4种评分系统在非酒精性脂肪肝病肝纤维化程度的诊断效能评价

Evaluation of four scoring systems in diagnosis of hepatic fibrosis in patients with nonalcoholic fatty liver disease

摘要:

目的评价天冬氨酸氨基转移酶血小板比率指数（APRI）、BARD（BMI，AST/ALT，DM）评分、BAAT（BMI，年龄，ALT，TG）评分和非酒精性脂肪肝病（NAFLD）纤维化评分（NFS）4 种肝纤维化评分系统在该院NAFLD患者中的临床应用价值，并探索联合使用评分系统的应用效能。方法选取2013 年7 月~2016年9 月确诊为NAFLD的患者为研究对象。测定其临床及实验室指标，计算NFS、APRI、BARD、BAAT得分，并以组织学结果为参照，评价这些系统的诊断价值。结果96 例NAFLD 患者中66 例有肝纤维化。经计算，NFS系统诊断NAFLD患者是否有肝纤维化的敏感性为1.92%，特异性为100%；APRI 系统的敏感性为7.58%，特异性为93.33%；BARD 系统的敏感性为63.64%，特异性为16.67%；BAAT 系统的敏感性为0，特异性为94.74%。NFS 联合APRI 的敏感性为10.71%，特异性为90%；BARD 联合BAAT 的敏感性为76.36%，特异性为10.34%。结论当联合使用BARD 和BAAT 时，可获得高敏感性，故可用于NAFLD 的初步筛查；当单独使用NFS 或APRI时，其特异性较高，可用于NAFLD的进一步鉴别诊断。

Abstract:

Objective To evaluate the diagnostic value of NFS, APRI, BARD and BAAT four scoring systems in patients with nonalcoholic fatty liver disease (NAFLD) in our hospital and to explore the diagnostic efficacy of combination of these systems. Methods The patients diagnosed with NAFLD in our hospital from July 2013 to September 2016 were enrolled. The clinical and laboratory parameters were measured. The scores of NFS, APRI, BARD and BAAT were calculated. The diagnostic value of these systems was evaluated with reference to histological results. Results In the 96 patients with NAFLD, 66 patients had hepatic fibrosis. The sensitivity and the specificity of the NFS system for diagnosis of hepatic fibrosis in the patients were 1.92% and 100% respectively. The sensitivity of APRI system was 7.58% and the specificity was 93.33%. The sensitivity of BAAT score and BARD score was 0.00% and 63.64% respectively and the specificity was 94.74% and 16.67% respectively. The sensitivity of NFS combined with APRI was 10.71% and the specificity was 90.00%. The sensitivity of BARD combined with BAAT was 76.36% and the specificity was 10.34%. Conclusions Because of high sensitivity, combination of BARD with BAAT can be used for initial screening of NAFLD. Single use of NFS or APRI has high specificity, so they can be used for further differential diagnosis of NAFLD.