Nobili Valerio, Alisi Anna, Vania Andrea, Tiribelli Claudio, Pietrobattista Andrea, Bedogni Giorgio
Department of Hepatogastroenterology and Nutrition, Pediatric Hospital IRCCS Bambino Gesù, Via S, Onofrio 4, 00165 Rome, Italy.
BMC Med. 2009 May 1;7:21. doi: 10.1186/1741-7015-7-21.
Liver fibrosis is a stage of non-alcoholic fatty liver disease (NAFLD) which is responsible for liver-related morbidity and mortality in adults. Accordingly, the search for non-invasive markers of liver fibrosis has been the subject of intensive efforts in adults with NAFLD. Here, we developed a simple algorithm for the prediction of liver fibrosis in children with NAFLD followed at a tertiary care center.
The study included 136 male and 67 female children with NAFLD aged 3.3 to 18.0 years; 141 (69%) of them had fibrosis at liver biopsy. On the basis of biological plausibility, readily availability and evidence from adult studies, we evaluated the following potential predictors of liver fibrosis at bootstrapped stepwise logistic regression: gender, age, body mass index, waist circumference, alanine transaminase, aspartate transaminase, gamma-glutamyl-transferase, albumin, prothrombin time, glucose, insulin, triglycerides and cholesterol. A final model was developed using bootstrapped logistic regression with bias-correction. We used this model to develop the 'pediatric NAFLD fibrosis index' (PNFI), which varies between 0 and 10.
The final model was based on age, waist circumference and triglycerides and had a area under the receiver operating characteristic curve of 0.85 (95% bootstrapped confidence interval (CI) with bias correction 0.80 to 0.90) for the prediction of liver fibrosis. A PNFI >or= 9 (positive likelihood ratio = 28.6, 95% CI 4.0 to 201.0; positive predictive value = 98.5, 95% CI 91.8 to 100.0) could be used to rule in liver fibrosis without performing liver biopsy.
PNFI may help clinicians to predict liver fibrosis in children with NAFLD, but external validation is needed before it can be employed for this purpose.
肝纤维化是非酒精性脂肪性肝病（NAFLD）的一个阶段，在成人中它是导致肝脏相关发病和死亡的原因。因此，寻找肝纤维化的非侵入性标志物一直是NAFLD成人患者深入研究的课题。在此，我们开发了一种简单算法，用于预测在三级医疗中心随访的NAFLD儿童的肝纤维化情况。
该研究纳入了136名男性和67名女性NAFLD儿童，年龄在3.3至18.0岁之间；其中141名（69%）在肝活检时有纤维化。基于生物学合理性、可得性以及成人研究的证据，我们在自抽样逐步逻辑回归中评估了以下肝纤维化的潜在预测因素：性别、年龄、体重指数、腰围、丙氨酸转氨酶、天冬氨酸转氨酶、γ-谷氨酰转移酶、白蛋白、凝血酶原时间、葡萄糖、胰岛素、甘油三酯和胆固醇。使用带有偏差校正的自抽样逻辑回归建立了最终模型。我们用这个模型开发了“儿童NAFLD纤维化指数”（PNFI），其范围在0到10之间。
最终模型基于年龄、腰围和甘油三酯，在预测肝纤维化方面，受试者工作特征曲线下面积为0.85（95%自抽样偏差校正置信区间（CI）为0.80至0.90）。PNFI≥9（阳性似然比 = 28.6，95% CI为4.0至201.0；阳性预测值 = 98.5，95% CI为91.8至100.0）可用于在不进行肝活检的情况下判定肝纤维化。
PNFI可能有助于临床医生预测NAFLD儿童的肝纤维化，但在用于此目的之前需要进行外部验证。
