Poor Diagnostic Efficacy of Noninvasive Tests for Advanced Fibrosis in Obese or Younger Than 60 Diabetic NAFLD patients
Poor Diagnostic Efficacy of Noninvasive Tests for Advanced Fibrosis in Obese or Younger Than 60 Diabetic NAFLD patients
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DOI：
10.1016/j.cgh.2022.05.015
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发表时间：
2023-03-21
影响因子：
12.6
通讯作者：
Cheung, Ramsey C.
中科院分区：
文献类型：
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作者：
Ito, Takanori;Nguyen, Vy H.;Cheung, Ramsey C.
背景和目标：基于血清的非侵入性检测（NIT）已被广泛用于评估非酒精性脂肪性肝病（NAFLD）患者的肝纤维化。然而，在不同年龄、体重指数（BMI）和是否存在2型糖尿病（T2 DM）的患者中，NIT的诊断疗效可能会有所不同，并且尚未得到充分表征。方法：我们分析了来自日本、台湾和韩国6个中心的1489例经活检证实的NAFLD患者。使用组织学作为金标准，我们比较了纤维化-4指数（FIB-4）、NAFLD纤维化评分（NFS）和新的Hepamet纤维化评分（HFS）的受试者操作特征（AUROC）下的面积，重点关注按年龄、BMI和T2 DM存在分层的亚组中的性能。结果：根据组织学，整个队列中44.0%（655/1489）患有F2-4，20.6%（307/1489）患有F3-4纤维化。FIB-4在F2-4（0.701 vs NFS 0.676和HFS 0.682，P = .001）和F3-4（0.767 vs NFS 0.736和HFS 0.752，P = .002）中的AUROC最高。然而，对于F3-4纤维化，所有3种NIT的AUROC在老年（>60岁）、非肥胖（BMI）
BACKGROUND & AIMS: Serum-based noninvasive tests (NITs) have been widely used to assess liver fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). However, the diagnostic efficacy of NITs across ranges of age, body mass index (BMI), and presence of type 2 diabetes (T2DM) may vary and have not been well-characterized. METHODS: We analyzed 1489 patients with biopsy-proven NAFLD from 6 centers in Japan, Taiwan, and Korea. Using histology as the gold standard, we compared the areas under the receiver operating characteristic (AUROCs) of Fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS), and the new Hepamet fibrosis score (HFS), with a focus on performance in subgroups as stratified by age, BMI, and the presence of T2DM. RESULTS: By histology, 44.0% of the overall cohort (655/1489) had F2-4, and 20.6% (307/1489) had F3-4 fibrosis. FIB-4 had the highest AUROCs for both F2-4 (0.701 vs NFS 0.676 and HFS 0.682, P = .001) and F3-4 (0.767 vs NFS 0.736 and HFS 0.752, P = .002). However, for F3-4 fibrosis, the AUROCs of all 3 NITs were generally higher in older (>60 years), nonobese (BMI