Performance of noninvasive scores for the diagnosis of advanced liver fibrosis in morbidly obese with nonalcoholic fatty liver disease
Performance of noninvasive scores for the diagnosis of advanced liver fibrosis in morbidly obese with nonalcoholic fatty liver disease
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DOI：
10.1097/meg.0000000000001519
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发表时间：
2020-03-01
影响因子：
2.1
通讯作者：
Coral, Gabriela P.
中科院分区：
文献类型：
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作者：
Carli, Maria A. L. de;de Carli, Luiz A.;Coral, Gabriela P.
目的肝纤维化是非酒精性脂肪性肝病（NAFLD）相关死亡率的最重要预测因素之一。使用非侵入性标记物具有评估简单且成本低廉的优点。本研究的目的是评估六种无创评分在病态肥胖患者晚期肝纤维化诊断中的表现。材料和方法回顾性研究验证包括 323 名接受减肥手术的病态肥胖患者。晚期纤维化定义为第 3 期和第 4 期（间隔纤维化或肝硬化）。评估以下非侵入性肝纤维化评分的准确性、敏感性、特异性、阳性（PPV）或阴性（NPV）预测值以及阳性（PLR）或阴性（NLR）似然比检验：天冬氨酸转氨酶（AST）/丙氨酸转氨酶（ALT）比值（AAR）； AST与血小板比率指数（APRI）；诗人; FIB4、NAFLD纤维化评分（NFS）和BAAT，与术中肝活检的组织学结果进行比较。使用验证研究中确定的截止点：AAR > 1； APRL > 0.98；吟游诗人 >= 2； FIB4 > 2.67； NFS > 0.676 且 BAAT > 1。结果 29 名患者 (8.97%) 出现晚期纤维化。 APRI 表现出较高的特异性（99.61%）、PPV（85.71%）、PLR（62.5）和准确性（0.93）。 FIB4 是准确度 (0.9) 和 PLR (10.53) 的第二个测试。 BAAT 的灵敏度最高（73.08%），NPV 最高（94.78%）； NFS 的敏感性最低（12.5%），BARD 的准确性最低（0.44）。结论APRI 和FIB-4 是预测晚期纤维化性能最佳的测试。
ObjectivesLiver fibrosis is one of the most important predictors of mortality related to nonalcoholic fatty liver disease (NAFLD). The use of noninvasive markers has the advantage of a simple and low-cost evaluation. The aim of this study was to evaluate the performance of six noninvasive scores for the diagnosis of advanced liver fibrosis in morbidly obese patients.Material and methodsA retrospective study validation included 323 morbidly obese patients undergoing bariatric surgery. Advance fibrosis was defined as stage 3 and 4 (septal fibrosis or cirrhosis). Accuracy, sensitivity, specificity, positive (PPV) or negative (NPV) predictive value, and positive (PLR) or negative (NLR) likelihood ratio test of the following noninvasive liver fibrosis scores were evaluated: aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (AAR); AST to platelet ratio index (APRI); BARD; FIB4, NAFLD fibrosis score (NFS) and BAAT, which were compared with the histological findings of the intraoperative liver biopsy. The cutoff points established in the validation studies were used: AAR > 1; APRL > 0.98; BARD >= 2; FIB4 > 2.67; NFS > 0.676 and BAAT > 1.ResultsTwenty-nine patients (8.97%) presented advanced fibrosis. APRI presented the higher specificity (99.61%), PPV (85.71%), PLR (62.5) and accuracy (0.93). FIB4 was the second test in accuracy (0.9) and in PLR (10.53). BAAT presented the highest sensitivity (73.08%) and NPV (94.78%); NFS the lowest sensitivity (12,5%), and BARD the lowest accuracy (0.44).ConclusionAPRI and FIB-4 were the tests with best performance to predict advanced fibrosis.