APRI、TyG在MAFLD诊断及其纤维化中的预测价值

Predictive Value of APRI and TyG in the Diagnosis of MAFLD and Its Fibrosis

摘要: MAFLD现在是导致终末期肝病的第二大原因，也是美国等待肝移植的成年人中原发性肝癌的第二大常见原因。MAFLD由良性非酒精性脂肪肝(NAFL)和较严重的非酒精性脂肪性肝炎(NASH)组成。MAFLD患者存在进展为显著肝纤维化的高风险。MAFLD向NASH的进展被认为是未来纤维化和肝硬化发展的驱动力。并且肝纤维化的严重程度与肝脏相关的发病率和死亡率有很强的相关性。肝活检被认为是确定MAFLD的金标准，因为出血和并发症的风险增加不建议常规使用。目前临床上筛查MAFLD最常用的检查为腹部超声，但该检查有个重要的局限性：当脂肪变性较轻(<30%)时，其敏感性较低。虽然CT及MRI在诊断脂肪肝中敏感性比超声高，但因其价格昂贵，临床难以推广使用。目前确定无创的生物标志物是尚未满足的临床需求。寻找其他无创血清学指标用以评估MAFLD的纤维化程度成为当前研究的重中之重。本文对天冬氨酸转氨酶/血小板比值(APRI)、甘油三酯葡萄糖指数(TyG)对代谢相关脂肪性肝病(MAFLD)患者肝纤维化的诊断效能进行了综述，期望对后续的研究和治疗带来一定的启示。

Abstract: MAFLD now is the second leading cause of end-stage liver disease. It is also the second most com-mon cause of primary liver cancer among adults waiting for a liver transplant in the United States. MAFLD consists of benign non-alcoholic fatty liver disease (NAFL) and more severe non-alcoholic steatohepatitis (NASH). Patients with MAFLD are at high risk for progression to significant hepatic fibrosis. The progression of MAFLD to NASH is thought to be a driving force for the future develop-ment of fibrosis and cirrhosis. Moreover, the severity of hepatic fibrosis was strongly correlated with liver-related morbidity and mortality. Liver biopsy is considered the gold standard for determining MAFLD and is not recommended for routine use because of the increased risk of bleeding and com-plications. Abdominal ultrasound is currently the most commonly used test in clinical screening for MAFLD, but this test has an important limitation: when steatosis is mild (<30%), it is less sensitive. Although CT and MRI are more sensitive than ultrasound in the diagnosis of fatty liver, they are dif-ficult to popularize clinically due to their high cost. There is currently an unmet clinical need to identify noninvasive biomarkers. Finding other noninvasive serological indicators to evaluate the degree of fibrosis in MAFLD has become the priority of current research. In this review, the diagnos-tic efficacy of aspartate aminotransferase/platelet ratio (APRI) and triglyceride glucose index (TyG) on hepatic fibrosis in patients with metabolism-related fatty liver disease (MAFLD) was reviewed, hoping to bring some enlightenment for subsequent research and treatment.