Validation of the non-alcoholic fatty liver disease activity score
Validation of the non-alcoholic fatty liver disease activity score
复制标题
DOI：
10.1111/j.1365-2036.2011.04695.x
复制
发表时间：
2011-07-15
影响因子：
7.6
通讯作者：
Harrison, S. A.
中科院分区：
文献类型：
--
作者：
Hjelkrem, M.;Stauch, C.;Harrison, S. A.
非酒精性脂肪性肝病（NAFLD）活动性评分（NAS）是由非酒精性脂肪性肝炎（NASH）临床研究网络（CRN）设计的评分系统，旨在涵盖NAFLD的频谱并评估组织学变化。然而，NAS以及NAS与NASH诊断之间的相关性尚未在NASH CRN之外得到验证。目的验证NASH CRN外的NAS。方法回顾性分析2003年1月至2010年5月期间接受成人NAFLD或脂肪性肝炎肝活检的患者。活检标本由一名肝脏病理学家进行两次盲法评估，一次确定诊断（脂肪性肝炎或脂肪变性/非脂肪性肝炎），第二次确定NAS。结果共对386例肝活检进行了评价。患者活检时的平均年龄为49.9±10.2岁。51%的患者发现NASH。对于NAS >= 5诊断脂肪性肝炎和NAS = 4诊断脂肪性肝炎，其敏感性增加到85%，特异性降低到81%；NPV: 84%, PPV: 82%, Cohen’s kappa为0.658。结论NAFLD活动性评分是一种有效的评分系统，涵盖了NAFLD的频谱，在组织学诊断和NAFLD活动性评分之间具有很高的一致性。NAFLD活度评分>= 4对于预测脂肪性肝炎具有最佳的敏感性和特异性，是NASH介入试验的推荐值。
BackgroundThe non-alcoholic fatty liver disease (NAFLD) activity score (NAS) is a scoring system designed by the Nonalcoholic Steatohepatitis (NASH) Clinical Research Network (CRN) to encompass the spectrum of NAFLD and evaluate histological changes. However, the NAS and the correlation between the NAS and a diagnosis of NASH have not been validated outside the NASH CRN.AimTo validate the NAS outside the NASH CRN.MethodsThis study retrospectively examined liver biopsies from adults with NAFLD or steatohepatitis obtained from January 2003 to May 2010. Biopsy specimens were evaluated twice in a blinded manner by a single hepatopathologist, once to determine a diagnosis (steatohepatitis or steatosis/not-steatohepatitis), and a second time to determine the NAS.ResultsA total of 386 liver biopsies were evaluated. Mean age of patients at time of biopsy was 49.9 +/- 10.2 years. NASH was found in 51% of the patients. For NAS >= 5 as a diagnosis of steatohepatitis and NAS = 4 as a diagnosis of steatohepatitis increased the sensitivity to 85% with a decrease in specificity to 81%; NPV: 84%, PPV: 82% and Cohen's kappa 0.658.ConclusionsThe NAFLD activity score is a valid scoring system encompassing the spectrum of NAFLD with an excellent level of agreement between the histological diagnosis and the NAFLD activity score. A NAFLD activity score >= 4 has optimal sensitivity and specificity for predicting steatohepatitis, and is the recommended value for admission into an interventional trial for NASH.