Development and validation of a new histological score for pediatric non-alcoholic fatty liver disease
Development and validation of a new histological score for pediatric non-alcoholic fatty liver disease
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DOI：
10.1016/j.jhep.2012.07.027
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发表时间：
2012-12-01
影响因子：
25.7
通讯作者：
Nobili, Valerio
中科院分区：
文献类型：
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作者：
Alkhouri, Naim;De Vito, Rita;Nobili, Valerio
背景与目的：儿科非酒精性脂肪性肝病(NAFLD)可表现为以门脉损害和门脉炎症(PI)为主要特征的独特的组织病理学模式。我们的目的是开发一种新的儿童NAFLD分级评分，用于临床试验，考虑PI的存在和组织学特征的重量。方法：我们的训练集包括203名经生物病理证实的NAFLD儿童。非酒精性脂肪性肝炎(NASH)的诊断依据Brunt标准。对组织学特征进行评分：脂肪变性(0-3)、小叶炎症(0-3)、气球(0-2)和PI(0-2)。对每个特征进行Logistic回归分析以施加权重。新的评分被称为儿科NAFLD组织学评分或PNHS。验证集包括100名患有NAFLD的儿童。结果：初始队列的平均年龄为12.4+/-3.4岁，26名患者(12.8%)存在显著的纤维化(纤维化阶段2)。135例确诊为NASH，平均NAS为4.5+/-1.4。NASH组的平均PNHS为89+/-20.5，而非NASH组为21.9+/-24.5，P
Background & Aims: Pediatric non-alcoholic fatty liver disease (NAFLD) may present with a distinct histopathological pattern characterized by the presence of predominant portal-based injury and portal inflammation (PI). We aimed at developing a new grading score for pediatric NAFLD to be used in clinical trials that takes into account the presence of PI and the weight of histological features.Methods: Our training set consisted of 203 children with biopsyproven NAFLD. The diagnosis of non-alcoholic steatohepatitis (NASH) was based on Brunt's criteria. Histological features were scored: steatosis (0-3), lobular inflammation (0-3), ballooning (0-2), and PI (0-2). Logistic regression analysis was performed to apply weight to each feature. The new score was called the Pediatric NAFLD Histological Score or PNHS. The validation set consisted of 100 children with NAFLD.Results: The mean age of the initial cohort was 12.4 +/- 3.4 years and significant fibrosis (fibrosis stage 2) was present in 26 patients (12.8%). NASH was diagnosed in 135 patients with a mean NAS of 4.5 +/- 1.4. The mean PNHS in the NASH group was 89 +/- 20.5 compared to 21.9 +/- 24.5 in the "not NASH" group, p