纤维化的非侵入性技术的潜力，即纤维化（FIB）-4评分、FIB-5评分、天冬氨酸氨基转移酶（AST）/丙氨酸氨基转移酶（ALT）比值以及天冬氨酸氨基转移酶与血小板比值指数（APRI）。
本研究在印度一家三级医疗医院按照横断面观察性设计进行。研究纳入了血清AST和ALT水平升高且超声检查有脂肪沉积的成年患者，因为这些提示存在肝纤维化风险，即MAFLD或代谢功能障碍相关脂肪性肝炎。将FIB-4、FIB-5、APRI和AST/ALT比值的特异性和敏感性与FibroScan®（FibroScan® 502，法国巴黎Echosens公司）的进行比较。
在替代的非侵入性方法中，FIB-4具有最高的特异性（78%）和敏感性（85%），最接近FibroScan®的特异性（88%）和敏感性（92%）。FIB-5和APRI表现出中等的敏感性（分别为80%和76%）和特异性（分别为75%和70%）。AST/ALT比值的诊断能力相对较差，特异性为60%，敏感性为65%。所比较方法的曲线下面积（AUC）分别为0.82（FIB-4）、0.79（FIB-5）、0.74（APRI）和0.65（AST/ALT比值）。
FibroScan®是评估MAFLD患者肝纤维化的首选方法。然而，当无法使用时，FIB-4可能是识别或排除晚期纤维化的次优可靠替代方法。其他方法（FIB-5、APRI和AST/ALT）准确性较低。
