Care standards for non-alcoholic fatty liver disease in the United Kingdom 2016: a cross-sectional survey
Care standards for non-alcoholic fatty liver disease in the United Kingdom 2016: a cross-sectional survey
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DOI：
10.1136/flgastro-2017-100806
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发表时间：
2017-10-01
影响因子：
2.6
通讯作者：
Tsochatzism, Emmanouil
中科院分区：
文献类型：
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作者：
Sheridan, David A.;Aithal, Guru;Tsochatzism, Emmanouil
美国国家健康与护理卓越研究所和欧洲肝脏研究协会、欧洲糖尿病研究协会、欧洲肥胖研究协会于 2016 年发布了非酒精性脂肪性肝病 (NAFLD) 评估的客观指南。在发布这些指南之前，我们对胃肠病学家和肝脏病学家进行了有关 NAFLD 诊断和管理的横断面调查。 设计 2016 年 2 月至 2016 年 5 月期间，向英国肝脏研究协会和英国胃肠病学会的成员分发了一项在线调查。结果 175 名胃肠病学家/肝病学家做出了回应，其中 116 名完成了调查，代表 84 个英国中心。 22% 有当地 NAFLD 指南。 45% 的人每年从初级保健机构收到超过 300 次转诊，以调查肝功能测试 (LFT) 异常。临床评估往往在二级而非初级保健中进行，包括体重指数（82% vs 26%）、无创肝脏筛查（86% vs 32%）和超声检查（81% vs 37%）。广泛使用的无创纤维化风险分层工具包括 AST/ALT 比值（53%）、Fibroscan（50%）和 NAFLD 纤维化评分（41%）。 78% 的人在选定的病例中考虑进行肝活检。 50% 的人建议将 10% 的减肥目标作为一线治疗。生活方式干预措施的实施大部分交还给初级保健（56%）。少数人可以直接获得社区体重管理服务（22%）。 F3/4 纤维化（72.9%）和高风险非侵入性纤维化测试（51%）有利于随访。活检时单纯脂肪变性（30%）和低风险非侵入性评分（25%）有利于出院。 结论 该调查强调了 NAFLD 评估服务提供需要改进的领域，包括提高对 2 型糖尿病患者非酒精性脂肪性肝炎的认识、简化异常 LFT 转诊途径、定义非侵入性肝纤维化评估工具、肝活检的使用、管理代谢综合征特征和改善生活方式干预的机会。
Objective Guidelines for the assessment of non-alcoholic fatty liver disease (NAFLD) have been published in 2016 by National Institute for Health and Care Excellence and European Associations for the study of the Liver-European Association for the study of Diabetes-European Association for the study of Obesity. Prior to publication of these guidelines, we performed a cross-sectional survey of gastroenterologists and hepatologists regarding NAFLD diagnosis and management.Design An online survey was circulated to members of British Association for the Study of the Liver and British Society of Gastroenterology between February 2016 and May 2016.Results 175 gastroenterologists/hepatologists responded, 116 completing the survey, representing 84 UK centres. 22% had local NAFLD guidelines. 45% received >300 referrals per year from primary care for investigation of abnormal liver function tests (LFTs). Clinical assessment tended to be performed in secondary rather than primary care including body mass index (82% vs 26%) and non-invasive liver screen (86% vs 32%) and ultrasound (81 % vs 37%).Widely used tools for non-invasive fibrosis risk stratification were AST/ALT ratio (53%), Fibroscan (50%) and NAFLD fibrosis score (41 %). 78% considered liver biopsy in selected cases. 50% recommended 10% weight loss target as first-line treatment. Delivery of lifestyle interventions was mostly handed back to primary care (56%). A minority have direct access to community weight management services (22%). Follow-up was favoured by F3/4 fibrosis (72.9%), and high-risk non-invasive fibrosis tests (51 %). Discharge was favoured by simple steatosis at biopsy (30%), and low-risk non-invasive scores (25%).Conclusions The survey highlights areas for improvement of service provision for NAFLD assessment including improved recognition of non-alcoholic steatohepatitis in people with type 2 diabetes, streamlining abnormal LFT referral pathways, defining non-invasive liver fibrosis assessment tools, use of liver biopsy, managing metabolic syndrome features and improved access to lifestyle interventions.