A Simple Index for Nonalcoholic Steatohepatitis-HUFA-Based on Routinely Performed Blood Tests
A Simple Index for Nonalcoholic Steatohepatitis-HUFA-Based on Routinely Performed Blood Tests
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DOI：
10.3390/medicina55060243
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发表时间：
2019-06-01
影响因子：
2.6
通讯作者：
Culafic, Djordje
中科院分区：
文献类型：
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作者：
Culafic, Milica;Kovacevic, Sandra Vezmar;Culafic, Djordje
背景和目标：数据表明，近30%的一般人群患有脂肪变性，其中高达5%的人群发展为非酒精性脂肪性肝炎（NASH）。肝活检仍然被认为是诊断NASH的金标准。人们正在努力寻找不涉及侵入性程序的敏感诊断测试，以解决非酒精性脂肪肝患者的共同问题-无论他们患有NASH还是单纯的脂肪变性。我们的目的是研究独立的预测因子，并开发一种非侵入性，易于执行，低成本的参数集，可用于临床实践中区分单纯性脂肪变性和NASH。方法：？非酒精性脂肪性肝病（NAFLD）患者的横断面研究分为两组：I组-单纯性脂肪变性（SS）和II组-活检证实的NASH。严格的纳入标准和逐步分析允许大量的测量/估计参数的评价。结果：纳入111例患者，其中82例为单纯性脂肪变性，29例为活检证实的NASH。当胰岛素抵抗的稳态模型评估（HOMA-IR）高于2.5、尿酸高于380 μ mol/L、铁蛋白高于100 μ g/L和ALT高于45 U/L时，NASH的概率最高。一个使用首字母的缩写被创建并命名为HUFA索引。该组合模型的受试者工作特征曲线下面积（AUROC）为0.94，NASH的敏感性、特异性、阳性预测值和阴性预测值分别为70.3%、95.1%、83.1%和90.0%。结论：我们提出了一个简单的非侵入性预测指标HUFA，包括四个容易获得的参数（HOMA-IR，尿酸，铁蛋白和ALT），以识别NASH患者，这可能会减少NAFLD患者常规肝活检的需要。
Background and objectives: Data suggests that nearly 30% of the general population have steatosis and up to 5% of this population develops nonalcoholic steatohepatitis (NASH). Liver biopsy is still considered to be the gold standard for the diagnosis of NASH. Great effort is being made toward the identification of sensitive diagnostic tests that do not involve invasive procedures to address a common concern in patients with the nonalcoholic fatty liver disease-whether they have NASH or simple steatosis. We aimed to investigate the independent predictors and develop a non-invasive, easy-to-perform, low-cost set of parameters that may be used in clinical practice to differentiate simple steatosis from NASH. Methods: ? cross-sectional study of nonalcoholic fatty liver disease (NAFLD) patients divided into two groups: group I-simple steatosis (SS) and group II-biopsy-proven NASH. Strict inclusion criteria and stepwise analysis allowed the evaluation of a vast number of measured/estimated parameters. Results: One hundred and eleven patients were included-82 with simple steatosis and 29 with biopsy-proven NASH. The probability of NASH was the highest when homeostatic model assessment of insulin resistance (HOMA-IR) was above 2.5, uric acid above 380 mu mol/L, ferritin above 100 mu g/L and ALT above 45 U/L. An acronym of using first letters was created and named the HUFA index. This combined model resulted in an area under the receiver operator characteristic curve (AUROC) of 0.94, provided sensitivity, specificity, positive predictive value and a negative predictive value for NASH of 70.3%, 95.1%, 83.1% and 90.0%, respectively. Conclusion: We suggest a simple non-invasive predictive index HUFA that encompasses four easily available parameters (HOMA-IR, uric acid, ferritin and ALT) to identify patients with NASH, which may reduce the need for a liver biopsy on a routine basis in patients with NAFLD.