Deparmtent of Gastroenterology, Kashan University of Medical Sciences, Kashan, Iran.
Hepatobiliary Pancreat Dis Int. 2012 Oct;11(5):513-20. doi: 10.1016/s1499-3872(12)60216-1.
Controversy exists about the correlation between liver ultrasonography and serum parameters for evaluating the severity of liver involvement in non-alcoholic fatty liver disease (NAFLD). This study was designed to determine the association between liver ultrasonography staging in NAFLD and serum parameters correlated with disease severity in previous studies; and set optimal cut-off points for those serum parameters correlated with NAFLD staging at ultrasonography, in order to differentiate ultrasonographic groups (USGs).
This cross-sectional study evaluated outpatients with evidence of NAFLD in ultrasonography referred to a general hospital. Those with positive viral markers, abnormal serum ceruloplasmin or gamma-globulin concentrations were excluded. A radiologist performed the ultrasonography staging and stratified the patients into mild, moderate, and severe groups. Fasting serum alanine aminotransferase (ALT), aspartate aminotransferase, alkaline phosphatase, triglyceride (TG), high and low density lipoprotein (HDL, LDL), and cholesterol were checked.
Two hundred and forty-five patients with a mean age (+/-standard deviation) of 41.63(+/-11.46) years were included. There were no significant differences when mean laboratory concentrations were compared between moderate and severe USGs. Therefore, these groups were combined to create revised USGs ("mild" versus "moderate or severe"). There were associations between the revised USGs, and ALT, TG, HDL levels, and diabetes mellitus [odds ratios=2.81 (95% confidence interval (CI): 1.37-5.76), 2.48 (95% CI: 1.29- 4.78), 0.36 (95% CI: 0.18-0.74), and 5.65 (95% CI: 2.86-11.16) respectively; all P values <0.01]. A cut-off value of 32.5 mg/dL for ALT gave a sensitivity of 70% and a specificity of 62%, for differentiating between the revised USGs.
Serum ALT, TG, and HDL concentrations seem to be associated with the staging by liver ultrasonography in NAFLD. They might be used to predict the staging of liver ultrasonography in these patients.
关于非酒精性脂肪性肝病（NAFLD）肝脏超声与血清学参数评估肝脏受累严重程度的相关性存在争议。本研究旨在确定 NAFLD 肝脏超声分期与既往研究中与疾病严重程度相关的血清参数之间的相关性；并为与超声分期相关的血清参数设定最佳截断值，以区分超声组（USG）。
这项横断面研究评估了在综合医院就诊的超声检查证实有 NAFLD 的门诊患者。排除有阳性病毒标志物、血清铜蓝蛋白或γ球蛋白浓度异常的患者。一位放射科医生进行超声分期，并将患者分为轻度、中度和重度组。检测空腹血清丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶、碱性磷酸酶、甘油三酯（TG）、高低密度脂蛋白（HDL、LDL）和胆固醇。
纳入 245 例年龄（均数±标准差）为 41.63±11.46 岁的患者。中度和重度 USG 之间的平均实验室浓度无显著差异。因此，将这些组合并为修订后的 USG（“轻度”与“中度或重度”）。修订后的 USG 与 ALT、TG、HDL 水平和糖尿病有关[比值比=2.81（95%置信区间（CI）：1.37-5.76）、2.48（95%CI：1.29-4.78）、0.36（95%CI：0.18-0.74）和 5.65（95%CI：2.86-11.16）；所有 P 值均<0.01]。ALT 的截断值为 32.5mg/dL 时，区分修订后的 USG 的敏感性为 70%，特异性为 62%。
血清 ALT、TG 和 HDL 浓度似乎与 NAFLD 肝脏超声分期相关。它们可用于预测这些患者的肝脏超声分期。
