Eur J Gastroen & Hepat：一种简单的非侵入性非酒精性脂肪性肝病肝纤维化评分系统
2013-06-19 王姗 编译 医学论坛网
非酒精性脂肪性肝病是一种常见疾病，许多患者的谷丙转氨酶水平正常。Stuart Mc Pherson医生称，现在需要一种用于进展期肝纤维化患者的有效的筛选方法，以便为患者提供专科护理。 研究小组对肝活检证实为非酒精性脂肪性肝病且谷丙转氨酶水平正常的病人进行非侵入性肝纤维化测试结果的评估。此研究包括研究小组对在1999～2009年间一家脂肪肝诊所的病人的评价。肝活检使用K
非酒精性脂肪性肝病是一种常见疾病，许多患者的谷丙转氨酶水平正常。Stuart Mc Pherson医生称，现在需要一种用于进展期肝纤维化患者的有效的筛选方法，以便为患者提供专科护理。
研究小组对肝活检证实为非酒精性脂肪性肝病且谷丙转氨酶水平正常的病人进行非侵入性肝纤维化测试结果的评估。此研究包括研究小组对在1999～2009年间一家脂肪肝诊所的病人的评价。肝活检使用Kleiner评分系统进行评估。这个团队着重研究天冬氨酸转移酶 谷丙转氨酶/谷丙转氨酶的比值、BARD、FIB-4，并计算非酒精性脂肪性肝病肝纤维化的评分。研究共包括305名患者。
此研究观察到，所有患者中处于进展期肝纤维化者，24%为谷丙转氨酶正常，17%为谷丙转氨酶升高。FIB-4为识别谷丙转氨酶正常的患者进展期肝纤维化的最佳指标。AST/谷丙转氨酶的比值、BARD和非酒精性脂肪性肝病肝纤维化评分对于ALT水平正常的患者的进展期肝纤维化评价，其敏感性很好，但特异性低。FIB-4在谷丙转氨酶升高的患者中结果最佳。使用FIB-4指标，可使61%谷丙转氨酶水平正常的患者及63%谷丙转氨酶升高的患者排除进展期肝纤维化，从而避免进行肝活检。相比之下，AST/谷丙转氨酶的比值、BARD及非酒精性脂肪性肝病评分可导致相当一部分病情较轻的病人进行肝活检。
McPherson医生认为：对于谷丙转氨酶正常及升高的患者，FIB-4是一项很好的指标，能够可靠的排除进展期肝纤维的存在，以降低肝活检的必要性。
Background
Nonalcoholic fatty liver disease (NAFLD) is common and many affected individuals have normal-range alanine aminotransferase (ALT) levels. There is a need for a robust screening tool to triage individuals with advanced fibrosis for specialist care.
Aim
The aim of this study was to assess the performance of noninvasive fibrosis tests in patients with biopsy-proven NAFLD and normal levels of ALT.
Methods
Patients presenting at a fatty liver clinic between 1999 and 2009 were included in the study. Liver biopsies were assessed using the Kleiner score. The aspartate aminotransferase (AST)/ALT ratio, BARD, FIB-4 and NAFLD fibrosis scores were calculated.
Results
A total of 305 patients were included [70 with normal ALT levels (women: ALT≤30 IU/l, men: ALT≤45 IU/l) and 235 with elevated levels]. In total, 24% of patients with normal ALT levels and 17% of those with elevated ALT levels had advanced fibrosis (Kleiner stage 3–4). The FIB-4 performed best in identifying advanced fibrosis in patients with normal ALT (area under receiver operating characteristic curve=0.86, 82% sensitivity, 77% specificity and 92% negative predictive value). The sensitivity of the AST/ALT ratio and BARD and NAFLD fibrosis scores for advanced fibrosis was good in patients with normal ALT levels (94, 94 and 82%, respectively), but the specificity was low (44, 26 and 51%, respectively). The FIB-4 yielded best results in patients with elevated ALT levels. Using the FIB-4, 61% of patients with normal ALT levels and 63% of those with elevated ALT levels could avoid liver biopsy to exclude advanced fibrosis. In contrast, AST/ALT ratio and BARD and NAFLD scores would have led to a high proportion of patients with mild disease having to undergo a biopsy.
Conclusion
The FIB-4 yielded good results in patients with normal or elevated ALT levels, reliably excluding advanced fibrosis and reducing the need for liver biopsy.
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#侵入性#
36
#脂肪性#
48
#非侵入性#
42
#肝纤维#
40
#脂肪性肝病#
43
#AST#
33
#酒精性#
34
#GAS#
42
#非酒精性#
44
#EPA#
34