Borman Meredith A, Ladak Farah, Crotty Pam, Pollett Aaron, Kirsch Richard, Pomier-Layrargues Gilles, Beaton Melanie, Duarte-Rojo Andres, Elkashab Magdy, Myers Robert P
Liver Unit, Division of Gastroenterology and Hepatology, University of Calgary, 6D22, Teaching, Research and Wellness Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
Department of Pathology, Mt. Sinai Hospital, Toronto, ON, Canada.
Hepatol Int. 2013 Jun;7(2):592-9. doi: 10.1007/s12072-012-9401-4. Epub 2012 Sep 29.
Noninvasive tools for the detection of hepatic steatosis are needed. The Fatty Liver Index (FLI), which includes body mass index (BMI), waist circumference, triglycerides, and γ-glutamyl-transferase, has been proposed as a screening tool for fatty liver. Our objective was to validate the FLI for the detection and quantification of hepatic steatosis in an obese population.
Patients with chronic liver disease and BMI ≥ 28 kg/m(2) underwent liver biopsy and FLI determination. FLI performance for diagnosing steatosis compared with biopsy was assessed using areas under receiver operating characteristic curves (AUROCs), and a novel model for the prediction of significant steatosis (≥5 %) was derived.
Among 250 included patients, 65 % were male, and the median BMI was 33 kg/m(2); 48 % had nonalcoholic fatty liver disease, and 77 % had significant (≥5 %) steatosis. The FLI was weakly correlated with the percentage (ρ = 0.25, p = 0.0001) and grade of steatosis (ρ = 0.28, p < 0.00005). The median FLI was higher among patients with significant steatosis (91 vs. 80 with <5 % steatosis; p = 0.0001) and the AUROC for this outcome was 0.67 (95 % CI 0.59-0.76). At an optimal FLI cut-off of 79, the FLI was 81 % sensitive and 49 % specific, and had positive and negative predictive values of 84 and 43 %, respectively. A novel index including triglycerides, glucose, alkaline phosphatase, and BMI outperformed the FLI for predicting significant steatosis [AUROCs 0.78 vs. 0.68; p = 0.009 (n = 247)].
In obese patients, the FLI is a poor predictor of significant steatosis and has limited utility for steatosis quantification compared with liver histology. A novel index including triglycerides, glucose, alkaline phosphatase, and BMI may be useful, but requires validation.
需要用于检测肝脂肪变性的非侵入性工具。脂肪肝指数（FLI），包括体重指数（BMI）、腰围、甘油三酯和γ-谷氨酰转移酶，已被提议作为脂肪肝的筛查工具。我们的目的是验证FLI在肥胖人群中检测和量化肝脂肪变性的能力。
对患有慢性肝病且BMI≥28kg/m²的患者进行肝活检和FLI测定。使用受试者工作特征曲线下面积（AUROC）评估FLI与活检相比诊断脂肪变性的性能，并得出预测显著脂肪变性（≥5%）的新模型。
在纳入的250例患者中，65%为男性，BMI中位数为33kg/m²；48%患有非酒精性脂肪性肝病，77%有显著（≥5%）脂肪变性。FLI与脂肪变性百分比（ρ = 0.25，p = 0.0001）和脂肪变性分级（ρ = 0.28，p < 0.00005）呈弱相关。显著脂肪变性患者的FLI中位数更高（脂肪变性<5%者为80，显著脂肪变性者为91；p = 0.0001），该结果的AUROC为0.67（95%CI 0.59 - 0.76）。在最佳FLI临界值为79时，FLI的敏感性为81%，特异性为49%，阳性预测值和阴性预测值分别为84%和43%。一个包括甘油三酯、葡萄糖、碱性磷酸酶和BMI的新指数在预测显著脂肪变性方面优于FLI [AUROC分别为0.78和0.68；p = 0.009（n = 247）]。
在肥胖患者中，FLI对显著脂肪变性的预测能力较差，与肝组织学相比，其在脂肪变性量化方面的效用有限。一个包括甘油三酯、葡萄糖、碱性磷酸酶和BMI的新指数可能有用，但需要验证。
