Liver fibrosis in overweight patients
Liver fibrosis in overweight patients
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DOI：
10.1016/s0016-5085(00)70364-7
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发表时间：
2000-06-01
期刊：
影响因子：
29.4
通讯作者：
Poynard, T
中科院分区：
文献类型：
--
作者：
Ratziu, V;Giral, P;Poynard, T
背景与目的：临床上常见的问题是肝功能检查结果异常的超重患者是否应该进行肝活检。虽然可能发生严重的肝损伤，但其患病率和风险因素尚不清楚。研究方法：回顾性研究了93例肝功能检查异常（但无明显肝病），体重指数（BMI）> 25 kg/m2，且无酒精性、病毒性、自身免疫性、药物诱导或遗传性肝病的连续患者。临床，生物学和组织学变量与间隔纤维化或肝硬化进行了测试。结果如下：28例患者（30%）存在间隔纤维化，其中10例（11%）存在肝硬化，年龄≥ 50岁（比值比[OR]，14.1），BMI ≥ 28 kg/m（2）（OR，5.7），甘油三酯≥ 1.7 mmol/L（OR，5），丙氨酸氨基转移酶（ALT）≥ 2N在组织学特征中，间隔纤维化与坏死性炎症活动强烈相关（OR，44），A评分结合年龄、BMI、甘油三酯，当评分为0或1时，ALT对间隔纤维化的阴性预测值为100结论：室间隔纤维化常发生在肝功能异常的超重患者中。结合BMI、年龄、ALT和甘油三酯的临床生物学评分可以改善肝活检患者的选择。
Background & Aims: A common clinical issue is whether overweight patients with abnormal liver function test results should undergo liver biopsy. Although serious liver injury can occur, its prevalence and risk factors are not well known. Methods: Ninety-three consecutive patients with abnormal liver function tests (but without overt liver disease), body mass index (BMI) > 25 kg/m(2), and no alcoholic, viral, autoimmune, drug-induced, or genetic liver disease were retrospectively studied. Clinical, biological, and histological variables were tested for association with septal fibrosis or cirrhosis. Results: Septal fibrosis was present in 28 patients (30%) including cirrhosis in 10 (11%), Age greater than or equal to 50 years (odds ratio [OR], 14.1), BMI greater than or equal to 28 kg/m(2) (OR, 5.7), triglycerides greater than or equal to 1.7 mmol/L (OR, 5), and alanine aminotransferase (ALT) greater than or equal to 2N (OR, 4.6) were independently associated with septal fibrosis, Among histological features, septal fibrosis was strongly associated with necroinflammatory activity (OR, 44), A score combining age, BMI, triglycerides, and ALT had 100% negative predictive value for septal fibrosis when scoring 0 or 1 (100% sensitivity for a specificity of 47%), Conclusions: Septal fibrosis occurs frequently in overweight patients with abnormal liver function tests. A clinicobiological score combining BMI, age, ALT, and triglycerides could improve selection of patients for liver biopsy.