用于预测非酒精性脂肪性肝病患儿是否存在晚期纤维化的儿童非酒精性脂肪性肝病纤维化评分（PNFS）的开发。
The development of the pediatric NAFLD fibrosis score (PNFS) to predict the presence of advanced fibrosis in children with nonalcoholic fatty liver disease.
作者信息
Alkhouri Naim, Mansoor Sana, Giammaria Paola, Liccardo Daniela, Lopez Rocio, Nobili Valerio
机构信息
Department of Pediatric Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, United States of America; Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio, United States of America.
Department of Pediatric Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, United States of America.
出版信息
PLoS One. 2014 Aug 14;9(8):e104558. doi: 10.1371/journal.pone.0104558. eCollection 2014.
BACKGROUND
Noninvasive hepatic fibrosis scores that predict the presence of advanced fibrosis have been developed and validated in adult patients with NAFLD. The aims of our study were to assess the utility of commonly used adult fibrosis scores in pediatric NAFLD and to develop a pediatric specific fibrosis score that can predict advanced fibrosis.
METHODS
Consecutive children with biopsy-proven NAFLD were included. Fibrosis was determined by an experienced pathologist (F0-4). Advanced fibrosis was defined as fibrosis stage ≥ 3. The following adult fibrosis scores were calculated for each child: AST/ALT ratio, AST/platelet ratio index (APRI), NAFLD fibrosis score (NFS), and FIB-4 Index. Multivariable logistic regression analysis was performed to build a new pediatric model for predicting advanced fibrosis.
RESULTS
Our cohort consisted of 242 children with a mean age of 12.4 ± 3.1 years and 63% were female. 36 (15%) subjects had advanced fibrosis. APRI and FIB-4 were higher in patients with advanced fibrosis compared to those with fibrosis stage 0-2; however, AST/ALT ratio and NFS were not different between the two groups. We used our data to develop a new model to predict advanced fibrosis which included: ALT, alkaline phosphatase, platelet counts and GGT. The multivariable logistic regression model (z) was defined as follows: z = 1.1+(0.34sqrt(ALT))+(0.002alkaline phosphatase) - (1.1log(platelets) - (0.02GGT). This value was then converted into a probability distribution (p) with a value between 0 to 100 by the following formula: p = 100 × exp(z)/[1+exp(z)]. The AUCROC for this model was 0.74 (95% CI: 0.66, 0.82). This was found to be significantly better than APRI, NAFLD Fibrosis Score and FIB-4 Index.
CONCLUSION
Noninvasive hepatic fibrosis scores developed in adults had poor performance in diagnosing advanced fibrosis in children with NAFLD. We developed a new pediatric NAFLD fibrosis score with improved performance characteristics.
背景
预测晚期纤维化存在的非侵入性肝纤维化评分已在成人非酒精性脂肪性肝病（NAFLD）患者中得到开发和验证。我们研究的目的是评估常用的成人纤维化评分在儿童NAFLD中的效用，并开发一种能够预测晚期纤维化的儿童特异性纤维化评分。
方法
纳入经活检证实为NAFLD的连续儿童患者。纤维化由经验丰富的病理学家确定（F0 - 4）。晚期纤维化定义为纤维化分期≥3。为每个儿童计算以下成人纤维化评分：AST/ALT比值、AST/血小板比值指数（APRI）、NAFLD纤维化评分（NFS）和FIB - 4指数。进行多变量逻辑回归分析以建立预测晚期纤维化的新儿童模型。
结果
我们的队列包括242名儿童，平均年龄为12.4±3.1岁，63%为女性。36名（15%）受试者有晚期纤维化。与纤维化分期为0 - 2的患者相比，晚期纤维化患者的APRI和FIB - 4更高；然而，两组之间的AST/ALT比值和NFS没有差异。我们利用我们的数据开发了一个预测晚期纤维化的新模型，该模型包括：ALT、碱性磷酸酶、血小板计数和γ - 谷氨酰转移酶（GGT）。多变量逻辑回归模型（z）定义如下：z = 1.1 +（0.34×sqrt(ALT)）+（0.002×碱性磷酸酶） - （1.1×log(血小板)） - （0.02×GGT）。然后通过以下公式将该值转换为概率分布（p），其值在0到100之间：p = 100×exp(z)/[1 + exp(z)]。该模型的曲线下面积（AUCROC）为0.74（95%置信区间：0.66，0.82）。发现该模型明显优于APRI、NAFLD纤维化评分和FIB - 4指数。
结论
成人开发的非侵入性肝纤维化评分在诊断儿童NAFLD的晚期纤维化方面表现不佳。我们开发了一种具有改进性能特征的新的儿童NAFLD纤维化评分。
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