Performance and limitations of steatosis biomarkers in patients with nonalcoholic fatty liver disease
Performance and limitations of steatosis biomarkers in patients with nonalcoholic fatty liver disease
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DOI：
10.1111/apt.12963
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发表时间：
2014-11-01
影响因子：
7.6
通讯作者：
Ratziu, V.
中科院分区：
文献类型：
--
作者：
Fedchuk, L.;Nascimbeni, F.;Ratziu, V.
BackgroundSeveral脂肪变性生物标志物是有限的独立validation.AimTo确定诊断价值和局限性的几个脂肪变性生物标志物使用肝活检作为参考标准，在一个大的队列的患者怀疑NAFLD.MethodsThree百二十四个连续的肝活检被列入。组织学脂肪变性被归类为无（66%）。五个脂肪变性的生物标志物进行了测量：脂肪肝指数（FLI），NAFLD肝脂肪评分（NAFLD-LFS），肝脂肪变性指数（HSI），内脏脂肪指数（VAI）和甘油三酯x葡萄糖（TyG）index.ResultsSteatosis等级患病率为：无5%，轻度39%，中度30%和重度27%。除VAI外，脂肪变性生物标志物在脂肪变性分级中显示出线性趋势。然而，它们与脂肪变性的组织学量的相关性仅为弱-中度。所有脂肪变性生物标志物对脂肪变性的存在具有足够的诊断准确性：FLI、LFS、HSI、VAI和TyG的AUROC分别为0.83、0.80、0.81、0.92和0.90。然而，他们量化脂肪变性的能力很差：他们都没有区分中度和重度脂肪变性，预测脂肪变性>33%的AUROC分别为0.65、0.72、0.65、0.59和0.59，FLI、LFS、HSI、VAI和TyG。纤维化和炎症均显著混淆了脂肪变性生物标志物和脂肪变性之间的关联。脂肪变性标志物均与HOMA-IR相关，与组织学脂肪变性无关。结论5种脂肪变性标志物均能诊断脂肪变性，且与胰岛素抵抗相关。它们受到纤维化和炎症的混淆，并且不能准确地量化脂肪变性;这可能限制它们的临床实用性。需要更多的研究来确定真正独立和定量的脂肪变性标志物。
BackgroundSeveral steatosis biomarkers are available with limited independent validation.AimTo determine diagnostic value and limitations of several steatosis biomarkers using liver biopsy as reference standard in a large cohort of patients with suspected NAFLD.MethodsThree hundred and twenty-four consecutive liver biopsies were included. Histological steatosis was categorised as none (66%). Five steatosis biomarkers were measured: fatty liver index (FLI), NAFLD liver fat score (NAFLD-LFS), hepatic steatosis index (HSI), visceral adiposity index (VAI) and triglyceride x glucose (TyG) index.ResultsSteatosis grades prevalence was: none 5%, mild 39%, moderate 30% and severe 27%. Except for VAI, the steatosis biomarkers showed a linear trend across the steatosis grades. However, their correlation with the histological amount of steatosis was only weak-moderate. All steatosis biomarkers had an adequate diagnostic accuracy for the presence of steatosis: AUROCs for FLI, LFS, HSI, VAI and TyG were 0.83, 0.80, 0.81, 0.92 and 0.90. However, their ability to quantify steatosis was poor: none of them distinguished between moderate and severe steatosis and the AUROCs for predicting steatosis >33% were 0.65, 0.72, 0.65, 0.59 and 0.59 for FLI, LFS, HSI, VAI and TyG. Both fibrosis and inflammation significantly confounded the association between steatosis biomarkers and steatosis. The steatosis biomarkers were all correlated with HOMA-IR, independent from histological steatosis.ConclusionsAll five steatosis biomarkers can diagnose steatosis and are correlated with insulin resistance. They are confounded by fibrosis and inflammation, and do not accurately quantify steatosis; this may limit their clinical utility. More research is needed to identify truly independent and quantitative markers of steatosis.