非酒精性脂肪性肝病显著肝纤维化的无创诊断

Noninvasive diagnosis of advanced fibrosis in patients with non-alcoholic fatty liver disease

目的:通过对非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)患者多个肝纤维化非创伤性诊断模型的验证和分析比较,评价其诊断价值.方法:选取29例NAFLD患者,进行肝组织活检和病理学分期,并检测血清指标,用受试者操作特征(ROC)曲线等方法评估APRI指数、AST/ALT比率、BARD评分等模型的诊断价值.结果:29例病例中17例(58.9%)为男性,平均年龄(51±12)岁,平均体质量指数为(27±5)kg/m2,糖尿病患者15(51.7%);病理肝纤维化分级提示显著纤维化S3-S4:6例(20.6%).各诊断模型对肝脏显著纤维化程度都具有一定诊断价值,其中AST/ALT比率表现最佳[其曲线下面积(AUROC)为0.83],其次为BARD评分(AUROC0.77)和APRI指数(AUROC0.67).AST/ALT比率和BARD评分模型的阴性预测值均大于90%(分别为93%和95%).阳性预测值均处于中低等水平.AST/ALT比率和BARD评分模型分别可使68.9%和37.9%的患者避免肝活检.结论:肝纤维化非创伤性诊断模型能较好地区分存在显著肝纤维化的NAFLD患者,其中以AST/ALT比率、BARD评分模型较为有效,可以避免部分患者行肝穿刺检查.

AIM：To compare the diagnostic performance of multiple simple non-invasive tests in identifying advanced fibrosis in patients with biopsy-proven non-alcoholic fatty liver disease （NAFLD）.METHODS：Twenty-nine patients with biopsyproven NAFLD were included in the study.The AST/ALT ratio,AST to platelet ratio index,and BARD score were calculated in these patients.The diagnostic performance of non-invasive tests was assessed by using the receiver operating characteristic （ROC） curves.RESULTS：Of 29 patients,17 were males （58.9%） and 12 were females;15 （51.7%） had diabetes;6 （20.6%） had advanced fibrosis （S 3-S 4）.Their mean age was 51 ± 12 years,and their mean body mass index was （27 ± 5） kg/m 2.The AST/ALT ratio had the best diagnostic accuracy for advanced fibrosis （AUROC=0.83）,followed by BARD score （AUROC=0.77） and AST to platelet ratio index （AUROC=0.67）.The AST/ALT ratio and BARD score had negative predictive values greater than 90% （93% and 95%,respectively）.Positive predictive values were modest.To exclude advanced fibrosis,liver biopsy could potentially be avoided in 68.9% of patients with AST/ALT ratio,and in 37.9% patients with BARD score.CONCLUSION：Non-invasive tests,especially the ALT/AST ratio and BARD score,can reliably exclude advanced fibrosis in patients with NAFLD.