Predictive scoring system for advanced liver fibrosis in Japanese patients with severe obesity
Predictive scoring system for advanced liver fibrosis in Japanese patients with severe obesity
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DOI：
10.1007/s00595-021-02266-w
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发表时间：
2021-04-07
期刊：
影响因子：
2.5
通讯作者：
Takikawa, Yasuhiro
中科院分区：
文献类型：
--
作者：
Nikai, Haruka;Sasaki, Akira;Takikawa, Yasuhiro
目的：本研究的目的是检查严重肥胖的日本患者中晚期肝纤维化的预测评分系统。方法72例患者行腹腔镜袖状胃切除术，术中行肝穿刺活检。我们将这些患者分为两组：Brunt分期>= 2（晚期纤维化）和0/1（无/轻度纤维化）。进行逻辑回归分析以确定晚期纤维化的预测因子。结果16例患者有晚期纤维化，56例无/轻度纤维化。2型糖尿病（T2 DM）在晚期肝纤维化组的患病率显著高于无/轻度肝纤维化组。对预测晚期纤维化的因素进行的单变量分析显示，T2 DM组中AST/ALT比值、血清胰岛素水平、HOMA-IR和IV型胶原7S存在显著差异。根据多变量分析，IV型胶原7S是独立预测因子，临界值为5.6 ng/mL。我们创造了一个流程图;高风险（T2 DM和IV型胶原7S >= 5.6 ng/mL）、中等风险（T2 DM和IV型胶原7S < 5.6 ng/mL）和低风险（非DM）。对于高危人群，敏感性、特异性、阳性预测值和阴性预测值分别为56.2%、94.4%、75.0%和87.9%。结论该分类系统有可能对肝纤维化风险进行准确分类。
Purpose The aim of this study was to examine the predictive scoring system of advanced liver fibrosis in severely obese Japanese patients. Methods Seventy-two patients underwent laparoscopic sleeve gastrectomy and intraoperative liver biopsies. We classified these patients into two groups: Brunt stage >= 2 (advanced fibrosis) and 0/1 (none/mild fibrosis). A logistic regression analysis was performed to identify the predictors of advanced fibrosis. Results Sixteen patients had advanced fibrosis, while 56 had no/mild fibrosis. The prevalence of type 2 diabetes mellitus (T2DM) in advanced fibrosis group was significantly higher than in none/mild fibrosis. An univariate analysis of the factors predicting advanced fibrosis showed significant differences in AST/ALT ratio, serum insulin levels, HOMA-IR, and type IV collagen 7S in the T2DM group. According to a multivariate analysis, type IV collagen 7S was an independent predictor and the cutoff value was 5.6 ng/mL. We created a flow chart; high risk (T2DM and type IV collagen 7S >= 5.6 ng/mL), moderate risk (T2DM and type IV collagen 7S < 5.6 ng/mL), and low risk (non-DM). For those at high risk, the sensitivity, specificity, positive predictive value, and negative predictive value were 56.2%, 94.4%, 75.0%, and 87.9%, respectively. Conclusion This classification system has the potential to accurately categorize the risk of liver fibrosis.