PDF(Pubmed)
Abstract：
Introduction: Nonalcoholic fatty liver disease (NAFLD) is believed to be the most common chronic liver disease worldwide. Therapies are under development for nonalcoholic steatohepatitis (NASH), the progressive form of NAFLD, such that the prevalence of NASH with liver fibrosis, which is likely to require treatment, may be of interest to healthcare decision makers. Noninvasive tests are used in initial screening for NASH, as well as in observational studies of NASH prevalence. However, existing evidence does not address how estimated prevalence varies with different noninvasive tests. This analysis estimated the prevalence of NASH among US adults and assessed variation with different noninvasive tests. Methods: A cross-sectional analysis was conducted using the 2017-March 2020 National Health and Nutrition Examination Survey cycle. Participants with presumed NAFLD (steatosis and without alternative causes of liver disease) were identified, among whom NASH was predicted based on FAST score, Fibrosis-4 (FIB-4), and AST-to-Platelet Ratio Index (APRI) cutoffs across 11 scenarios. Among NASH participants, fibrosis stages were explored based on distribution across the spectrum of liver-stiffness measurements. Results: Among participants with complete data for the analysis (N=6969), prevalence of presumed NAFLD was 25.6%. Within presumed NAFLD, prediction of NASH using imaging-based NIT cutoffs yielded estimated prevalence of 1.3%-4.8% (3.3 million-12.2 million) based on FAST score cutoffs from 0.35-0.67. Using biomarker-based NIT cutoffs yielded estimated prevalence of 0.4%-12.3% (1.0 million-14.5 million) based on FIB-4 cutoffs from 0.90-2.67, and 0.1%-1.9% (0.2-5.0 million) based on APRI cutoffs from 0.50-1.50. Conclusion: Prevalence of NASH among US adults was estimated to range from 1.3% to 4.8% when predicted using imaging-based noninvasive test values for participants with presumed NAFLD, generally aligning with estimates in the literature of prevalence of biopsy-confirmed NASH. Use of biomarker-based noninvasive test values for prediction of NASH yielded a wider range of estimates with FIB-4, and a considerably lower range of estimates with APRI.
摘要：
非酒精性脂肪性肝病（NAFLD）被认为是全球最常见的慢性肝病。非酒精性脂肪性肝炎（NASH）的治疗方法正在开发中，NAFLD的渐进形式，这样NASH合并肝纤维化的患病率，这可能需要治疗，医疗保健决策者可能会感兴趣。非侵入性测试用于NASH的初始筛查，以及NASH患病率的观察性研究。然而,现有证据没有说明估计的患病率在不同的非侵入性测试中如何变化.该分析估计了美国成年人中NASH的患病率，并评估了不同非侵入性测试的差异。方法:采用2017-2020年3月全国健康与营养检查调查周期进行横断面分析。确定了假定的NAFLD（脂肪变性且没有肝病的替代原因）的参与者，其中NASH是根据FAST分数预测的，纤维化-4（FIB-4），和AST与血小板比率指数（APRI）在11种情况下截止。在NASH参与者中，根据肝脏硬度测量谱的分布对纤维化分期进行了探索。结果：在具有完整分析数据的参与者中（N=6969），推测的NAFLD患病率为25.6%.在推定的NAFLD内，使用基于成像的NIT截止值预测NASH,基于0.35-0.67的FAST评分截止值,估计患病率为1.3%-4.8%(330万至1220万).使用基于生物标志物的NIT截止值，基于0.90-2.67的FIB-4截止值，估计患病率为0.4％-12.3％（100万-1450万），基于0.50-1.50的APRI截止值，为0.1％-1.9％（0.2-5.0万）。结论：当使用基于成像的非侵入性测试值预测患有NAFLD的参与者时，美国成年人中NASH的患病率估计为1.3%至4.8%。通常与文献中活检证实的NASH患病率的估计值一致。使用基于生物标志物的非侵入性测试值来预测NASH，FIB-4的估计值范围更广，而APRI的估计值范围要低得多。
