Prevalence of liver fibrosis and risk factors in a general population using non-invasive biomarkers (FibroTest).
Prevalence of liver fibrosis and risk factors in a general population using non-invasive biomarkers (FibroTest).
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DOI：
10.1186/1471-230x-10-40
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发表时间：
2010-04-22
影响因子：
2.4
通讯作者：
Giordanella JP
中科院分区：
文献类型：
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作者：
Poynard T;Lebray P;Ingiliz P;Varaut A;Varsat B;Ngo Y;Norha P;Munteanu M;Drane F;Messous D;Bismut FI;Carrau JP;Massard J;Ratziu V;Giordanella JP
FibroTest和弹性成像已被验证为最常见的慢性肝病和糖尿病患者纤维化筛查中肝纤维化的生物标志物。一个挑战是使用它们来估计纤维化的患病率，确定独立的风险因素，并提出一般人群的筛查策略。我们前瞻性研究了7,463名40岁或以上的连续受试者。在三级临床试验机构对推定为晚期纤维化（FibroTest大于0.48）的受试者进行了再研究。样本特征与法国人群相似。FibroTest在99.6%中可解释。推定纤维化的患病率为2.8%（209/7，463），其中肝硬化患病率为0.3%（25/7，463）; 105/209（50%）推定纤维化的受试者接受了重新调查。50例受试者证实了纤维化，27例仍疑似纤维化，25例不确定，3例受试者未通过假阳性FibroTest或假阴性弹性成像证实。FibroTest的假阴性率为0.4%（3/766）。确诊的纤维化的原因是酒精性和非酒精性脂肪性肝病（NAFLD）66%，NAFLD 13%，酒精9%，HCV 6%，其他6%。与确诊的纤维化独立相关的因素（均P < 0.003）是年龄、男性、腰围、HCV抗体和使用碳水化合物缺乏转铁蛋白估计的饮酒量，从而能够比较和提出有效的筛查导向策略。生物标志物已允许估计40岁或以上的一般人群中晚期纤维化的患病率约为2.8%，以及可用于验证选择性或非选择性筛查策略的几个风险因素。
FibroTest and elastography have been validated as biomarkers of liver fibrosis in the most frequent chronic liver diseases and in the fibrosis screening of patients with diabetes. One challenge was to use them for estimating the prevalence of fibrosis, identifying independent risk factors and to propose screening strategies in the general population. We prospectively studied 7,463 consecutive subjects aged 40 years or older. Subjects with presumed advanced fibrosis (FibroTest greater than 0.48) were re-investigated in a tertiary center. The sample characteristics were similar to those of the French population. FibroTest was interpretable in 99.6%. The prevalence of presumed fibrosis was 2.8%, (209/7,463), including cirrhosis in 0.3% (25/7,463); 105/209 (50%) subjects with presumed fibrosis accepted re-investigation. Fibrosis was confirmed in 50, still suspected in 27, indeterminate in 25 and not confirmed with false positive FibroTest or false negative elastography in 3 subjects. False negative rate of FibroTest estimated using elastography was 0.4% (3/766). The attributable causes for confirmed fibrosis were both alcoholic and nonalcoholic fatty liver disease (NAFLD) in 66%, NAFLD in 13%, alcohol in 9%, HCV in 6%, and other in 6%. Factors independently associated (all P < 0.003) with confirmed fibrosis were age, male gender, waist circumference, HCV antibody and alcohol consumption estimated using carbohydrate-deficient transferrin, enabling efficient screening-oriented strategies to be compared and proposed. Biomarkers have permitted to estimate prevalence of advanced fibrosis around 2.8% in a general population aged 40 years or older, and several risk factors which may be used for the validation of selective or non-selective screening strategies.