成年体检患者非酒精性脂肪性肝病评分系统的开发：一项大型横断面和前瞻性验证研究。
Development of non-alcoholic fatty liver disease scoring system among adult medical check-up patients: a large cross-sectional and prospective validation study.
作者信息
Lesmana Cosmas Rinaldi A, Pakasi Levina S, Inggriani Sri, Aidawati Maria L, Lesmana Laurentius A
机构信息
Digestive Disease and GI Oncology Centre, Medistra Hospital, University of Indonesia ; Department of Internal Medicine, Hepatobiliary Division, Cipto Mangunkusumo Hospital, University of Indonesia.
Digestive Disease and GI Oncology Centre, Medistra Hospital, University of Indonesia.
出版信息
Diabetes Metab Syndr Obes. 2015 Apr 23;8:213-8. doi: 10.2147/DMSO.S80364. eCollection 2015.
BACKGROUND
Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in the community. However, NAFLD remains undiagnosed in most people with limited access to imaging facilities in most developing countries.
OBJECTIVE
To examine the prevalence of NAFLD and to develop the risk scoring model for predicting the presence of NAFLD among adult medical check-up patients.
METHOD
A large prospective cross-sectional study was conducted among medical check-up patients who underwent transabdominal ultrasound examination between January and December 2013 in Medistra Hospital, Jakarta. Data were obtained from the patients' medical records. Logistic regression analyses were undertaken to identify the best combination of risk factors for predicting fatty liver using the backward (likelihood ratio) approach. The adjusted odds ratio and 95% confidence interval were estimated using the logistic regression coefficient. The prediction model was assessed using the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test and was validated on a new, prospective cohort. Statistical analysis was done using SPSS version 17.
RESULTS
A total of 1,054 cases was included in this study. Fatty liver was present in 538 (51.0%) patients. Bivariate analyses found associations among fatty liver and several risk factors. Six risk factors were incorporated to build the final prediction model. All scores were summed up to obtain the total score. A probability equation was developed by applying linear regression analysis on the total score. The prediction model had good diagnostic performance with an area under the receiver operating characteristic curve =0.833 (95% confidence interval =0.809-0.857). The Hosmer-Lemeshow goodness-of-fit P-value was 0.232, which indicated the appropriateness of the logistic regression model to predict fatty liver. On the validation set, the scoring system proved to be moderately accurate and can potentially be applied to larger population setting.
CONCLUSION
The presence of fatty liver in NAFLD patients can be predicted using our proposed fatty liver scoring system.
背景
非酒精性脂肪性肝病（NAFLD）是社区中最常见的肝脏疾病。然而，在大多数发展中国家，由于难以获得影像检查设备，大多数NAFLD患者仍未得到诊断。
目的
研究NAFLD的患病率，并建立预测成年体检患者是否患有NAFLD的风险评分模型。
方法
于2013年1月至12月在雅加达Medistra医院对接受经腹超声检查的体检患者进行了一项大型前瞻性横断面研究。数据来自患者的病历。采用向后（似然比）法进行逻辑回归分析，以确定预测脂肪肝的最佳危险因素组合。使用逻辑回归系数估计调整后的比值比和95%置信区间。使用受试者工作特征曲线和Hosmer-Lemeshow拟合优度检验对预测模型进行评估，并在一个新的前瞻性队列中进行验证。使用SPSS 17版进行统计分析。
结果
本研究共纳入1054例病例。538例（51.0%）患者存在脂肪肝。双变量分析发现脂肪肝与几个危险因素之间存在关联。纳入六个危险因素建立最终预测模型。将所有得分相加得到总分。通过对总分进行线性回归分析得出概率方程。预测模型具有良好的诊断性能，受试者工作特征曲线下面积=0.833（95%置信区间=0.809-0.857）。Hosmer-Lemeshow拟合优度P值为0.232，表明逻辑回归模型适用于预测脂肪肝。在验证集上，评分系统被证明具有中等准确性，并且有可能应用于更大的人群。
结论
使用我们提出的脂肪肝评分系统可以预测NAFLD患者是否存在脂肪肝。
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