在患有MASLD的肥胖患者中,FIB-4和BAST纤维化风险分类之间的不一致:来自OBREDI-TR研究的结果
Ozge Kama Basci1, Alihan Oral2, Ali Kirik1
1Department of Internal Medicine, Faculty of Medicine, Balikesir University, Altieylül, Balikesir 10145, Türkiye.
Diagnostics (Basel, Switzerland)
|February 27, 2026
概括
在患有代谢功能障碍相关的脂肪性肝病 (MASLD) 的肥胖患者中,FIB-4得分可能低估了纤维化风险,特别是在严重肥胖的情况下. 在这些人中,BAST评分提供了可能更准确的评估.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 代谢障碍 代谢障碍 代谢障碍
- 肥胖医学 肥胖医学
背景情况:
- 非侵入性纤维化得分对于代谢功能障碍相关的脂肪性肝病 (MASLD) 的风险分层至关重要.
- 在患有MASLD的肥胖个体中,纤维化-4 (FIB-4) 指数的表现受到争议,可能低估纤维化风险.
- 作为MASLD中纤维化评估的替代方案,建议采用BAST得分,包括代谢和人体测量数据.
研究的目的:
- 在患有MASLD的肥胖患者中,评估FIB-4和BAST得分之间的纤维化风险分类不一致.
- 分析肥胖严重程度和内脏脂肪性如何影响FIB-4和BAST分数之间的一致性.
主要方法:
- 在OBREDI-TR队列中对2950名患有MASLD的肥胖成年人的二次分析.
- 纤维化风险分类使用FIB-4和BAST分数的标准截止值.
- 使用加权的科恩卡帕评估一致性,并评估与肥胖类和内脏脂肪指数 (VAI) 的不一致性模式.
主要成果:
- 在FIB-4和BAST分数之间发现了非常差的一致性 (κ = 0.041).
- 在22.3%的患者中发生了不和,随着肥胖的严重程度而增加.
- 在III类肥胖症中,FIB-4通常表示低风险,而BAST表示高风险,与较高的VAI相关.
结论:
- 在肥胖的MASLD患者中,FIB-4可能低估了纤维化风险,特别是那些患有病态肥胖和高内脏脂肪的患者.
- 在这种人群中,BAST得分在识别纤维化风险升高方面似乎更为敏感.
- 为准确评估肥胖MASLD患者的纤维化风险,建议采用以表型为导向的多模式方法.
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