CAP及FAST评分在肝移植术后新发非酒精性脂肪肝中的应用价值探讨

The Utility of CAP and FAST Score in De-Novo NAFLD after Liver Transplantation

摘要: 目的：分析受控衰减参数(controlled attenuation parameter, CAP)以及FAST评分在评估肝移植(Liver transplantation, LT)后新发非酒精性脂肪肝(nonalcoholic fatty liver disease, NAFLD)中的应用价值。方法：这是一项单中心、前瞻性研究，对2014~2021年接受LT并在青岛大学附属医院器官移植中心规律随访的成年LT受者进行腹部超声检查及瞬态弹性成像(Transient elastography, TE)检测，建立受试者工作(receiver operating characteristic, ROC)曲线分析CAP在评估LT后新发NAFLD方面的应用价值，并通过计算FibroScan-天冬氨酸氨基转移酶评分(FibroScan-aspartate aminotransferase score, FAST)以评估LT后新发NAFLD患者的非酒精性脂肪性肝炎(nonalcoholic steatohepatitis, NASH)进展风险。结果：本研究对符合纳入标准的113例LT受者进行了TE检测，LT手术至TE检测的中位时间为3.3 (2.2~4.5)年，新发NAFLD的发病率为35.4% (40/113)，其中，52.5% (21/40)为轻度NAFLD，22.5% (9/40)为中度NAFLD，25.0% (10/40)为重度NAFLD。CAP诊断LT后新发NAFLD、LT后中–重度NAFLD及重度NAFLD的ROC曲线下面积分别为0.80 (0.70~0.90)、0.95 (0.89~1.00)和0.99 (0.97~1.00)，截止值分别为240.5 dB/m、264.5 dB/m和296.0 dB/m，且FAST值与LT后NASH进展高风险密切相关(P = 0.001)。单因素分析表明，LT后新发NAFLD患者的白蛋白水平(P = 0.039)、ALT水平(P = 0.029)、AST水平(P = 0.004)以及重度NAFLD (P = 0.044)与NASH高风险显著相关，而多因素分析提示，AST水平(OR 1.394, 95%CI 1.052~1.847, P = 0.021)是LT后新发NAFLD患者NASH进展高风险的独立危险因素。结论：CAP是LT后新发NAFLD患者诊断和严重程度分级的良好工具，具有良好的敏感性和特异性，尤其是在中度至重度LT后新发NAFLD中诊断性能尤为突出，可以用于量化LT后新发NAFLD。在LT后新发NAFLD患者中，FAST评分可用来评估其NASH进展风险，监测AST水平对预防LT后新发NAFLD患者NASH进展具有重要意义。

Abstract: Aims: This study aimed to determine of the utility of controlled attenuation parameter (CAP) and FibroScan-AST (FAST) score in the evaluation of de-novo nonalcoholic fatty liver disease (de-novo NAFLD) after liver transplantation (LT). Methods: In this prospective, single-center study, ab-dominal ultrasound and Transient Elastography (TE) were performed for adult patients who un-derwent LT between 2014 and 2021, and were regularly followed up at the Organ Transplantation Center of the Affiliated Hospital of Qingdao University. Receiver operating characteristics (ROC) curve was constructed to determine the diagnostic performance of CAP in the detection of de-novo NAFLD after LT, and the FAST score was calculated to assess de-novo NAFLD patients at risk of pro-gressive NASH. Results: A total of 113 LT recipients were included in the study. The median period from LT to TE detection was 3.3 (2.2~4.5) years. The incidence of de-novo NAFLD was 35.4% (40/113), of which 52.5% (21/40) had mild NAFLD, 22.5% (9/40) had moderate NAFLD, and 25.0% (10/40) had severe NAFLD. CAP diagnosed de-novo NAFLD, moderate-severe NAFLD, and severe NAFLD with the area under the ROC curves (AUROC) mean 0.80 (0.70~0.90), 0.95 (0.89~1.00), and 0.99 (0.97~1.00), respectively. The cut-off values were 240.5 dB/m, 264.5 dB/m, and 296.0 dB/m, respectively. The FAST score identifying the risk of progressive NASH was significantly correlated with the severity of de novo NAFLD after LT (P = 0.001). Univariate analysis demonstrated that al-bumin levels (P = 0.039), ALT levels (P = 0.029), AST levels (P = 0.004), and severe NAFLD (P = 0.044) were significantly associated with high risk of NASH in patients with de-novo NAFLD after LT. The multivariate analysis suggested that AST (OR 1.394, 95%CI 1.052 to 1.847; P = 0.021) was an independent risk factor for NASH progression in de-novo NAFLD patients after LT. Conclusions: CAP provides an efficient way for the diagnosis and severity classification of patients with de-novo NAFLD after LT, especially in those with moderate to severe NAFLD, which can be applied to quantify de-novo NAFLD after LT. In patients with de-novo NAFLD after LT, FAST score can be used to assess the risk of NASH progression, and serum AST level is an important index for predicting NASH pro-gression.