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A.評估肝纖維化指標
肝纖維化指數 Fibrosis-4 (FIB-4)Score
年齡(Age)
麩胺酸苯醋酸轉氨基酶(AST)
麩丙酮酸轉胺酶(ALT)
血小板(PLT)

 

肝纖維化指數(FIB-4)公式
= age [years] x AST [U/L]/(platelet [109/L] x (ALT [U/L])1/2

 

閾值

檢測具有嚴重肝纖維化*

納入

排除

2.67

<1.3

檢測具有肝硬化

3.48

<1.67

*不適用於年齡小於35歲以及高風險族群(糖尿病、肥胖等)

 

參考文獻 : 

  • European Association for the Study of the Liver. (2015). EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. Journal of hepatology, 63(1), 237-264.
  • McPherson, Stuart, et al. "Age as a confounding factor for the accurate non-invasive diagnosis of advanced NAFLD fibrosis." The American journal of gastroenterology 112.5 (2017): 740.
  • Barb, Diana, et al. "Type 2 diabetes mellitus increases the risk of hepatic fibrosis in individuals with obesity and nonalcoholic fatty liver disease." Obesity 29.11 (2021): 1950-1960.
  • Graupera, Isabel, et al. "Low accuracy of FIB-4 and NAFLD fibrosis scores for screening for liver fibrosis in the population." Clinical Gastroenterology and Hepatology 20.11 (2022): 2567-2576.
麩胺酸苯醋酸轉氨基酶-血小板比值指數 AST to Platelet Ratio Index (APRI)
麩胺酸苯醋酸轉氨基酶(AST)
AST正常值上限(AST ULN)
血小板(PLT)

 

麩胺酸苯醋酸轉氨基酶-血小板比值指數(APRI)公式
= AST [U/L] /ULN/Platelet [109/L] x 100

閾值
檢測具有嚴重肝纖維化

納入

排除

1.5

<0.3

檢測具有肝硬化

2.0

<0.5

 

嵾考文獻: 

  • European Association for the Study of the Liver. (2015). EASL-ALEH Clinical Practice Guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. Journal of hepatology, 63(1), 237-264.
  • Sripongpun, Pimsiri, et al. "Evaluation of aspartate aminotransferase to platelet ratio index and fibrosis 4 scores for hepatic fibrosis assessment compared with transient elastography in chronic hepatitis C patients." JGH Open 4.1 (2020): 69-74.
非酒精性脂肪肝疾病纖維化分數 NAFLD fibrosis score(NFS)
年齡(Age)
身體質量指數(BMI)
空腹血糖異常(IFG)/糖尿病(DM)
血小板(PLT)
麩胺酸苯醋酸轉氨基酶(AST)
麩丙酮酸轉胺酶(ALT)
白蛋白(Alb)

 

非酒精性脂肪肝疾病纖維化分數 (NFS)公式
= -1.675 + (0.037*age [years]) + (0.094*BMI [kg/m2]) + (1.13*IFG/diabetes [yes = 1, no = 0]) +

     (0.99*AST/ALT ratio) – (0.013*Platelet [X109/L]) – (0.66*Albumin [g/dl])

 

閾值

檢測具有嚴重肝纖維化*

納入

排除

0.672

<−1.44

*不適用於年齡小於35歲以及高風險族群(糖尿病、肥胖等)

Ø空腹血糖異常Impaired fasting glucose (IFG)定義:空腹禁食8小時以上血糖介於110–125 mg/dL.

參考文獻: 

  • Mellitus, D. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care 1997, 20, 1183–1197. 
  • McPherson, Stuart, et al. "Age as a confounding factor for the accurate non-invasive diagnosis of advanced NAFLD fibrosis." The American journal of gastroenterology 112.5 (2017): 740.
  • Barb, Diana, et al. "Type 2 diabetes mellitus increases the risk of hepatic fibrosis in individuals with obesity and nonalcoholic fatty liver disease." Obesity 29.11 (2021): 1950-1960.
  • Graupera, Isabel, et al. "Low accuracy of FIB-4 and NAFLD fibrosis scores for screening for liver fibrosis in the population." Clinical Gastroenterology and Hepatology 20.11 (2022): 2567-2576.
B. 評估脂肪變性程度
脂肪肝指數 Fatty liver index(FLI)
身體質量指數(BMI)
腰圍(WC)
三酸甘油脂(TG)
麩胺轉酸酶(GGT)

 

脂肪肝指數 (FLI) 公式
= (e 0.953*loge (triglycerides) + 0.139*BMI + 0.718*loge (ggt) +
    0.053*waist circumference - 15.745) / (1 + e 0.953*loge (triglycerides) +
    0.139*BMI + 0.718*loge (ggt) + 0.053*waist circumference - 15.745) * 100

閾值

檢測具有脂肪肝

納入

排除

≥60

<30

 

參考文獻: 

  • Rinella, Mary E., et al. "AASLD practice guidance on the clinical assessment and management of nonalcoholic fatty liver disease." Hepatology (2023): 10-1097.
  • Bedogni, Giorgio, et al. "The Fatty Liver Index: a simple and accurate predictor of hepatic steatosis in the general population." BMC gastroenterology 6.1 (2006): 1-7.
肝脂肪變性指數Hepatic steatosis index (HSI)
性別(Gender)
身體質量指數(BMI)
麩胺酸苯醋酸轉氨基酶(AST)
麩丙酮酸轉胺酶(ALT)
糖尿病(DM)

 

肝脂肪變性指數 (HSI) 公式
= 8 × (ALT / AST) + BMI + 2 (if diabetes) + 2 (if female)

閾值

檢測肝臟脂肪變性

納入

排除

>36

<30

 

參考文獻: 

  • Lee, Jeong-Hoon, et al. "Hepatic steatosis index: a simple screening tool reflecting nonalcoholic fatty liver disease." Digestive and liver disease 42.7 (2010): 503-508.
  • Sviklāne, Laura, et al. "Fatty liver index and hepatic steatosis index for prediction of non‐alcoholic fatty liver disease in type 1 diabetes." Journal of gastroenterology and hepatology 33.1 (2018): 270-276.