Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease
Development and validation of a simple NAFLD clinical scoring system for identifying patients without advanced disease
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DOI：
10.1136/gut.2007.146019
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发表时间：
2008-10-01
期刊：
影响因子：
24.5
通讯作者：
Neuschwander-Tetri, B. A.
中科院分区：
文献类型：
--
作者：
Harrison, S. A.;Oliver, D.;Neuschwander-Tetri, B. A.
背景：需要晚期非酒精性肝病（NAFLD）的临床预测因子来指导诊断评估和治疗。研究方法：为了更好地了解NAFLD的人口统计学特征和晚期疾病的风险因素，本研究分析了两个地理上独立的三级医疗中心的827例NAFLD患者。结果：队列中51%为女性，中位体重指数（BMI）为33 kg/m2; 3%的BMI正常。常见的合并症包括高血压（60%）和糖尿病（35%）; 91%的患者存在胰岛素抵抗，24%的患者存在晚期纤维化。当比较无纤维化或轻度纤维化患者与晚期纤维化患者时，BMI >= 28 kg/m2，年龄> 50岁，天冬氨酸转氨酶/丙氨酸转氨酶（AST/ALT）比值>= 0.8，定量评估检查指数（QUICKI）评分< 0.294单变量分析显示，晚期纤维化的优势比（OR）>= 2.4，与稳态模型评估（HOMA）> 6.2）和糖尿病（DM）单独相关。基于强制进入逻辑回归分析的结果，将三个变量合并为加权和（BMI >= 28= 1分，AAR>= 0.8= 2分，DM= 1分），以形成易于计算的用于预测晚期纤维化的复合评分，称为BARD评分。2-4分与晚期纤维化的OR为17（置信区间为9.2 - 31.9）和阴性预测值为96%相关。结论：NAFLD患者常存在胰岛素抵抗及其合并症。基于容易获得的临床数据的容易计算的评分可以可靠地排除这些患者中晚期纤维化的存在，特别是在非糖尿病患者中。
Background: Clinical predictors of advanced non-alcoholic liver disease (NAFLD) are needed to guide diagnostic evaluation and treatment. Methods: To better understand the demographics of NAFLD and risk factors for advanced disease, this study analysed 827 patients with NAFLD at two geographically separate tertiary medical centres. Results: The cohort was 51% female and had a median body mass index (BMI) of 33 kg/m(2); 3% had a normal BMI. Common co-morbidities included hypertension (60%) and diabetes (35%); insulin resistance was present in 91% and advanced fibrosis in 24% of patients. When comparing patients with no fibrosis or mild fibrosis to those with advanced fibrosis, BMI >= 28 kg/m(2), age > 50 years, and aspartate transaminase/alanine aminotransferase (AST/ALT) ratio >= 0.8, a quantitative assessment check index (QUICKI) score < 0.294 ( equivalent to homeostatasis model assessment (HOMA) > 6.2) and the presence of diabetes mellitus (DM) were individually associated by univariate analysis with odds ratios (ORs) of >= 2.4 for advanced fibrosis. Based on the results of forced entry logistic regression analysis, three variables were combined in a weighted sum ( BMI >= 28= 1 point, AAR of >= 0.8= 2 points, DM= 1 point) to form an easily calculated composite score for predicting advanced fibrosis called the BARD score. A score of 2-4 was associated with an OR for advanced fibrosis of 17 (confidence interval 9.2 to 31.9) and a negative predictive value of 96%. Conclusions: Insulin resistance and its co-morbidities are often present in patients with NAFLD. An easily calculated score based on readily available clinical data can reliably exclude the presence of advanced fibrosis in these patients, particularly among non-diabetics.