Hyaluronic acid levels can predict severe fibrosis and platelet counts can predict cirrhosis in patients with nonalcoholic fatty liver disease
Hyaluronic acid levels can predict severe fibrosis and platelet counts can predict cirrhosis in patients with nonalcoholic fatty liver disease
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DOI：
10.1111/j.1440-1746.2006.04447.x
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发表时间：
2006-09-01
影响因子：
4.1
通讯作者：
Shiratori, Keiko
中科院分区：
文献类型：
--
作者：
Kaneda, Hiroyuki;Hashimoto, Etsuko;Shiratori, Keiko
背景和目的：非酒精性脂肪性肝病（NAFLD）代表了从单纯脂肪变性到肝硬化的一系列肝脏疾病。因此，需要预测NAFLD伴晚期纤维化的标志物。本研究的目的是建立非侵入性NAFLD肝纤维化的预测标志物。方法：148例经活检证实的NAFLD患者。为了区分严重纤维化（桥接纤维化加肝硬化）和肝硬化，对患者进行了两次分析：首先，轻度纤维化与重度纤维化；第二，非肝硬化和肝硬化。进行单因素和多因素分析。检测严重纤维化和肝硬化的诊断能力通过受试者工作特征曲线下的面积来评估。测定血清标志物检测严重纤维化和肝硬化的临界值。结果：选择透明质酸作为严重纤维化的预测指标。42 ng/mL透明质酸的临界值对于无严重纤维化的患者具有100%的预测价值，并且与敏感性（100%，95%置信区间[CI] 90-100%）和特异性（89%,95%CI 80-94%）的最佳组合相关。发现血小板计数是肝硬化的独立预测因子。血小板计数的截断值为16 × 10(4)/ μ L，与灵敏度（100%,95% ci 82-100%）和特异性（95%,95% ci 90-98%）的最佳组合相关。结论：透明质酸水平可准确鉴别NAFLD合并严重纤维化患者，血小板计数可鉴别NAFLD合并肝硬化患者。因此，这些标志物为许多NAFLD患者的肝纤维化评估提供了很好的指导。
Background and Aim: Nonalcoholic fatty liver disease (NAFLD) represents a spectrum of liver disease from simple steatosis to cirrhosis. Therefore, markers for predicting NAFLD with advanced fibrosis are needed. The aim of this study was to establish non-invasive predictive markers of liver fibrosis in NAFLD.Methods: One hundred and forty-eight patients were diagnosed as having biopsy-proven NAFLD. In order to separately identify severe fibrosis (bridging fibrosis plus cirrhosis) and cirrhosis, the patients were analyzed twice: first, as mild fibrosis versus severe fibrosis; and second, as non-cirrhosis versus cirrhosis. Univariate and multivariate analyses were conducted. The diagnostic ability to detect severe fibrosis and cirrhosis was assessed by the area under the receiver operating characteristic curve. The cut-off values of serum markers to detect severe fibrosis and cirrhosis were determined.Results: Hyaluronic acid was selected as a predictive marker for severe fibrosis. A cut-off value of 42 ng/mL of hyaluronic acid had a 100% predictive value for patients free of severe fibrosis and was associated with an optimal combination of sensitivity (100%, 95% confidence interval [CI] 90-100%) and specificity (89%, 95%CI 80-94%). The platelet count was found to be an independent predictor of cirrhosis. A cut-off value of 16 x 10(4)/mu L for the platelet count was associated with an optimal combination of sensitivity (100%, 95%CI 82-100%) and specificity (95%, 95%CI 90-98%).Conclusions: Hyaluronic acid levels can accurately identify NAFLD patients with severe fibrosis, and the platelet count can identify NAFLD patients with cirrhosis. Thus, these markers offer a good guideline for the assessment of hepatic fibrosis in the many patients with NAFLD.