Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease.
Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease.
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DOI：
10.1016/j.cgh.2009.05.033
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发表时间：
2009-10
期刊：
影响因子：
--
通讯作者：
Nash Clinical Research Network
中科院分区：
文献类型：
--
作者：
Shah AG;Lydecker A;Murray K;Tetri BN;Contos MJ;Sanyal AJ;Nash Clinical Research Network
需要一种可靠且廉价的非酒精性脂肪性肝病（NAFLD）肝纤维化的非侵入性标志物。比较FIB 4指数（基于年龄、天冬氨酸和丙氨酸氨基转移酶以及血小板计数）与其他六种非侵入性纤维化标志物在NAFLD患者中的表现。使用全国范围内的541名NAFLD成人数据库，比较了FIB 4和其他7种标志物的接受者工作特征曲线（AUROC）下的折刀验证面积。沿着晚期纤维化的临界值，确定90%特异性、80%阳性预测值和90%阴性预测值的灵敏度。中位FIB 4评分为1.11（IQR = 0.74 - 1.67）。对于FIB 4，折刀验证的AUROC为0.802（95%CI：0.758，0.847）高于NAFLD纤维化评分（0.768 CI：0.720 - 0.816，p = 0.09），哥德堡大学肝硬化指数（0.743，CI：0.695 - 0.791，p <0.01），AST：ALT比值（0.742，CI：0.690-0.794，p <0.015），AST/血小板比值指数（0.730，置信区间：0.681 - 0.779，p <0.001），AST/血小板比值（0.720，0.669 - 0.770，p <0.001），BARD评分（0.70，p <0.001）和肝硬化判别评分（0.666，CI：0.614 - 0.718，p <0.001）。对于90%的固定特异性（FIB 4 = 1.93），识别晚期纤维化的灵敏度仅为50%（95% CI：46，55）。FIB 4 ≥ 2.67的阳性预测值为80%，FIB 4指数≤ 1.30的阴性预测值为90%。在NAFLD患者中，FIB 4指数上级于其他7种非侵入性纤维化标志物;然而，其性能特征突出了对更好的非侵入性标志物的需求。
There is a need for a reliable and inexpensive noninvasive marker of hepatic fibrosis in nonalcoholic fatty liver disease (NAFLD). To compare the performance of the FIB4 index (based on age, aspartate and alanine aminotransferase and platelet counts) with six other non-invasive markers of fibrosis in patients with NAFLD. Using a nation-wide database of 541 adults with NAFLD, jackknife-validated areas under receiver operating characteristic curves (AUROC) of FIB4 and seven other markers were compared. The sensitivity at 90% specificity, 80% positive predictive value, and 90% negative predictive values were determined along with cutoffs for advanced fibrosis. The median FIB4 score was 1.11 (IQR=0.74–1.67). The jackknife-validated AUROC for FIB4 was 0.802 (95% CI: 0.758, 0.847) which was higher than that for the NAFLD fibrosis score (0.768 CI:0.720–0.816, p= 0.09), Goteburg University Cirrhosis Index (0.743, CI:0.695–0.791, p< 0.01), AST:ALT ratio (0.742, CI:0.690–0.794, p< 0.015), AST to platelet ratio index (0.730, CI:0.681–0.779, p< 0.001), AST to platelet ratio (0.720, 0.669–0.770, p< 0.001), BARD score (0.70, p< 0.001) and cirrhosis discriminant score (0.666, CI:0.614–0.718, p< 0.001). For a fixed specificity of 90% (FIB4 = 1.93), the sensitivity of identifying advanced fibrosis was only 50% (95% CI: 46, 55). A FIB4 ≥ 2.67 had an 80% positive predictive value and a FIB4 index ≤ 1.30 had a 90% negative predictive value. The FIB4 index is superior to seven other non-invasive markers of fibrosis in patients with NAFLD; however its performance characteristics highlight the need for even better non-invasive markers.
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DOI：
10.1097/01.alc.0000128239.87611.f5
发表时间：
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影响因子：
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