A new composite model including metabolic syndrome, alanine aminotransferase and cytokeratin-18 for the diagnosis of non-alcoholic steatohepatitis in morbidly obese patients
A new composite model including metabolic syndrome, alanine aminotransferase and cytokeratin-18 for the diagnosis of non-alcoholic steatohepatitis in morbidly obese patients
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DOI：
10.1111/j.1365-2036.2010.04480.x
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发表时间：
2010-12-01
影响因子：
7.6
通讯作者：
Tran, A.
中科院分区：
文献类型：
--
作者：
Anty, R.;Iannelli, A.;Tran, A.
研究背景非侵入性方法可用于区分肥胖和病态肥胖患者中单纯性脂肪变性和非酒精性脂肪性肝炎（NASH）。目的开发一种新的评分系统来诊断明确的NASH。方法从464例接受减肥手术的病态肥胖患者中获得术前临床和生物学数据，包括血清半胱天冬酶3产生的细胞角蛋白18片段（CK18）和手术肝活检。队列分为两组：训练组（n = 310）和验证组（n = 154）。根据Kleiner分类法，非酒精性脂肪性肝病活动性评分（NAS）≥ 5分，定义为非酒精性NASH。结果丙氨酸氨基转移酶（ALT）、肌酸激酶18（CK 18）片段和代谢综合征的存在是训练组中NAS ≥ 5分的独立预测因素。这三个参数用于执行预测NAS >= 5的评分系统。而血清CK18片段单独具有受试者工作特征（AUROC）曲线下面积= 0.74，评分系统的AUROC曲线在训练组和验证组中分别为0.88和0.83。包括代谢综合征、ALT和CK18片段的Nice模型（Nice Model）能够准确预测病态肥胖受试者中的非酒精性脂肪肝疾病活动性评分>= 5。
P>BackgroundNon-invasive approaches are useful to differentiate simple steatosis from non-alcoholic steatohepatitis (NASH) in obese and morbidly obese patients.AimTo develop a new scoring system to diagnose definitive NASH.MethodsPreoperative clinical and biological data including serum caspase 3-generated cytokeratin-18 fragments (CK18) and surgical liver biopsies were obtained from 464 morbidly obese patients who had undergone bariatric surgery. The cohort was divided into two groups: training group (n = 310) and validation group (n = 154). Definitive NASH was defined according to Kleiner's classification with a Non-alcoholic fatty liver disease Activity Score (NAS) >= 5.ResultsAlanine aminotransferase (ALT), CK18 fragments and the presence of metabolic syndrome were independent predictors for discriminating patients with NAS >= 5 in the training group. These three parameters were used to carry out a scoring system for the prediction of NAS >= 5. Whereas serum CK18 fragment alone had an area under the receiver operating characteristic (AUROC) curve = 0.74, AUROC curves of the scoring system were 0.88 and 0.83 in the training group and the validation group, respectively.ConclusionA simple and non-invasive composite model (the Nice Model) including metabolic syndrome, ALT and CK18 fragments is able to predict accurately a non-alcoholic fatty liver disease activity score >= 5 in morbidly obese subjects.