Obez Hastalarda Alkole Bağlı Olmayan Yağlı Karaciğer Hastalığı (NAFLD) Prevalansı: Fibrozis-4 (FIB-4) İndeksi ve Aspartat Aminotransferaz/Trombosit Oranı (APRI) Skorlarının Karşılaştırmalı Değerlendirmesi

Yıl 2025, Cilt: 9 Sayı: 3, 298 - 306, 31.12.2025

Banu Açmaz , Sami Bahçebaşı , Nazmiye Serap Biçer , İfakat İrem Biçer , Erdem Aydın , Mehmet Yasin Türkmen , Fahri Bayram , Alper Sönmez

Öz

Amaç: Obezite tanılı olgularda alkole bağlı olmayan yağlı karaciğer hastalığı (NAFLD) sık görülmekte, ancak klinik farkındalık ve
tarama oranı düşüktür. Bu çalışma, obezite kliniğinde ultrasonografi (US) kullanım sıklığını ve APRI ile FIB-4 skorlarının hepatik
steatozla ilişkisini değerlendirmeyi amaçlamaktadır.
Gereç ve Yöntemler: Retrospektif, kesitsel tasarımla bir yıl içinde değerlendirilen 1.420 erişkin çalışmaya dahil edildi. Klinik ve
laboratuvar verileri dosya kayıtlarından elde edildi. Önceden klinik endikasyonlarla yapılmış 367 US raporu incelendi. Fibrozis riski,
FIB-4 ≥1,3 ve APRI ≥1 olarak tanımlandı.
Bulgular: US raporu bulunan hastaların oranı %25,8 olup, %63,2’sinde hepatik steatoz saptandı. APRI ≥1 tüm kohortun %31,1’ini
fibrozis riski altında sınıflandırırken, FIB-4 ≥1,3 yalnızca %3,5’ini belirledi. APRI değerleri BKİ ve glisemik durumdan bağımsızdı
ancak steatoz varlığında daha yüksekti (p<0,001). FIB-4 ise artan BKİ ve HbA1c ile birlikte yükseldi; bu durum formülde yer alan yaş
parametresinin, yaşla birlikte artan metabolik bozulmayı yansıtmasına bağlandı.
Sonuç: Obezite kliniklerinde ultrasonografi kullanımının düşük olması, NAFLD farkındalığının yetersizliğini göstermektedir. Obezite,
NAFLD ve ilerleyici karaciğer yetmezliği için önemli bir risk faktörüdür. Karaciğer biyopsisi invaziv bir yöntem olup, elastografi de birçok
merkezde erişilebilir değildir; ayrıca bu altın standart yöntemlerin tedavi seçimini veya klinik sonucu değiştirmediği bilinmektedir.
APRI’nin daha fazla hastayı fibrozis riski altında tanımlaması ve yaş faktöründen bağımsız olması, farkındalığın artmasına ve önleyici
yaklaşımların güçlenmesine katkı sağlayabilir. Bu nedenle, noninvaziv skorların klinik pratikte daha yaygın kullanımı teşvik edilmelidir

Anahtar Kelimeler

APRI , FIB-4 , Non-alkolik yağlı karaciğer hastalığı , Obezite , Ultrasonografi

Etik Beyan

Çalışma, Kayseri Şehir Hastanesi Girişimsel Olmayan Klinik Araştırmalar Etik Kurulu tarafından onaylanmıştır (Onay No: 368; Tarih: 11 Mart 2025).

Prevalence of Non-Alcoholic Fatty Liver Disease in Obese Patients: Comparative Evaluation of the Fibrosis-4 (FIB-4) Index and Aspartate Aminotransferase to Platelet Ratio Index (APRI)

Öz

Aim: Non-alcoholic fatty liver disease (NAFLD) is common among individuals with obesity, yet clinical screening remains inadequate.
This study aimed to assess ultrasonography (US) utilization and the relationship between APRI and FIB-4 scores and hepatic steatosis
in an obesity-clinic population.
Material and Methods: This retrospective single-center cross-sectional study included 1,420 adults evaluated over one year. Clinical
and laboratory data were retrieved from medical records. Previous abdominal US reports were available for 367 patients. Fibrosis risk
was defined as FIB-4 ≥1.3 and APRI ≥1. Group comparisons were performed using Kruskal–Wallis, Mann–Whitney U, and Chi-square
tests, and normality was assessed with the Shapiro–Wilk test. Results: US was available in 25.8% of patients, and hepatic steatosis was detected in 63.2% of those examined. APRI ≥1 classified 31.1%
of the cohort at fibrosis risk, whereas FIB-4 ≥1.3 identified only 3.5%. APRI values were independent of BMI and glycemic status but
were higher in patients with steatosis (p<0.001). FIB-4 increased with higher BMI and HbA1c, reflecting the influence of age in its
formula, as metabolic deterioration and obesity severity progress with aging.
Conclusion: The low rate of ultrasonography use in obesity clinics indicates insufficient awareness of NAFLD. Obesity represents a
significant risk factor for NAFLD and progressive liver failure. Liver biopsy is invasive, elastography is not widely available, and these
gold standard diagnostic methods do not alter treatment decisions or outcomes. The ability of APRI to identify a larger subgroup
of patients at fibrosis risk, independent of age, may enhance awareness and promote earlier preventive interventions. Therefore, the
broader implementation of noninvasive fibrosis scores should be encouraged in clinical practice.

Anahtar Kelimeler

APRI , FIB-4 , Non-alcoholic fatty liver disease , Obesity , Ultrasonography

Etik Beyan

The study was approved by the Non-Interventional Clinical Research Ethics Committee of Kayseri City Hospital (Approval No: 368; Date: March 11, 2025).

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