Shukla Akash, Kapileswar Swapnali, Gogtay Nithya, Joshi Amita, Dhore Prashant, Shah Chirag, Abraham Philip, Bhatia Shobna
Department of Gastroenterology, Seth G S Medical College and K E M Hospital, Acharya Donde Marg, Parel, Mumbai, 400 012, India.
Department of Clinical Pharmacology, Seth G S Medical College and K E M Hospital, Acharya Donde Marg, Parel, Mumbai, 400 012, India.
Indian J Gastroenterol. 2015 Jul;34(4):281-5. doi: 10.1007/s12664-015-0580-5. Epub 2015 Sep 4.
BACKGROUND/AIMS: Liver biopsy is the gold standard for detecting fibrosis in patients with nonalcoholic fatty liver disease (NAFLD). Due to limitations of biopsy, various combinations of serum markers have been studied to predict liver fibrosis; many of these are patented and expensive, thereby restricting their evaluation. We prospectively evaluated the correlation of commonly used serum markers with fibrosis in Indian patients with NAFLD.
Fifty-one patients (age 50.4 [SD 11.5] years) with biopsy-proven NAFLD underwent estimation of platelet count, total bilirubin, AST, ALT, serum albumin, γ-glutamyl transpeptidase (GGT), prothrombin time, serum cholesterol, triglycerides, α2-macroglobulin (A2M), apolipoprotein A1 (Apo A1), and haptoglobin. FIB-4, AST/platelet ratio index (APRI), and AST/ALT ratio were calculated and correlated with fibrosis (NAS-II score) on liver biopsy.
Thirty-eight (74.5 %) patients had inflammation and 48 (94.1 %) had ballooning degeneration on histology; 29 had fibrosis, of whom 11 had ≥F2 fibrosis. High GGT (odds ratio [OR] 8.4 [1.85-38.10]; p = 0.007, area under the curve [AUROC] 0.65), low platelet count (OR 7.57 [1.83-31.45]; p = 0.001, AUROC 0.833), and low Apo A1 (OR 12.04 [2.98-47.3]; p = 0.0002, AUROC 0.76) were associated with advanced fibrosis on multiple logistic regression; a novel score formulated by assigning 1 point for an abnormal value for each of these parameters correlated with absence of fibrosis (p = 0.0001; OR 0.102 [95 % confidence interval (CI) CI 0.025-0.418]), with negative predictive value of 94.29 % [95 % CI 80.81 to 99.13].
A score using simple markers including GGT, Apo A1, and platelet count correlated with absence of liver fibrosis in patients with NAFLD.
背景/目的：肝活检是非酒精性脂肪性肝病（NAFLD）患者纤维化检测的金标准。由于活检存在局限性，人们对多种血清标志物组合进行了研究以预测肝纤维化；其中许多标志物已获专利且价格昂贵，从而限制了对它们的评估。我们前瞻性评估了印度NAFLD患者常用血清标志物与纤维化的相关性。
51例经活检证实为NAFLD的患者（年龄50.4[标准差11.5]岁）接受了血小板计数、总胆红素、谷草转氨酶（AST）、谷丙转氨酶（ALT）、血清白蛋白、γ-谷氨酰转肽酶（GGT）、凝血酶原时间、血清胆固醇、甘油三酯、α2-巨球蛋白（A2M）、载脂蛋白A1（Apo A1）和触珠蛋白的检测。计算FIB-4、AST/血小板比值指数（APRI）和AST/ALT比值，并将其与肝活检时的纤维化（NAS-II评分）进行相关性分析。
38例（74.5%）患者组织学上有炎症，48例（94.1%）有气球样变性；29例有纤维化，其中11例纤维化程度≥F2。多因素logistic回归分析显示，高GGT（比值比[OR]8.4[1.85-38.10]；p=0.007，曲线下面积[AUROC]0.65）、低血小板计数（OR 7.57[1.83-31.45]；p=0.001，AUROC 0.833）和低Apo A1（OR 12.04[2.98-47.3]；p=0.0002，AUROC 0.76）与进展期纤维化相关；根据这些参数中每一个参数异常值赋予1分制定的新评分与无纤维化相关（p=0.0001；OR 0.102[95%置信区间（CI）CI 0.025-0.418]），阴性预测值为94.29%[95%CI 80.81至99.13]。
使用包括GGT、Apo A1和血小板计数在内的简单标志物的评分与NAFLD患者无肝纤维化相关。
