{"id":5406,"date":"2026-06-16T21:17:28","date_gmt":"2026-06-16T21:17:28","guid":{"rendered":"https:\/\/hepatology.ca\/?p=5406"},"modified":"2026-06-16T21:17:31","modified_gmt":"2026-06-16T21:17:31","slug":"casl-advocacy-letter-on-importance-of-ast-in-non-invasive-screening-strategies-for-masld-related-liver-fibrosis","status":"publish","type":"post","link":"https:\/\/hepatology.ca\/fr\/2026\/06\/16\/casl-advocacy-letter-on-importance-of-ast-in-non-invasive-screening-strategies-for-masld-related-liver-fibrosis\/","title":{"rendered":"Lettre de plaidoyer de la CASL sur l'importance de l'AST dans les strat\u00e9gies de d\u00e9pistage non invasives de la fibrose h\u00e9patique li\u00e9e \u00e0 la MASLD"},"content":{"rendered":"
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L'Association canadienne pour l'\u00e9tude du foie (ACEF) d\u00e9fend les int\u00e9r\u00eats de<\/em>\u00a0la n\u00e9cessit\u00e9 d'un soutien continu \u00e0 l'utilisation de l'aspartate\u00a0<\/em>aminotransf\u00e9rase (AST).\u00a0<\/em><\/p>\n

La lettre ci-dessous est le fruit d'une collaboration adress\u00e9e \u00e0 l'Institut\u00a0<\/em>national d'excellence en sant\u00e9 et en services sociaux (INESSS) pour militer en faveur de la poursuite de l'u<\/em>se de l'aspartate <\/em>aminotransf\u00e9rase (AST)<\/em>.\u00a0<\/em><\/p>\n

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Importance de l'AST dans les strat\u00e9gies de d\u00e9pistage non invasives de la fibrose h\u00e9patique li\u00e9e \u00e0 la MASLD<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t
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Chers membres d'INESSS,<\/p>\n

Au nom de l\u2019Association canadienne pour l\u2019\u00e9tude du foie (ACEF), nous tenons \u00e0 vous f\u00e9liciter pour votre leadership constant dans la promotion d\u2019une utilisation judicieuse des analyses biom\u00e9dicales au sein du syst\u00e8me de sant\u00e9 qu\u00e9b\u00e9cois. Nous appuyons fermement les efforts d\u00e9ploy\u00e9s pour optimiser l\u2019utilisation des ressources tout en maintenant des normes \u00e9lev\u00e9es en mati\u00e8re de soins aux patients.<\/p>\n

Nous souhaitons toutefois souligner un contexte clinique important et \u00e9volutif dans lequel le r\u00f4le de l'aspartate aminotransf\u00e9rase (AST) est \u00e0 la fois essentiel et fond\u00e9 sur des preuves : le d\u00e9pistage non invasif de la fibrose h\u00e9patique chez les personnes \u00e0 risque de st\u00e9atose h\u00e9patique associ\u00e9e \u00e0 un dysfonctionnement m\u00e9tabolique (MASLD), y compris les personnes atteintes de diab\u00e8te, d'ob\u00e9sit\u00e9, du VIH et d'autres populations \u00e0 haut risque.<\/p>\n

Comme indiqu\u00e9 dans votre outil clinique, l'AST est reconnue \u00e0 juste titre comme une composante des scores de fibrose valid\u00e9s, notamment le FIB-4. Ces derni\u00e8res ann\u00e9es, l'indice FIB-4 est devenu une pierre angulaire de la stratification du risque de premi\u00e8re intention pour la fibrose h\u00e9patique, approuv\u00e9 par toutes les principales directives internationales et nationales, y compris celles de la CASL, de l'AASLD, de l'EASL et, plus r\u00e9cemment, de Diab\u00e8te Canada.<\/p>\n

Le FIB-4 int\u00e8gre l'AST, l'ALT, l'\u00e2ge et le nombre de plaquettes dans un outil simple, largement accessible et peu co\u00fbteux permettant le d\u00e9pistage pr\u00e9coce des personnes \u00e0 risque de fibrose h\u00e9patique avanc\u00e9e. Son utilisation est d\u00e9sormais bien ancr\u00e9e dans les parcours de soins des populations \u00e0 risque accru, notamment les personnes atteintes de diab\u00e8te de type 2, d'ob\u00e9sit\u00e9 et d'autres affections cardiom\u00e9taboliques. Point important, les plus r\u00e9centes lignes directrices de Diab\u00e8te Canada \u2013 \u00e9labor\u00e9es sous l'\u00e9gide de l'Association canadienne de lutte contre la fibrose h\u00e9patique (ACLFH) \u2013 recommandent explicitement l'utilisation du FIB-4 comme strat\u00e9gie de d\u00e9pistage de premi\u00e8re intention chez ces populations \u00e0 haut risque.<\/p>\n

Dans ce contexte, l'AST n'est pas un biomarqueur redondant ou optionnel, mais bien un \u00e9l\u00e9ment essentiel d'un algorithme de d\u00e9pistage valid\u00e9, fond\u00e9 sur des donn\u00e9es probantes et conforme aux recommandations. Malheureusement, l'ALT seule ne permet pas d'exclure avec pr\u00e9cision une fibrose h\u00e9patique, puisque 20 % des patients atteints de fibrose h\u00e9patique avanc\u00e9e pr\u00e9sentent des taux d'ALT constamment normaux. C'est pourquoi le score FIB-4 est essentiel et largement recommand\u00e9 par les soci\u00e9t\u00e9s savantes. Limiter l'acc\u00e8s \u00e0 l'AST en dehors d'indications strictement d\u00e9finies risque de compromettre la mise en \u0153uvre de ces parcours de soins largement recommand\u00e9s.<\/p>\n

Du point de vue du syst\u00e8me de sant\u00e9, l'utilisation du FIB-4 est parfaitement conforme aux principes des soins ax\u00e9s sur la valeur. Il s'agit de\u00a0:<\/p>\n

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  • Rentable, tirant parti des tests de laboratoire couramment disponibles<\/li>\n
  • \u00c9volutif, permettant un d\u00e9pistage \u00e0 l'\u00e9chelle de la population dans les soins primaires<\/li>\n
  • Efficace, r\u00e9duisant les orientations inutiles vers des examens d'imagerie sp\u00e9cialis\u00e9s ou des proc\u00e9dures invasives.<\/li>\n
  • Impact clinique important, permettant une identification et une prise en charge plus pr\u00e9coces des personnes \u00e0 risque de maladie h\u00e9patique avanc\u00e9e<\/li>\n<\/ul>\n

    Compte tenu du fardeau croissant de la MASLD \u2014 maintenant la maladie du foie la plus r\u00e9pandue au Canada, touchant 32% de la population g\u00e9n\u00e9rale \u2014 et de sa forte association avec les affections cardiom\u00e9taboliques, la mise en \u0153uvre d\u2019outils de d\u00e9pistage simples, accessibles et valid\u00e9s tels que le FIB-4 est une priorit\u00e9 de sant\u00e9 publique.<\/p>\n

    Nous sugg\u00e9rons donc respectueusement de clarifier le cadre actuel d'utilisation des AST afin de reconna\u00eetre explicitement leur r\u00f4le essentiel au sein des syst\u00e8mes de score de fibrose valid\u00e9s, notamment le FIB-4, lorsqu'ils sont utilis\u00e9s dans le cadre des strat\u00e9gies de d\u00e9pistage de la fibrose h\u00e9patique associ\u00e9e \u00e0 la MASLD, conform\u00e9ment aux recommandations. Une telle clarification permettrait aux cliniciens d'aligner leur pratique sur les donn\u00e9es probantes actuelles et garantirait que les efforts visant \u00e0 r\u00e9duire les examens \u00e0 faible valeur ajout\u00e9e ne limitent pas involontairement l'acc\u00e8s aux soins \u00e0 forte valeur ajout\u00e9e, recommand\u00e9s par les directives.<\/p>\n

    L\u2019Association canadienne des maladies h\u00e9patiques (ACMH) demeure pleinement engag\u00e9e \u00e0 collaborer avec l\u2019INESSS et ses partenaires partout au Qu\u00e9bec afin de promouvoir des soins h\u00e9patiques fond\u00e9s sur des donn\u00e9es probantes, \u00e9quitables et durables. Nous serions heureux de contribuer aux futures mises \u00e0 jour de cet outil clinique et d\u2019appuyer l\u2019int\u00e9gration des protocoles de d\u00e9pistage de la st\u00e9atose h\u00e9patique non alcoolique (SHNA) dans la pratique clinique courante.<\/p>\n

    Sinc\u00e8rement,
    Giada Sebastiani<\/strong>
    Pr\u00e9sident de l'Association canadienne pour l'\u00e9tude du foie<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t

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    The Canadian Association for the Study of the Liver (CASL) is advocating on behalf of\u00a0the need for continuous support for […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ngg_post_thumbnail":0,"footnotes":""},"categories":[1],"tags":[40],"class_list":["post-5406","post","type-post","status-publish","format-standard","hentry","category-casl-news","tag-advocacy"],"acf":[],"yoast_head":"\nCASL Advocacy Letter on Importance of AST in Non-Invasive Screening Strategies for MASLD-Related Liver Fibrosis - 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