The Utility and Diagnostic Accuracy of Transient Elastography in Adults with Morbid Obesity: A Prospective Study.
The Utility and Diagnostic Accuracy of Transient Elastography in Adults with Morbid Obesity: A Prospective Study.
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瞬态弹性成像在成人病态肥胖中的实用性和诊断准确性：一项前瞻性研究。
DOI：
10.3390/jcm11051201
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发表时间：
2022-02-23
影响因子：
3.9
通讯作者：
Ibdah JA
中科院分区：
文献类型：
--
作者：
Ali AH;Al Juboori A;Petroski GF;Diaz-Arias AA;Syed-Abdul MM;Wheeler AA;Ganga RR;Pitt JB;Spencer NM;Hammoud GM;Rector RS;Parks EJ;Ibdah JA
病态肥胖患者患非酒精性脂肪肝（NAFLD）并发肝纤维化的风险很高。 Fibroscan 瞬时弹性成像 (TE) 在病态肥胖患者（体重指数 (BMI) ≥ 40 kg/m2）中的临床效用尚不明确。我们检查了 Fibroscan 在预测病态肥胖患者（BMI ≥ 40 kg/m2）显着肝纤维化（纤维化阶段≥2）方面的诊断准确性。前瞻性地招募了计划进行减肥手术的患者。术中肝活检、Fibroscan（XL 探针）肝硬度测量（LSM）以及生化评估均在同一天进行。终点是显着的肝纤维化，根据非酒精性脂肪性肝炎临床研究网络定义为纤维化阶段≥2。使用约登指数方法确定检测显着纤维化的最佳 LSM 截止值。通过逐步逻辑回归分析来分析常规临床、实验室和弹性成像数据，以确定显着肝纤维化的预测因素并建立预测模型。使用约登指数法确定了新模型预测显着纤维化的回归公式的最佳截止点。共纳入 167 名患者（平均年龄 46.4 岁），其中 83.2% 为女性。组织学评估显示脂肪性肝炎和显着纤维化的患病率分别为 40.7% 和 11.4%。发现显着纤维化组的中位 LSM 显着高于无或非显着纤维化组（分别为 18.2 kPa 和 7.7 kPa；p = 0.0004）。预测显着纤维化的最佳LSM截止值为12.8 kPa，准确度为71.3%，敏感性为73.7%，特异性为70.9%，阳性预测值为24.6%，阴性预测值为95.5%，ROC面积为0.723（95% CI：0.62-0.83）。 Logistic 回归分析确定了显着纤维化的三个独立预测因子：LSM、糖化血红蛋白和碱性磷酸酶。通过使用这三个变量来制定风险评分。在回归公式的最佳截止值下，风险评分预测显着纤维化的准确度为79.6%，敏感性为89.5%，特异性为78.4%，阳性预测值为34.7%，阴性预测值为98.3%，ROC面积为0.855（95% CI：0.76-0.95）。 Fibroscan 在预测病态肥胖受试者显着肝纤维化方面的效用有限，准确度为 71.3%。将血红蛋白 A1c 和碱性磷酸酶与 LSM 相结合的模型提高了检测该患者群体中显着纤维化的准确性。
Patients with morbid obesity are at high risk for nonalcoholic fatty liver disease (NAFLD) complicated by liver fibrosis. The clinical utility of transient elastography (TE) by Fibroscan in patients with morbid obesity (body mass index (BMI) ≥ 40 kg/m2) is not well-defined. We examined the diagnostic accuracy of Fibroscan in predicting significant liver fibrosis (fibrosis stage ≥2) in morbidly obese patients (BMI ≥ 40 kg/m2). Patients scheduled for bariatric surgery were prospectively enrolled. Intraoperative liver biopsy, liver-stiffness measurement (LSM) by Fibroscan (XL probe), and biochemical evaluation were all performed on the same day. The endpoint was significant liver fibrosis defined as fibrosis stage ≥2 based on the Nonalcoholic Steatohepatitis Clinical Research Network. The optimal LSM cutoff value for detecting significant fibrosis was determined by using the Youden Index method. Routine clinical, laboratory, and elastography data were analyzed by stepwise logistic regression analysis to identify predictors of significant liver fibrosis and build a predictive model. An optimal cutoff point of the new model’s regression formula for predicting significant fibrosis was determined by using the Youden index method. One hundred sixty-seven patients (mean age, 46.4 years) were included, of whom 83.2% were female. Histological assessment revealed the prevalence of steatohepatitis and significant fibrosis of 40.7% and 11.4%, respectively. The median LSM was found to be significantly higher in the significant fibrosis group compared to those in the no or non-significant fibrosis group (18.2 vs. 7.7 kPa, respectively; p = 0.0004). The optimal LSM cutoff for predicting significant fibrosis was 12.8 kPa, with an accuracy of 71.3%, sensitivity of 73.7%, specificity of 70.9%, positive predictive value of 24.6%, negative predictive value of 95.5%, and ROC area of 0.723 (95% CI: 0.62–0.83). Logistic regression analysis identified three independent predictors of significant fibrosis: LSM, hemoglobin A1c, and alkaline phosphatase. A risk score was developed by using these three variables. At an optimal cutoff value of the regression formula, the risk score had an accuracy of 79.6% for predicting significant fibrosis, sensitivity of 89.5%, specificity of 78.4%, positive predictive value of 34.7%, negative predictive value of 98.3%, and ROC area of 0.855 (95% CI: 0.76–0.95). Fibroscan utility in predicting significant liver fibrosis in morbidly obese subjects is limited with accuracy of 71.3%. A model incorporating hemoglobin A1c and alkaline phosphatase with LSM improves accuracy in detecting significant fibrosis in this patient population.
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