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Validity of fatty liver prediction scores for diagnosis of fatty liver by Fibroscan

Hepatobiliary & Pancreatic Diseases International 2024年第4期23卷 353-360页

作者： Seogsong Jeong Sun Jae Park Seong Kyun Na Sang Min Park Byung-Cheol Song Yun Hwan Oh Department of Biomedical Sciences Seoul National University Graduate SchoolSeoul 03080Korea Department of Biomedical Informatics CHA University School of MedicineCHA UniversitySeongnam 13488Korea Department of Internal Medicine Inje University College of MedicineSeoul 50834Korea Department of Family Medicine Seoul National University HospitalSeoul National University College of MedicineSeoul 03080Korea Department of Internal Medicine Jeju National University HospitalJeju National University College of MedicineJeju 63241Korea Department of Family Medicine Jeju National University HospitalJeju National University College of MedicineJeju 63241Korea Department of Family Medicine Chung-Ang University Gwangmyeong HospitalChung-Ang University College of MedicineGwangmyeong 14353Korea

Background:The Korea National Health and Nutrition Examination Survey nonalcoholic fatty liver disease(K-NAFLD)score was recently developed with the intent to operationally define nonalcoholic fatty liver disease(NAFLD).However,there remained an external validation that confirmed its diagnostic performance,especially in patients with alcohol consumption or hepatitis virus infection.Methods:Diagnostic accuracy of the K-NAFLD score was evaluated in a hospital-based cohort consisting of 1388 participants who received Fibroscan®.Multivariate-adjusted logistic regression models and the contrast estimation of receiver operating characteristic curves were used for validation of the K-NAFLD score,fatty liver index(FLI),and hepatic steatosis index(HSI).Results:K-NAFLD-moderate[adjusted odds ratio(aOR)=2.53,95%confidence interval(CI):1.13-5.65]and K-NAFLD-high(aOR=4.14,95%CI:1.69-10.13)groups showed higher risks of fatty liver compared to the K-NAFLD-low group after adjustments for demographic and clinical characteristics,and FLI-moderate and FLI-high groups revealed aORs of 2.05(95%CI:1.22-3.43)and 1.51(95%CI:0.78-2.90),respectively.In addition,the HSI was less predictive for Fibroscan®-defined fatty liver.Both K-NAFLD and FLI also demonstrated high accuracy in the prediction of fatty liver in patients with alcohol consumption and chronic hepatitis virus infection,and the adjusted area under curve values were comparable between K-NAFLD and FLI.Conclusions:Externally validation of the K-NAFLD and FLI showed that these scores may be a useful,noninvasive,and non-imaging modality for the identification of fatty liver.In addition,these scores also predicted fatty liver in patients with alcohol consumption and chronic hepatitis virus infection.

关键词： Nonalcoholic fatty liver disease fatty liver index Hepatic steatosis index

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liver Fat Scores for Noninvasive Diagnosis and Monitoring of Nonalcoholic fatty liver Disease in Epidemiological and Clinical Studies

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Journal of Clinical and Translational Hepatology 2023年第5期11卷 1212-1227页

作者： Mona Reinshagen Stefan Kabisch Andreas F.H.Pfeiffer Joachim Spranger Department of Endocrinology and Metabolism Campus Benjamin FranklinCharitéUniversity MedicineBerlinGermany Deutsches Zentrum für Diabetesforschung e.V. Geschäftsstelle am Helmholtz-Zentrum MünchenNeuherbergGermany

Nonalcoholic fatty liver disease(NAFLD)is strongly associated with the metabolic syndrome and type 2 diabetes and independently contributes to long-term complications.Being often asymptomatic but reversible,it would require population-wide screening,but direct diagnostics are either too invasive(liver biopsy),costly(MRI)or depending on the examiner’s expertise(ultrasonography).Hepatosteatosis is usually accommodated by features of the metabolic syndrome(e.***.obesity,disturbances in triglyceride and glucose metabolism),and signs of hepatocellular damage,all of which are reflected by biomarkers,which poorly predict NAFLD as single item,but provide a cheap diagnostic alternative when integrated into composite liver fat indices.fatty liver index,NAFLD LFS,and hepatic steatosis index are common and accurate indices for NAFLD prediction,but show limited accuracy for liver fat quantification.Other indices are rarely used.Hepatic fibrosis scores are commonly used in clinical practice,but their mandatory reflection of fibrotic reorganization,hepatic injury or systemic sequelae reduces sensitivity for the diagnosis of simple steatosis.Diet-induced liver fat changes are poorly reflected by liver fat indices,depending on the intervention and its specific impact of weight loss on NAFLD.This limited validity in longitudinal settings stimulates research for new equations.Adipokines,hepatokines,markers of cellular integrity,genetic variants but also simple and inexpensive routine parameters might be potential components.Currently,liver fat indices lack precision for NAFLD prediction or monitoring in individual patients,but in large cohorts they may substitute nonexistent imaging data and serve as a compound biomarker of metabolic syndrome and its cardiometabolic sequelae.

关键词： NAFLD liver fat indices fatty liver index Prediction Dietary intervention

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Discrepancies between Nonalcoholic and Metabolic-associated fatty liver Disease by Multiple Steatosis Assessment

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Journal of Clinical and Translational Hepatology 2022年第6期10卷 1013-1026页

作者： Congxiang Shao Junzhao Ye Xin Li Yansong Lin Shiting Feng Bing Liao Wei Wang Xiaorong Gong Bihui Zhong Department of Gastroenterology of the First Affiliated Hospital Sun Yat-sen UniversityGuangzhouGuangdongChina Department of Gastroenterology Affiliated Dongguan People’s HospitalSouthern Medical University(Dongguan People’s Hospital)DongguanGuangdongChina Department of Radiology of the First Affiliated Hospital Sun Yat-sen Univer-sityGuangzhouGuangdongChina Department of Pathology of the First Affiliated Hospital Sun Yat-sen UniversityGuangzhouGuangdongChina Department of Medical Ultrasonics of the First Affiliated Hospital Sun Yat-sen UniversityGuangzhouGuangdongChina Department of Gastroenterology First Affiliated HospitalGuangzhou Medical UniversityGuangzhouGuangdongChina

Background and Aims:The redefinition of metabolic-as-sociated fatty liver disease(MAFLD)from nonalcoholic fat-ty liver disease(NAFLD)has caused a revolution in clinical practice,and the characteristics of patients with steatosis but not MAFLD remain unclear.The aims were to compare the diagnosis rate of MAFLD in NAFLD using different steato-sis methods and explore the features of non-MAFLD-NAFLD and MAFLD-non-NAFLD.Methods:A cross-sectional study enrolling consecutive individuals was conducted at three medical centers in southern China from January 2015 to September 2020.Steatosis was evaluated by liver biopsy or magnetic resonance imaging-based proton density fat frac-tion(MRI-PDFF),ultrasound,controlled attenuation param-eter(CAP),and fatty liver index(FLI).Fibrosis was assessed by the NAFLD fibrosis score,transient elastography,or shear wave elastography.Results:The study enrolled 14,985 Chi-nese adults.The agreement of MAFLD and NAFLD diagnoses were 83%for FLI,95%for ultrasound,94%for both CAP and MRI-PDFF,and 95%for liver biopsy.The body mass index,blood pressure and lipid levels among non-MAFLD-NAFLD pa-tients were similar metabolic parameters(p>0.05 for all),but not the alanine aminotransferase and the proportion of pa-tients with insulin resistance,which were significantly higher in non-MAFLD-NAFLD with significant fibrosis.Conclusions:The new MAFLD definition ruled out 5-17%of NAFLD cases.NAFLD and MAFLD-NAFLD involved more severe metabolic abnormalities than MAFLD and MAFLD-non-NAFLD.Non-MAFLD-NAFLD patients with significant fibrosis had more se-vere liver injury and increased glycemic dysregulation within the normal range.Attention should be paid to its progression.

关键词： Controlled attenuation parameter fatty liver index liver biopsy Metabolic-associated fatty liver disease Magnetic resonance imaging-based proton density fat fraction

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Non-alcoholic fatty liver disease:a multidisciplinary clinical practice approach—the institutional adaptation to existing Clinical Practice Guidelines

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Emergency and Critical Care Medicine 2022年第1期2卷 12-22页

作者： Zoran Gluvic Ratko Tomasevic Ksenija Bojovic Milan Obradovic Esma R.Isenovic University Clinical-Hospital Centre Zemun-Belgrade Clinic of Internal MedicineSchool of MedicineUniversity of BelgradeBelgradeSerbia Clinical Centre of Serbia Clinic of Infectious and Tropical DiseasesSchool of MedicineUniversity of BelgradeBelgradeSerbia Department of Radiobiology and Molecular Genetics “VINČA”Institute of Nuclear Sciences-National Institute of thеRepublic of SerbiaUniversity of BelgradeBelgradeSerbia

Non-alcoholic fatty liver disease(NAFLD)is among the most frequently encountered chronic liver diseases in everyday clinical practice.It is considered the hepatic manifestation of metabolic syndrome.Today,liver biopsy is still the gold standard for NAFLD confirmation and assessing NAFLD’s possible progression to non-alcoholic steatohepatitis,fibrosis,cirrhosis,and hepatocellular carcinoma.Because of the high prevalence of NAFLD and potential associated risks of invasive diagnostic procedures,it is of great interest to recruit the patients for liver biopsy.However,as the presence of liver fibrosis determines the further clinical course,liver biopsy is expectedly reserved for those with increased fibrosis risk.The quality of liver biopsy recruitment and patient monitoring could be significantly improved by using non-invasive tools to assess liver fibrosis presence and interactive collaboration between general practitioners,gastroenterologists,and endocrinologists.As a result,the quality of liver biopsy recruitment and patients monitoring could be significantly improved.Here,we proposed clinical practice guidelines that could be implemented for everyday clinical practice in NAFLD patients.

关键词： Diagnostics of NAFLD fatty liver index Fibrosis score-4 Management of NAFLD Non-alcoholic fatty liver disease

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Ursodeoxycholic acid as a means of preventing atherosclerosis,steatosis and liver fibrosis in patients with nonalcoholic fatty liver disease

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World Journal of Gastroenterology 2021年第10期27卷 959-975页

作者： Maria Nadinskaia Marina Maevskaya Vladimir Ivashkin Khava Kodzoeva Irina Pirogova Evgeny Chesnokov Alexander Nersesov Jamilya Kaibullayeva Akzhan Konysbekova Aigul Raissova Feruza Khamrabaeva Elena Zueva Department of Propaedeutics of Internal Diseases Gastroenterology and HepatologySechenov First Moscow State Medical University(Sechenov University)Moscow 119991Russia Vasilenko Clinic of Internal Diseases Propedeutics Gastroenterology and HepatologyUniversity Clinical Hospital№2Sechenov First Moscow State Medical University(Sechenov University)Moscow 119991Russia LLC MC“Lotus” Center for Gastroenterology and HepatologyChelyabinsk 454092Russia Department of Hospital Therapy with the Course of Endocrinology and Clinical Pharmacology Tyumen State Medical UniversityTyumen 625003Russia Department of Gastroenterology S.Asfendiyarov Kazakh National Medical UniversityAlmaty 050000Kazakhstan Functional and Ultrasound Diagnostics Scientific and Research Institute of Cardiology and Internal DiseasesAlmaty 050000Kazakhstan Department of Internal Diseases Scientific and Research Institute of Cardiology and Internal DiseasesAlmaty 050000Kazakhstan Faculty of Therapy Tashkent Institute of Advanced Medical StudiesTashkent 100007Uzbekistan Department of Therapy№1 with Training General Practitioners Tashkent Medical AcademyTashkent 100109Uzbekistan

BACKGROUND Atherosclerotic cardiovascular disease(ASCVD)is the leading cause of mortality in patients with nonalcoholic fatty liver disease(NAFLD).Weight loss is a key factor for successful NAFLD and CVD therapy.Ursodeoxycholic acid(UDCA),which is one of the first-line therapeutic agents for treatment of NAFLD,is reported to have a beneficial effect on dyslipidemia and ASCVD risk because of antioxidant properties.AIM To evaluate the effects of 6 mo of UDCA treatment on hepatic function tests,lipid profile,hepatic steatosis and fibrosis,atherogenesis,and ASCVD risk in men and women with NAFLD,as well as to assess the impact of>5%weight reduction on these parameters.METHODS An open-label,multicenter,international noncomparative trial was carried out at primary health care settings and included 174 patients with ultrasound-diagnosed NAFLD who received 15 mg/kg/d UDCA for 6 mo and were prescribed lifestyle modification with diet and exercise.The efficacy criteria were liver enzymes,lipid profile,fatty liver index(FLI),noninvasive liver fibrosis tests(nonalcoholic fatty liver disease fibrosis score and liver fibrosis index),carotid intima-media thickness(CIMT),and ASCVD risk score.To test statistical hypotheses,the Wilcoxon test,paired t-test,Fisher’s exact test,and Pearson's chi-squared test were used.RESULTS The alanine aminotransferase(ALT)level changed by-14.1 U/L(-31.0;-5.3)from baseline to 3 mo and by-6.5 U/L(-14.0;0.1)from 3 to 6 mo.The magnitude of ALT,aspartate transaminase,and glutamyltransferase decrease was greater during the first 3 mo of treatment compared to the subsequent 3 mo(Pfatty liver disease fibrosis score or liver fibrosis index was foun

关键词： Ursodeoxycholic acid Nonalcoholic fatty liver disease liver function tests fatty liver index Carotid intima-media thickness Atherosclerotic cardiovascular disease

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利用人工神经网络建立脂肪性肝病的预测新模型

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Gastroenterology Report 2021年第1期9卷 31-37,I0001,I0002页

作者： Yi-Shu Chen Dan Chen Chao Shen Ming Chen Chao-Hui Jin Cheng-Fu Xu Chao-Hui Yu You-Ming Li Department of Gastroenterology The First Affiliated HospitalCollege of MedicineZhejiang UniversityHangzhouZhejiangP.R.China Health Management Center The First Affiliated HospitalCollege of MedicineZhejiang UniversityHangzhouZhejiangP.R.China Hithink Royal Flush Information Network Co. LtdHangzhouZhejiangP.R.China

背景:人工神经网络(ANN)是以数学模型模拟神经元活动的信息处理系统,因其强大的自我学习能力和非线性信息分析能力而应用于疾病诊断,尤其适用于复杂的系统性疾病。本研究旨在借助ANN建立脂肪性肝病(FLD)的预测模型。方法:本研究纳入在... 详细信息

背景:人工神经网络(ANN)是以数学模型模拟神经元活动的信息处理系统,因其强大的自我学习能力和非线性信息分析能力而应用于疾病诊断,尤其适用于复杂的系统性疾病。本研究旨在借助ANN建立脂肪性肝病(FLD)的预测模型。方法:本研究纳入在浙江大学医学院附属第一医院进行体检的共7,396对性别和年龄匹配的受试者,并将体检报告中的各项检查指标作为可能的输入变量进行ANN模型的训练。采用ROC曲线下面积(AUROC)评估该模型对FLD的预测能力,其他评估指标包括准确性、敏感性、特异性、Cohen’s k系数、Brier评分和Hosmer-Lemeshow检验等。本研究还使用本组数据重新训练了其他FLD诊断模型,包括脂肪肝指数(FLI)和肝脂肪变性指数(HSI),并与本研究建立的ANN模型进行比较。结果:经训练,最终纳入8个变量(年龄、性别、体质指数、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、尿酸、甘油三酯、空腹血糖)作为ANN诊断模型的输入节点,输出区间在0-1之间(1为存在FLD,0为不存在FLD)。取0.51作为截点值,在验证队列中,ANN模型预测FLD的AUROC为0.908(95%CI:0.901-0.915),显著高于FLI模型(0.881,95%CI:0.872-0.891;P<0.05)和HSI模型(0.885,95%CI:0.877-0.893;P<0.05)。与FLI模型和HSI模型相比,本研究建立的ANN模型呈现更高的预测准确性,与超声检查结果的一致性更好,校正能力也更强。结论:本研究建立的ANN模型对FLD具有良好的预测及诊断能力,我们期待ANN模型能在未来的临床和流行病学研究中得到广泛应用。

关键词： artificial neural network diagnostic model fatty liver disease fatty liver index Hepatic Steatosis index uric acid

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