Dunn Winston, Angulo Paul, Sanderson Schuyler, Jamil Laith H, Stadheim Linda, Rosen Charles, Malinchoc Michael, Kamath Patrick S, Shah Vijay H
Advanced Liver Disease Study Group and Miles and Shirley Fiterman Center for Digestive Diseases at Mayo Clinic, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
Gastroenterology. 2006 Oct;131(4):1057-63. doi: 10.1053/j.gastro.2006.08.020. Epub 2006 Aug 10.
BACKGROUND & AIMS: Distinguishing an alcohol basis from a nonalcoholic basis for the clinical and histologic spectrum of steatohepatitic liver disease is difficult because of unreliability of alcohol consumption history. Unfortunately, various biomarkers have had limited utility in distinguishing alcoholic liver disease (ALD) from nonalcoholic fatty liver disease (NAFLD). Thus, the aim of our study was to create and validate a model to diagnose ALD in patients with steatohepatitis.
A cross-sectional cohort study was performed at the Mayo Clinic, Rochester, Minnesota, to create a model using multivariable logistic regression analysis. This model was validated in 3 independent data sets comprising patients of varying severity of steatohepatitis spanning over 10 years.
Logistic regression identified mean corpuscular volume, aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio, body mass index, and gender as the most important variables that separated patients with ALD from NAFLD. These variables were used to generate the ALD/NAFLD Index (ANI), with ANI of greater than zero incrementally favoring ALD and ANI of less than zero incrementally favoring a diagnosis of NAFLD, thus making ALD unlikely. ANI had a c-statistic of 0.989 in the derivation sample, and 0.974, 0.989, 0.767 in the 3 validation samples. ANI performance characteristics were significantly better than several conventional and recently proposed biomarkers used to differentiate ALD from NAFLD, including the histopathologic marker protein tyrosine phosphatase 1b, AST/ALT ratio, gamma-glutamyl transferase, and carbohydrate-deficient transferrin.
ANI, derived from easily available objective variables, accurately differentiates ALD from NAFLD in hospitalized, ambulatory, and pretransplantation patients and compares favorably with other traditional and proposed biomarkers.
由于饮酒史的不可靠性，区分脂肪性肝炎性肝病临床和组织学谱中的酒精性基础与非酒精性基础很困难。不幸的是，各种生物标志物在区分酒精性肝病（ALD）和非酒精性脂肪性肝病（NAFLD）方面的效用有限。因此，我们研究的目的是创建并验证一个用于诊断脂肪性肝炎患者中ALD的模型。
在明尼苏达州罗切斯特市的梅奥诊所进行了一项横断面队列研究，使用多变量逻辑回归分析创建一个模型。该模型在3个独立数据集中进行了验证，这些数据集包含了超过10年中不同严重程度脂肪性肝炎患者。
逻辑回归确定平均红细胞体积、天冬氨酸转氨酶（AST）/丙氨酸转氨酶（ALT）比值、体重指数和性别是区分ALD患者与NAFLD患者的最重要变量。这些变量用于生成ALD/NAFLD指数（ANI），ANI大于零逐渐支持ALD，ANI小于零逐渐支持NAFLD诊断，从而使ALD不太可能。在推导样本中ANI的c统计量为0.989，在3个验证样本中分别为0.974、0.989、0.767。ANI的性能特征明显优于用于区分ALD和NAFLD的几种传统和最近提出的生物标志物，包括组织病理学标志物蛋白酪氨酸磷酸酶1b、AST/ALT比值、γ-谷氨酰转移酶和缺糖转铁蛋白。
由易于获得的客观变量得出的ANI，在住院、门诊和移植前患者中能准确区分ALD和NAFLD，并且与其他传统和提出的生物标志物相比具有优势。
