Modified thresholds for fibrosis risk scores in nonalcoholic fatty liver disease are necessary in the obese
Modified thresholds for fibrosis risk scores in nonalcoholic fatty liver disease are necessary in the obese
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DOI：
10.1007/s11695-016-2246-5
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发表时间：
2017-01-01
期刊：
影响因子：
2.9
通讯作者：
Brown, Wendy A.
中科院分区：
文献类型：
--
作者：
Ooi, Geraldine J.;Burton, Paul R.;Brown, Wendy A.
肥胖及其相关的合并症是非酒精性脂肪性肝病（NAFLD）的重要危险因素。肝纤维化是NAFLD长期预后的主要决定因素。一个非侵入性的工具，准确地识别肥胖患者肝纤维化的风险增加将是显着的价值。已经提出了NAFLD患者的纤维化风险评分，但尚未在肥胖人群中得到验证。我们对107例接受初次减肥手术的高危肥胖患者进行了一项前瞻性研究，旨在验证减肥手术患者中已建立的简单纤维化评分。计算拟定的纤维化评分（NAFLD纤维化评分;体重指数（BMI）、天冬氨酸氨基转移酶（AST）/丙氨酸氨基转移酶比值（ALT）和糖尿病（BARD）;纤维化-4（FIB-4）; Forn;和AST与血小板比值指数），并比较通过术中肝活检组织学确定的肝纤维化。确定准确度，并优化纤维化评分阈值。这些修改后的阈值随后在一个独立的减肥手术人群中得到验证。68例患者存在一定程度的纤维化，其中23例患者（23%）存在显著纤维化（F2-4）。Forn评分最能预测显著的纤维化（受试者操作特征曲线下面积（AUROC）0.724，p = 0.001）。采用标准阈值，Forn评分识别显著纤维化（F2-4）的灵敏度为0%。使用修改后的阈值3.5，敏感性和阴性预测值增加到85.7%和94.7%。该阈值应用于一个独立的验证队列，具有良好的准确性。使用简单标记物的纤维化风险评分在描绘肥胖患者显著NAFLD相关纤维化方面具有中等成功率。然而，在这一队列中，需要降低阈值以最大限度地提高诊断准确性。
Obesity and its related comorbidities are significant risk factors for nonalcoholic fatty liver disease (NAFLD). Liver fibrosis is the major determinant of long-term outcomes in NAFLD. A non-invasive tool that accurately identifies obese patients at elevated risk of liver fibrosis would be of significant value. Fibrosis risk scores in patients with NAFLD have been proposed but have not been validated in obese populations. We aimed to validate established simple fibrosis scores in bariatric surgical patients.We conducted a prospective study of 107 consecutive high-risk obese patients undergoing primary bariatric surgery. Proposed fibrosis scores (NAFLD fibrosis score; body mass index (BMI), aspartate aminotransferase (AST)/alanine aminotransferase ratio (ALT), and diabetes (BARD); Fibrosis-4 (FIB-4); Forn; and AST to platelet ratio index) were calculated and compared hepatic fibrosis determined by histology of intraoperative liver biopsies. Accuracy was determined, and fibrosis score thresholds were optimized. These modified thresholds were then validated in an independent bariatric surgical population.Liver biopsies were available in 101 patients. Sixty-eight patients had some degree of fibrosis, with 23 patients (23 %) having significant fibrosis (F2-4). The Forn score best predicted significant fibrosis (area under the receiver operator characteristic curve (AUROC) 0.724, p = 0.001). With standard thresholds, the sensitivity for the Forn score for identification of significant fibrosis (F2-4) was 0 %. Using modified thresholds of 3.5, the sensitivity and negative predictive value increased to 85.7 and 94.7 %. This threshold was applied to an independent validation cohort with good accuracy.Fibrosis risk scores using simple markers have moderate success at delineating obese patients with significant NAFLD-related fibrosis. Thresholds, however, need to be lowered to maximize diagnostic accuracy in this cohort.