Kombination von NAFLD Fibrosis Score und transienter Elastografie zur Identifikation mittelgradiger Fibrosestadien (II/III) bei nicht-alkoholischer Fettlebererkrankung

Zusammenfassung

Einleitung Die nicht-alkoholische Fettlebererkrankung (NAFLD) gehört mittlerweile weltweit zu den häufigsten Ursachen für eine chronische Leberschädigung. Aktuell sind die therapeutischen Optionen limitiert und neue pharmakologische Therapieoptionen werden primär im Rahmen von Studien untersucht. Da viele aktuelle Studien zumeist auf NAFLD-Patienten mit den Fibrosestadien II und III (nach Kleiner) abzielen, ist die nicht-invasive Identifikation dieser Patienten von zunehmender Bedeutung.

Ziel Evaluation von Lebersteifigkeitsmessung (LSM) und NAFLD Fibrosis Score (NFS) im Hinblick auf die Vorhersage eines Fibrosestadiums II/III.

Methoden Patienten mit bioptisch gesicherter NAFLD Diagnose wurden in die Studie eingeschlossen. Vor der Leberbiopsie wurden alle Patienten klinisch, laborchemisch und mittels LSM evaluiert. Anschließend wurde die Vorhersagekraft von NFS und LSM im Hinblick auf das Vorliegen einer Fibrose Stadium II/III untersucht.

Ergebnisse 134 NALFD-Patienten wurden in die Studie eingeschlossen und untersucht. Das mittlere Alter betrug 53 (IQR 36 – 60) Jahre, 55 Patienten (41 %) waren weiblich. 82 % der Patienten waren übergewichtig/adipös mit typischen Befundkonstellationen des Metabolischen Syndroms. 84 Patienten (66 %) zeigten Zeichen einer Fibrose, bei 42 (50 %) bestand eine fortgeschrittene Fibrose. LSM und NFS korrelierten mit dem Fibrosestadium (r = 0,696 bzw. r = 0,685, p < 0,01). NFS-Werte zwischen –2,0 und + 0,5 und LSM-Werte zwischen 8 und 22kPa waren mit hoher Wahrscheinlichkeit für das Vorliegen eines Fibrosestadiums II/III assoziiert. Wenn beide dieser Kriterien erfüllt waren, bestand zu 61 % ein Fibrosestadium II/II. Wenn hingegen keines der beiden Kriterien erfüllt war, lag die Wahrscheinlichkeit für eine Fibrose II/III lediglich bei 6 % (negativer prädiktiver Wert 94 %).

Schlussfolgerung Die Kombination von LSM und NFS ermöglicht die Identifikation von Patienten mit erhöhtem Risiko für ein Fibrosestadium II/III. Daher könnte der Einsatz dieser beiden nicht-invasiven Tests speziell in Kombination als Screening-Tool für NAFLD-Patienten im Hinblick auf das Vorhandensein einer Fibrose II/III eingesetzt werden. Durch den Einsatz dieser Verfahren könnten außerdem nicht-notwendige Biopsien vermieden werden.

Abstract

Introduction Non-alcoholic fatty liver disease (NAFLD) has become one of the most frequent causes of chronic liver disease. Currently, therapeutic options for NAFLD patients are limited, but new pharmacologic agents are being investigated in the course of clinical trials. Because most of these studies are focusing on patients with fibrosis stages II and III (according to Kleiner), non-invasive identification of patients with intermediate fibrosis stages (II and III) is of increasing interest.

Aims Evaluation of NAFLD Fibrosis Score (NFS) and liver stiffness measurement (LSM) for prediction of fibrosis stages II/III.

Methods Patients with histologically confirmed NAFLD diagnosis were included in the study. All patients underwent a clinical and laboratory examination as well as a LSM prior to liver biopsy. Predictive value of NFS and LSM with respect to identification of fibrosis stages II/III was assessed.

Results 134 NAFLD patients were included and analyzed. Median age was 53 (IQR 36 – 60) years, 55 patients (41 %) were female. 82 % of our patients were overweight/obese with typical aspects of metabolic syndrome. 84 patients (66 %) had liver fibrosis, 42 (50 %) advanced fibrosis. LSM and NFS correlated with fibrosis stage (r = 0.696 and r = 0.685, respectively; p < 0.01 for both). NFS values between –2.0 and + 0.5, and LSM values between 8 and 22kPa were associated with fibrosis stages II/III. If both criteria were met, probability of fibrosis stage II/III was 61 %. If none of the two criteria was met, chance for fibrosis stage II/III was only 6 % (negative predictive value 94 %).

Conclusion Combination of LSM and NFS enables identification of patients with significant probability of fibrosis stage II/III. Accordingly, these tests, especially in combination, may be a suitable screening tool for fibrosis stages II/III in NAFLD. The use of these non-invasive methods might also help to avoid unnecessary biopsies.

Schlüsselwörter

Fettleber - NAFLD - NAFLD Fibrosis Score - Lebersteifigkeit - Fibrose

Key words

fatty liver - NAFLD - NAFLD Fibrosis Score - liver stiffness measurement - fibrosis

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