A novel 2-step approach combining the NAFLD fibrosis score and liver stiffness measurement for predicting advanced fibrosis
A novel 2-step approach combining the NAFLD fibrosis score and liver stiffness measurement for predicting advanced fibrosis
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DOI：
10.1007/s12072-014-9596-7
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发表时间：
2015-10-01
影响因子：
6.6
通讯作者：
Mahadeva, Sanjiv
中科院分区：
文献类型：
--
作者：
Chan, Wah-Kheong;Mustapha, Nik Raihan Nik;Mahadeva, Sanjiv
部分 NAFLD 患者的非酒精性脂肪肝 (NAFLD) 纤维化评分 (NFS) 是不确定的。将 NFS 与肝脏硬度测量 (LSM) 相结合可以改善对晚期纤维化的预测。我们的目的是评估 NFS 和 LSM 在预测 NAFLD 患者晚期纤维化方面的作用。对计划进行肝活检的连续成年 NAFLD 患者计算 NFS 并获得 LSM。评估了使用任一模式和组合预测晚期纤维化的准确性。结合 NFS 和 LSM 的算法是根据训练队列开发的，随后在验证队列中进行测试。训练队列和验证队列中分别有 101 名患者和 46 名患者。在训练队列中，单独使用 NFS、单独 LSM、单独 LSM（带有灰色区域）、对所有患者进行两种测试以及仅对不确定和高 NFS 患者使用 LSM 的两步方法的错误分类百分比分别为 5.0%、28.7%、2.0%、2.0% 和 4.0%。需要肝活检的患者比例分别为30.7%、0%、36.6%、36.6%和18.8%。在验证队列中，错误分类的百分比分别为 8.7%、28.3%、2.2%、2.2% 和 8.7%。需要肝活检的患者比例分别为 28.3%、0%、41.3%、43.5% 和 19.6%。新型两步法进一步减少了需要肝活检的患者数量，同时保持了预测晚期纤维化的准确性。对于所有患者来说，NFS 和 LSM 的组合与单独使用其中任何一种测试相比并没有明显的优势。
The non-alcoholic fatty liver disease (NAFLD) fibrosis score (NFS) is indeterminate in a proportion of NAFLD patients. Combining the NFS with liver stiffness measurement (LSM) may improve prediction of advanced fibrosis. We aim to evaluate the NFS and LSM in predicting advanced fibrosis in NAFLD patients.The NFS was calculated and LSM obtained for consecutive adult NAFLD patients scheduled for liver biopsy. The accuracy of predicting advanced fibrosis using either modality and in combination were assessed. An algorithm combining the NFS and LSM was developed from a training cohort and subsequently tested in a validation cohort.There were 101 and 46 patients in the training and validation cohort, respectively. In the training cohort, the percentages of misclassifications using the NFS alone, LSM alone, LSM alone (with grey zone), both tests for all patients and a 2-step approach using LSM only for patients with indeterminate and high NFS were 5.0, 28.7, 2.0, 2.0 and 4.0 %, respectively. The percentages of patients requiring liver biopsy were 30.7, 0, 36.6, 36.6 and 18.8 %, respectively. In the validation cohort, the percentages of misclassifications were 8.7, 28.3, 2.2, 2.2 and 8.7 %, respectively. The percentages of patients requiring liver biopsy were 28.3, 0, 41.3, 43.5 and 19.6 %, respectively.The novel 2-step approach further reduced the number of patients requiring a liver biopsy whilst maintaining the accuracy to predict advanced fibrosis. The combination of NFS and LSM for all patients provided no apparent advantage over using either of the tests alone.