Introduction: Nonalcoholic fatty liver disease covers a broad spectrum. Simple steatosis has usually a benign course while nonalcoholic steatohepatitis (NASH) can progress into hepatocellular carcinoma, and cirrhosis. Therefore, differentiating patients with benign steatosis and NASH is crucial. Liver biopsy, the usual gold standard for NASH diagnosis, cannot be used as a screening method due to its associated risks. This is especially problematic for obese patients with a prevalence of nonalcoholic fatty liver disease (NAFLD) in #x3e;80% of patients. The aim of this study was therefore to develop and validate a noninvasive NASH screening test in a cohort of high-risk, morbidly obese patients. Methods: This prospective study examined diagnostic accuracy in accordance with STARD guidelines. 112 liver biopsies were consecutively assigned to either a training or validation cohort. Using the Bedossa histological scoring system, the cohorts were subdivided into NASH versus NAFLD/No NAFLD. Predictors of NASH were evaluated with receiver operating characteristic (ROC) curves. A model was then constructed using a backward stepwise logistic regression and evaluated in an independent validation cohort. Results: 53.5% of the patients had NASH and 4 patients had cirrhosis. Mean body mass index (BMI) was 49.8 ± 7.5 kg/m². Backward stepwise logistic regression identified 4 parameters associated with the presence of NASH: alanin-aminotransferase, albumin, BMI, and triglycerides. The noninvasive NASH detection score (NI-NASH-DS) had an ROC of 0.851 and 0.727 in the training and validation cohorts, respectively. Sensitivity and specificity were 77.1% and 88% in the training cohort and 88% and 48% in the validation cohort which was much better than the established noninvasive scores. Discussion/Conclusion: The NI-NASH-DS is easy-to-use, inexpensive, and noninvasive and can reliably detect NASH in patients with morbid obesity. Due to its simplicity, it can be used frequently and repeatedly.
Obes Facts

中文翻译：

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用于肥胖症患者无创非酒精性脂肪性肝炎检测的新型评分系统的开发和验证

简介：非酒精性脂肪肝的范围很广。单纯性脂肪变性通常具有良性过程，而非酒精性脂肪性肝炎 (NASH) 可发展为肝细胞癌和肝硬化。因此，区分良性脂肪变性和 NASH 患者至关重要。肝活检是 NASH 诊断的常用金标准，由于其相关风险，不能用作筛查方法。这对于在 #x3e 中患有非酒精性脂肪肝 (NAFLD) 的肥胖患者尤其成问题；80% 的患者。因此，本研究的目的是在一组高危、病态肥胖患者中开发和验证无创 NASH 筛查测试。方法：这项前瞻性研究根据 STARD 指南检查了诊断准确性。112 份肝活检被连续分配到训练或验证队列。使用 Bedossa 组织学评分系统，将队列细分为 NASH 与 NAFLD/无 NAFLD。NASH 的预测因子通过受试者工作特征 (ROC) 曲线进行评估。然后使用向后逐步逻辑回归构建模型并在独立验证队列中进行评估。结果： 53.5%的患者患有NASH，4名患者患有肝硬化。平均体重指数 (BMI) 为 49.8 ± 7.5 kg/m ². 向后逐步逻辑回归确定了与 NASH 存在相关的 4 个参数：丙氨酸氨基转移酶、白蛋白、BMI 和甘油三酯。无创 NASH 检测评分 (NI-NASH-DS) 在训练和验证队列中的 ROC 分别为 0.851 和 0.727。训练队列的敏感性和特异性分别为 77.1% 和 88%，验证队列的敏感性和特异性分别为 88% 和 48%，这远优于既定的无创评分。讨论/结论： NI-NASH-DS 易于使用、价格低廉且无创，可以可靠地检测病态肥胖患者的 NASH。由于它的简单性，它可​​以经常和重复使用。
肥胖事实