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Abstract：
BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) with hepatic histological NAFLD activity score ≥ 4 and fibrosis stage F ≥ 2 is regarded as \"at risk\" non-alcoholic steatohepatitis (NASH). Based on an international consensus, NAFLD and NASH were renamed as metabolic dysfunction-associated steatotic liver disease (MASLD) and metabolic dysfunction-associated steatohepatitis (MASH), respectively; hence, we introduced the term \"high-risk MASH\". Diagnostic values of seven non-invasive models, including FibroScan-aspartate transaminase (FAST), fibrosis-4 (FIB-4), aspartate transaminase to platelet ratio index (APRI), etc. for high-risk MASH have rarely been studied and compared in MASLD.
OBJECTIVE: To assess the clinical value of seven non-invasive models as alternatives to liver biopsy for diagnosing high-risk MASH.
METHODS: A retrospective analysis was conducted on 309 patients diagnosed with NAFLD via liver biopsy at Beijing Ditan Hospital, between January 2012 and December 2020. After screening for MASLD and the exclusion criteria, 279 patients were included and categorized into high-risk and non-high-risk MASH groups. Utilizing threshold values of each model, sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV), were calculated. Receiver operating characteristic curves were constructed to evaluate their diagnostic efficacy based on the area under the curve (AUROC).
RESULTS: MASLD diagnostic criteria were met by 99.4% patients with NAFLD. The MASLD population was analyzed in two cohorts: Overall population (279 patients) and the subgroup (117 patients) who underwent liver transient elastography (FibroScan). In the overall population, FIB-4 showed better diagnostic efficacy and higher PPV, with sensitivity, specificity, PPV, NPV, and AUROC of 26.9%, 95.2%, 73.5%, 72.2%, and 0.75. APRI, Forns index, and aspartate transaminase to alanine transaminase ratio (ARR) showed moderate diagnostic efficacy, whereas S index and gamma-glutamyl transpeptidase to platelet ratio (GPR) were relatively weaker. In the subgroup, FAST had the highest diagnostic efficacy, its sensitivity, specificity, PPV, NPV, and AUROC were 44.2%, 92.3%, 82.1%, 67.4%, and 0.82. The FIB-4 AUROC was 0.76. S index and GPR exhibited almost no diagnostic value for high-risk MASH.
CONCLUSIONS: FAST and FIB-4 could replace liver biopsy as more effectively diagnostic methods for high-risk MASH compared to APRI, Forns index, ARR, S index, and GPR; FAST is superior to FIB-4.
OBJECTIVE: To assess the clinical value of seven non-invasive models as alternatives to liver biopsy for diagnosing high-risk MASH.
METHODS: A retrospective analysis was conducted on 309 patients diagnosed with NAFLD via liver biopsy at Beijing Ditan Hospital, between January 2012 and December 2020. After screening for MASLD and the exclusion criteria, 279 patients were included and categorized into high-risk and non-high-risk MASH groups. Utilizing threshold values of each model, sensitivity, specificity, positive predictive value (PPV), and negative predictive values (NPV), were calculated. Receiver operating characteristic curves were constructed to evaluate their diagnostic efficacy based on the area under the curve (AUROC).
RESULTS: MASLD diagnostic criteria were met by 99.4% patients with NAFLD. The MASLD population was analyzed in two cohorts: Overall population (279 patients) and the subgroup (117 patients) who underwent liver transient elastography (FibroScan). In the overall population, FIB-4 showed better diagnostic efficacy and higher PPV, with sensitivity, specificity, PPV, NPV, and AUROC of 26.9%, 95.2%, 73.5%, 72.2%, and 0.75. APRI, Forns index, and aspartate transaminase to alanine transaminase ratio (ARR) showed moderate diagnostic efficacy, whereas S index and gamma-glutamyl transpeptidase to platelet ratio (GPR) were relatively weaker. In the subgroup, FAST had the highest diagnostic efficacy, its sensitivity, specificity, PPV, NPV, and AUROC were 44.2%, 92.3%, 82.1%, 67.4%, and 0.82. The FIB-4 AUROC was 0.76. S index and GPR exhibited almost no diagnostic value for high-risk MASH.
CONCLUSIONS: FAST and FIB-4 could replace liver biopsy as more effectively diagnostic methods for high-risk MASH compared to APRI, Forns index, ARR, S index, and GPR; FAST is superior to FIB-4.
摘要：
背景：非酒精性脂肪性肝病（NAFLD）肝组织学NAFLD活动评分≥4，纤维化阶段F≥2被视为“处于危险中”非酒精性脂肪性肝炎（NASH）。基于国际共识,NAFLD和NASH更名为代谢功能障碍相关脂肪性肝炎（MASLD）和代谢功能障碍相关脂肪性肝炎（MASH）。分别；因此，我们引入了“高风险MASH”一词。七种非侵入性模型的诊断价值，包括FibroScan-天冬氨酸转氨酶（FAST），纤维化-4（FIB-4），天冬氨酸转氨酶与血小板比值指数(APRI),等。对于高风险MASH，很少在MASLD中进行研究和比较。
目的：评估七种非侵入性模型作为肝活检诊断高危MASH的替代方法的临床价值。
方法：对北京地坛医院肝活检诊断为NAFLD的309例患者进行回顾性分析。2012年1月至2020年12月。在筛选MASLD和排除标准后，279例患者被纳入并分为高危和非高危MASH组。利用每个模型的阈值，灵敏度,特异性，阳性预测值(PPV)，和负预测值(NPV)，被计算。构建受试者工作特征曲线以基于曲线下面积(AUROC)评价其诊断效能。
结果：99.4%的NAFLD患者符合MASLD诊断标准。在两个队列中分析了MASLD人群：总体人群（279名患者）和接受肝脏瞬时弹性成像（FibroScan）的亚组（117名患者）。在总人口中,FIB-4显示更好的诊断效能和更高的PPV，有了敏感性,特异性，PPV,NPV,AUROC为26.9%，95.2%,73.5%,72.2%,和0.75。APRI,Forns索引，天冬氨酸转氨酶与丙氨酸转氨酶比值（ARR）显示出中等诊断功效，而S指数和γ-谷氨酰转肽酶与血小板比率(GPR)相对较弱。在子组中，FAST的诊断效能最高,其灵敏度,特异性，PPV,NPV,AUROC为44.2%,92.3%,82.1%,67.4%,0.82FIB-4AUROC为0.76。S指数和GPR对高危MASH几乎没有诊断价值。
结论：与APRI相比，FAST和FIB-4可以代替肝活检作为高危MASH的更有效的诊断方法，Forns索引，ARR,S指数，和探地雷达；FAST优于FIB-4。
目的：评估七种非侵入性模型作为肝活检诊断高危MASH的替代方法的临床价值。
方法：对北京地坛医院肝活检诊断为NAFLD的309例患者进行回顾性分析。2012年1月至2020年12月。在筛选MASLD和排除标准后，279例患者被纳入并分为高危和非高危MASH组。利用每个模型的阈值，灵敏度,特异性，阳性预测值(PPV)，和负预测值(NPV)，被计算。构建受试者工作特征曲线以基于曲线下面积(AUROC)评价其诊断效能。
结果：99.4%的NAFLD患者符合MASLD诊断标准。在两个队列中分析了MASLD人群：总体人群（279名患者）和接受肝脏瞬时弹性成像（FibroScan）的亚组（117名患者）。在总人口中,FIB-4显示更好的诊断效能和更高的PPV，有了敏感性,特异性，PPV,NPV,AUROC为26.9%，95.2%,73.5%,72.2%,和0.75。APRI,Forns索引，天冬氨酸转氨酶与丙氨酸转氨酶比值（ARR）显示出中等诊断功效，而S指数和γ-谷氨酰转肽酶与血小板比率(GPR)相对较弱。在子组中，FAST的诊断效能最高,其灵敏度,特异性，PPV,NPV,AUROC为44.2%,92.3%,82.1%,67.4%,0.82FIB-4AUROC为0.76。S指数和GPR对高危MASH几乎没有诊断价值。
结论：与APRI相比，FAST和FIB-4可以代替肝活检作为高危MASH的更有效的诊断方法，Forns索引，ARR,S指数，和探地雷达；FAST优于FIB-4。
