UNASSIGNED:最近描述了FibroScan-AST(FAST)评分,以检测非酒精性脂肪性肝炎(NASH)患者的非酒精性脂肪性肝病(NAFLD)活动评分(NAS≥4)和肝活检(NASHNAS≥4F≥2)的显着纤维化(≥F2)。
UNASSIGNED:本研究的目的是验证印度NAFLD患者的FAST评分并得出最佳临界值。
未经证实:60例经活检证实的NAFLD患者[男性:38例(63.3%),年龄40(32-52)岁]对肝脏组织学3个月内评估FAST评分的所有参数进行回顾性分析。
未经证实:17例患者(28.3%)存在组织学NASH,11例(18.3%)患者NASH+NAS≥4+F≥2。FAST评分区分NASH+NAS≥4+F≥2的曲线下面积(AUROC)为0.81。使用Newsome等人的截止值,排除截止值(FAST:≤0.35)的阴性预测值(NPV)为0.88[敏感性:0.91,特异性:0.14,阴性似然比(LR):0.64],而规则截止值(FAST:≥0.67)的阳性预测值(PPV)为0.33(敏感性:0.73,特异性:0.67,阳性LR:2.22).15例(25%)患者按照组织学正确分类,28例(46.67%)患者落在灰色地带。在重新计算我们患者的最佳临界值时,排除截止值(FAST:≤0.55)的NPV为0.95(敏感性:0.90,特异性:0.45,阴性LR:0.21),而最佳规则截止值(FAST:≥0.78)的PPV为0.70(敏感性:0.64,特异性0.94,阳性LR:10.39).有了这些截止点,27(45%)患者落在灰色地带,29(48.3%)根据组织学正确分类,表现优于Newsome等人的截止值(P<0.001)。
未经证实:FAST评分显示用于检测组织学上具有显著纤维化和炎症的NASH的良好AUROC。应根据疾病的患病率重新校准截止值。
UNASSIGNED:印度的NAFLD负担很高,估计有2500万患者面临严重肝病的潜在风险。肝活检仍是诊断NASH的金标准,尽管其在常规临床实践中的应用有限。同时检测脂肪变性的非侵入性测试,因此,炎症和纤维化是小时的需要。FAST评分最近已被建议用于肝活检中具有显著纤维化(≥F2)和炎症(NAS≥4)的NASH的非侵入性检测。我们验证了FAST评分在印度NAFLD患者肝活检中检测具有显著纤维化和炎症的NASH的实用性。这种非侵入性的,易于使用和非专有的FAST评分可以正确分类超过50%的患者的疾病严重程度。然而,我们的结果表明,应根据给定人群中NASH+NAS≥4+F≥2的预期患病率重新校准截止值.
UNASSIGNED: The FibroScan-AST (FAST) score was recently described to detect patients with nonalcoholic steatohepatitis (NASH) having elevated nonalcoholic fatty liver disease (NAFLD) activity score (NAS ≥ 4) and significant fibrosis (≥ F2) on liver biopsy (NASH+ NAS ≥ 4 + F ≥ 2).
UNASSIGNED: The aim of this study was to validate the FAST score in Indian patients with NAFLD and to derive optimal cut-offs.
UNASSIGNED: Sixty patients with biopsy-proven NAFLD [men: 38 (63.3%), age 40 (32-52) years] with all parameters for assessing the FAST score within 3 months of liver histology were retrospectively analysed.
UNASSIGNED: Histological NASH was present in 17 patients (28.3%), while 11 (18.3%) patients had NASH + NAS ≥ 4 + F ≥ 2. The area under the curve (AUROC) of the FAST score for discriminating NASH + NAS ≥ 4 + F ≥ 2 was 0.81. Using cut-offs by Newsome et al, the rule-out cut-off (FAST: ≤ 0.35) had a negative predictive value (NPV) of 0.88 [sensitivity: 0.91, specificity: 0.14, negative likelihood ratio (LR): 0.64], while the rule-in cut-off (FAST: ≥ 0.67) had a positive predictive value (PPV) of 0.33 (sensitivity: 0.73, specificity: 0.67, positive LR: 2.22). Fifteen (25%) patients were correctly classified as per histology, while 28 (46.67%) patients fell in the grey zone. On recalculating the optimal cut-offs for our patients, the rule-out cut-off (FAST: ≤ 0.55) had an NPV of 0.95 (sensitivity: 0.90, specificity: 0.45, negative LR: 0.21), while the optimal rule-in cut-off (FAST: ≥ 0.78) had a PPV of 0.70 (sensitivity: 0.64, specificity 0.94, positive LR: 10.39). With these cut-offs, 27 (45%) patients fell in the grey zone and 29 (48.3%) were correctly classified as per histology, performing better than the cut-offs by Newsome et al (P < 0.001).
UNASSIGNED: The FAST score demonstrates good AUROC for detecting NASH with significant fibrosis and inflammation on histology. Cut-offs should be recalibrated based on prevalence of disease.
UNASSIGNED: India has a high burden of NAFLD with an estimated 25 million patients at potential risk for significant liver disease. Liver biopsy remains the gold standard for diagnosing NASH, although its application in routine clinical practice is limited. Noninvasive tests for the simultaneous detection of steatosis, inflammation and fibrosis are thus the need of the hour. The FAST score has been recently suggested for the noninvasive detection of NASH with significant fibrosis (≥ F2) and inflammation (NAS ≥ 4) on liver biopsy. We validated the utility of the FAST score for detecting NASH with significant fibrosis and inflammation on liver biopsy in Indian patients with NAFLD. This noninvasive, easy-to-use and nonproprietary FAST score can correctly classify disease severity in more than 50% patients. However, our results suggest that cut-offs should be recalibrated based on the anticipated prevalence of NASH + NAS ≥ 4 + F ≥ 2 in the given population.