Utility of Ultrasound, Transaminases, and Visual Inspection to Assess Nonalcoholic Fatty Liver Disease in Bariatric Surgery Patients.
Utility of Ultrasound, Transaminases, and Visual Inspection to Assess Nonalcoholic Fatty Liver Disease in Bariatric Surgery Patients.
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DOI：
10.1007/s11695-015-1707-6
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发表时间：
2015-12
期刊：
影响因子：
2.9
通讯作者：
Gerhard GS
中科院分区：
文献类型：
--
作者：
Petrick A;Benotti P;Wood GC;Still CD;Strodel WE;Gabrielsen J;Rolston D;Chu X;Argyropoulos G;Ibele A;Gerhard GS
非酒精性脂肪性肝病（NAFLD）在极度肥胖的成年人中很常见，可能会影响长期健康和生存。肝活检是唯一准确的诊断和分期测试，但侵入性和昂贵。非侵入性测试提供了一种有吸引力的替代方案，但整体准确性仍然是一个重要问题。本研究旨在确定术前超声和肝脏转氨酶水平以及术中肝脏目视检查的准确性和临床实用性，以评估肝脏组织学证实的NAFLD的存在。前瞻性收集了2004年1月至2009年2月期间接受Roux-en-Y胃旁路手术并术中楔形活检的580例病态肥胖成人患者的数据。513例患者的超声、ALT和AST水平以及记录的目视检查的完整数据可用。NAFLD的患病率为69%，NASH的患病率为32%。个体非侵入性临床评估显示，检测脂肪变性、脂肪性肝炎或纤维化的灵敏度、特异性和准确性较低。所有测试的正常或异常结果的组合提高了预测效用。对于NAFLD/NASH中的主要组织学发现，所有三种评估的异常检测的灵敏度为95- 98%，特异性为28- 48%。对于NAFLD/NASH的主要组织学发现，所有三种评估的正常测试具有12- 22%的灵敏度和89- 97%的特异性。虽然NAFLD的个体临床试验的准确性有限，但使用联合临床试验可能是有用的。
Nonalcoholic fatty liver disease (NAFLD) is common in adults with extreme obesity and can impact long-term health and survival. Liver biopsy is the only accurate test for diagnosis and staging, but is invasive and costly. Non-invasive testing offers an attractive alternate, but the overall accuracy remains a significant issue. This study was conducted to determine the accuracy and clinical utility of preoperative ultrasound and liver transaminase levels, as well as intra-operative hepatic visual inspection, for assessing presence of NAFLD as confirmed by hepatic histology. Data was collected prospectively from 580 morbidly obese adult patients who underwent Roux-en-Y gastric bypass surgery with intraoperative wedge biopsy between January 2004 and February 2009. Complete data for ultrasound, ALT and AST levels, and documented visual inspection was available for 513 patients. The prevalence of NAFLD was 69 % and that of NASH was 32 %. The individual non-invasive clinical assessments demonstrated low sensitivity, specificity, and accuracy for detecting the presence of steatosis, steatohepatitis, or fibrosis. The combination of normal or abnormal results for all tests improved predictive utility. Abnormal tests with all three assessments had a sensitivity of 95–98 % and a specificity of 28–48 % for major histologic findings in NAFLD/NASH. Normal tests with all three assessments had a sensitivity of 12–22 % and a specificity of 89–97 % for major histologic findings in NAFLD/NASH. Although individual clinical tests for NAFLD have limited accuracy, the use of combined clinical tests may prove useful.