高危人群代谢功能障碍相关性脂肪性肝炎和纤维化的一步式无创诊断。

IF 5.8 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY United European Gastroenterology Journal Pub Date : 2024-09-01 Epub Date: 2024-08-04 DOI:10.1002/ueg2.12589
Paula Iruzubieta, Rebeca Mayo, Itziar Mincholé, Ibon Martínez-Arranz, María Teresa Arias-Loste, Luis Ibañez-Samaniego, Javier Ampuero, Javier Abad, Rosa Martín-Mateos, Ana Belén Fernández-Laso, Agustín Albillos, Rafael Bañares, José Luis Calleja, Manuel Romero-Gómez, Rocío Aller, Javier Crespo
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引用次数: 0

摘要

背景和目的:2型糖尿病(T2DM)、年龄和肥胖是代谢功能障碍相关性脂肪性肝病(MASLD)的危险因素。我们旨在评估无创检验(NIT)在诊断高危人群代谢功能障碍相关性脂肪性肝炎(MASH)和肝纤维化方面的性能:多中心横断面研究,包括124名50岁以上的超重/肥胖和T2DM患者经活检证实的MASLD。进行了振动控制瞬态弹性成像、纤维化-4 指数(FIB-4)、非酒精性脂肪肝纤维化评分(NFS)、OWLiver Panel(OWLiver DM2 + 代谢组学-高级脂肪性肝炎纤维化评分-MASEF)和 FibroScan-AST。计算了敏感性、特异性、阳性预测值 (PPV)、阴性预测值 (NPV) 和接收器操作特征曲线下面积 (AUC)。对 NITs 进行了单独评估和连续/平行组合评估:35例(28.2%)患者为早期MASH,66例(53.2%)患者为伴有明显纤维化的MASH(高危MASH)。OWLiver Panel 将 86.1% 的患者正确归类为 MASH,准确率、灵敏度、特异性、PPV 和 NPV 分别为 0.77、0.86、0.35、0.85 和 0.36。三级肥胖、糖尿病控制或性别对 OWLiver Panel 的性能没有影响(P > 0.1)。除 NFS 外,高危 MASH 的 NIT 的 AUC 均大于 0.70。MASEF 对高危 MASH(AUC 0.77 [0.68-0.85],NPV 72%)和晚期纤维化(AUC 0.80 [0.71-0.88],NPV 92%)显示出最高的准确性和 NPV。与单独使用 MASEF 相比,联合使用 NITs 来识别高危 MASH 没有带来任何额外的益处:结论:使用 OWLiver Panel 的一步式筛查策略可准确检测出 MASLD 高危人群中的 MASH 和高危 MASH。
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One-step non-invasive diagnosis of metabolic dysfunction-associated steatohepatitis and fibrosis in high-risk population.

Background and aim: Type 2 Diabetes mellitus (T2DM), age, and obesity are risk factors for metabolic dysfunction-associated steatotic liver disease (MASLD). We aimed to assess the performance of non-invasive tests (NITs) for the diagnosis of metabolic dysfunction-associated steatohepatitis (MASH) and fibrosis in high-risk subjects.

Methods: Multicentre cross-sectional study that included 124 biopsy-proven MASLD in more than 50 years-old patients with overweight/obesity and T2DM. Vibration-controlled transient elastography, Fibrosis-4 index (FIB-4), Non-alcoholic fatty liver disease fibrosis score (NFS), OWLiver Panel (OWLiver DM2 + Metabolomics-Advanced Steatohepatitis Fibrosis Score -MASEF) and FibroScan-AST were performed. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and area under the receiver operating characteristic curve (AUC) were calculated. NITs were assessed individually and in sequential/parallel combinations.

Results: 35 (28.2%) patients had early MASH and 66 (53.2%) had MASH with significant fibrosis (at-risk MASH). The OWLiver Panel correctly classified 86.1% as MASH, showing an accuracy, sensitivity, specificity, PPV, and NPV of 0.77, 0.86, 0.35, 0.85, and 0.36, respectively. Class III obesity, diabetes control, or gender did not impact on the performance of the OWLiver Panel (p > 0.1). NITs for at-risk MASH showed an AUC > 0.70 except for NFS. MASEF showed the highest accuracy and NPV for at-risk MASH (AUC 0.77 [0.68-0.85], NPV 72%) and advanced fibrosis (AUC 0.80 [0.71-0.88], NPV 92%). Combinations of NITs for the identification of at-risk MASH did not provide any additional benefit over using MASEF alone.

Conclusion: One-step screening strategy with the OWLiver Panel has high accuracy to detect MASH and at-risk MASH in high-risk subjects for MASLD.

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来源期刊
United European Gastroenterology Journal
United European Gastroenterology Journal GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
10.50
自引率
13.30%
发文量
147
期刊介绍: United European Gastroenterology Journal (UEG Journal) is the official Journal of the United European Gastroenterology (UEG), a professional non-profit organisation combining all the leading European societies concerned with digestive disease. UEG’s member societies represent over 22,000 specialists working across medicine, surgery, paediatrics, GI oncology and endoscopy, which makes UEG a unique platform for collaboration and the exchange of knowledge.
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