de Cleva Roberto, Duarte Livio Fiolo, Crenitte Milton Roberto Furst, de Oliveira Claudia Pinto Marques, Pajecki Denis, Santo Marco Aurelio
Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil.
Gastroenterology Department, University of São Paulo Medical School, São Paulo, Brazil.
Surg Obes Relat Dis. 2016 May;12(4):862-867. doi: 10.1016/j.soard.2015.11.011. Epub 2015 Nov 19.
Nonalcoholic steatohepatitis is observed in 25%-55% of patients with severe obesity and in 2%-12% with bridging fibrosis or cirrhosis. There is currently no noninvasive test for the diagnosis of severe liver fibrosis before bariatric surgery.
To determine the best noninvasive test for predicting advanced liver disease in patients with severe obesity.
University tertiary care hospital, Brazil.
A cross-sectional retrospective study was conducted with 699 patients with severe obesity undergoing bariatric surgery: 568 without a biopsy (nonbiopsy cohort) and 131 patients who had undergone an intraoperative liver biopsy. The tissues were subjected to histologic diagnosis (Brunt criteria) and classified as advanced fibrosis (stages 3 and 4) or no significant fibrosis (absence of nonalcoholic steatohepatitis and stages 1 or 2). The following predictive indices of cirrhosis were calculated in all patients: aspartate aminotransferase/alanine aminotransferase ratio (AAR), age-platelet (AP) index, aminotransferase-to-platelet ratio index (APRI), cirrhosis discriminant score (CDS), and hepatitis C antiviral long-term treatment against cirrhosis (HALT-C). The cutoff values, sensitivity, specificity, and areas under the receiver operating characteristic curves (AUROCs) were calculated for patients with biopsies.
The AUROC of the AAR, AP, APRI, CDS, and HALT-C model for predicting advanced fibrosis or cirrhosis were, respectively, .522, .88, .99, .905, and .921. The calculated cutoff values, sensitivity, and specificity, respectively, were as follows: AAR: .94, .7, .45; AP 5, .7, .93; APRI .44, 1.0, .97; CDS 6, .7, .97; and HALT-C: .76, 1.0, .77.
APRI index was the best predictor of advanced liver disease in patients with severe obesity.
在25%-55%的重度肥胖患者中观察到非酒精性脂肪性肝炎，在2%-12%有桥接纤维化或肝硬化的患者中也观察到该疾病。目前在减肥手术前尚无用于诊断严重肝纤维化的非侵入性检查。
确定预测重度肥胖患者晚期肝病的最佳非侵入性检查。
巴西的大学三级护理医院。
对699例接受减肥手术的重度肥胖患者进行了一项横断面回顾性研究：568例未进行活检（非活检队列），131例患者进行了术中肝活检。对组织进行组织学诊断（布伦特标准），并分类为晚期纤维化（3期和4期）或无明显纤维化（无非酒精性脂肪性肝炎且为1期或2期）。在所有患者中计算以下肝硬化预测指标：天冬氨酸转氨酶/丙氨酸转氨酶比值（AAR）、年龄-血小板（AP）指数、转氨酶-血小板比值指数（APRI）、肝硬化判别评分（CDS）和丙型肝炎抗病毒长期治疗抗肝硬化（HALT-C）。计算活检患者的临界值、敏感性、特异性和受试者工作特征曲线下面积（AUROC）。
AAR、AP、APRI、CDS和HALT-C模型预测晚期纤维化或肝硬化的AUROC分别为0.522、0.88、0.99、0.905和0.921。计算出的临界值、敏感性和特异性分别如下：AAR：0.94、0.7、0.45；AP 5、0.7、0.93；APRI 0.44、1.0、0.97；CDS 6、0.7、0.97；以及HALT-C：0.76、1.0、0.77。
APRI指数是重度肥胖患者晚期肝病的最佳预测指标。
