Noninvasive markers of fibrosis in nonalcoholic fatty liver disease: Validating the European liver fibrosis panel and exploring simple markers
Noninvasive markers of fibrosis in nonalcoholic fatty liver disease: Validating the European liver fibrosis panel and exploring simple markers
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DOI：
10.1002/hep.21984
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发表时间：
2008-02-01
期刊：
影响因子：
13.5
通讯作者：
Rosenberg, William M.
中科院分区：
文献类型：
--
作者：
Guha, Indra Neil;Parkes, Julie;Rosenberg, William M.
在非酒精性脂肪性肝病（NAFLD）中检测纤维化对于确定预后以及对患者进行分层以进行新兴的治疗干预非常重要。我们在一个独立的NAFLD患者队列中验证了原始欧洲肝纤维化组合（OELF）以及一种不含年龄的简化算法，即增强肝纤维化组合（ELF）。此外，我们探讨了在现有的组合检测中添加简单标志物是否能够提高诊断性能。来自2个中心的196名连续招募的患者被纳入验证研究。使用受试者工作特征曲线、预测值和临床效用模型比较了ELF组合、简单标志物以及联合组合的判别分数的诊断准确性。ELF组合在区分严重纤维化时曲线下面积（AUC）为0.90，区分中度纤维化时为0.82，区分无纤维化时为0.76。通过去除年龄简化算法并没有改变诊断性能。在组合中添加简单标志物提高了诊断性能，在检测严重纤维化、中度纤维化和无纤维化时AUC分别为0.98、0.93和0.84。临床效用模型显示，使用ELF组合和联合组合分别有82%和88%的肝活检可潜在地避免用于严重纤维化的诊断。ELF组合在一个独立的NAFLD患者验证队列中具有良好的诊断准确性。添加已确定的简单标志物可提高在不同纤维化阶段的诊断性能，这将有可能对NAFLD患者进行更好的分层，以用于新兴的治疗策略。
The detection of fibrosis within nonalcoholic fatty liver disease (NAFLD) is important for ascertaining prognosis and the stratification of patients for emerging therapeutic intervention. We validated the Original European Liver Fibrosis panel (OELF) and a simplified algorithm not containing age, the Enhanced Liver fibrosis panel (ELF), in an independent cohort of patients with NAFLD. Furthermore, we explored whether the addition of simple markers to the existing panel test could improve diagnostic performance. One hundred ninety-six consecutively recruited patients from 2 centers were included in the validation study. The diagnostic accuracy of the discriminant scores of the ELF panel, simple markers, and a combined panel were compared using receiver operator curves, predictive values, and a clinical utility model. The ELF panel had an area under the curve (AUC) of 0.90 for distinguishing severe fibrosis, 0.82 for moderate fibrosis, and 0.76 for no fibrosis. Simplification of the algorithm by removing age did not alter diagnostic performance. Addition of simple markers to the panel improved diagnostic performance with AUCs of 0.98, 0.93, and 0.84 for the detection of severe fibrosis, moderate fibrosis, and no fibrosis, respectively. The clinical utility model showed that 82% and 88% of liver biopsies could be potentially avoided for the diagnosis of severe fibrosis using ELF and the combined panel, respectively. The ELF panel has good diagnostic accuracy in an independent validation cohort of patients with NAFLD. The addition of established simple markers augments the diagnostic performance across different stages of fibrosis, which will potentially allow superior stratification of patients with NAFLD for emerging therapeutic strategies.