Faculty of Medicine, University of Latvia, Riga, Latvia.
Pauls Stradins Clinical University Hospital, Riga, Latvia.
J Gastroenterol Hepatol. 2018 Jan;33(1):270-276. doi: 10.1111/jgh.13814.
Little is known about the diagnostic value of hepatic steatosis index (HSI) and fatty liver index (FLI), as well as their link to metabolic syndrome in type 1 diabetes mellitus. We have screened the effectiveness of FLI and HSI in an observational pilot study of 40 patients with type 1 diabetes.
FLI and HSI were calculated for 201 patients with type 1 diabetes. Forty patients with FLI/HSI values corresponding to different risk of liver steatosis were invited for liver magnetic resonance study. In-phase/opposed-phase technique of magnetic resonance was used. Accuracy of indices was assessed from the area under the receiver operating characteristic curve.
Twelve (30.0%) patients had liver steatosis. For FLI, sensitivity was 90%; specificity, 74%; positive likelihood ratio, 3.46; negative likelihood ratio, 0.14; positive predictive value, 0.64; and negative predictive value, 0.93. For HSI, sensitivity was 86%; specificity, 66%; positive likelihood ratio, 1.95; negative likelihood ratio, 0.21; positive predictive value, 0.50; and negative predictive value, 0.92. Area under the receiver operating characteristic curve for FLI was 0.86 (95% confidence interval [0.72; 0.99]); for HSI 0.75 [0.58; 0.91]. Liver fat correlated with liver enzymes, waist circumference, triglycerides, and C-reactive protein. FLI correlated with C-reactive protein, liver enzymes, and blood pressure. HSI correlated with waist circumference and C-reactive protein. FLI ≥ 60 and HSI ≥ 36 were significantly associated with metabolic syndrome and nephropathy.
The tested indices, especially FLI, can serve as surrogate markers for liver fat content and metabolic syndrome in type 1 diabetes.
对于肝脂肪变性指数（HSI）和脂肪肝指数（FLI）的诊断价值，以及它们与 1 型糖尿病代谢综合征的关系，目前了解甚少。我们在一项针对 40 例 1 型糖尿病患者的观察性试点研究中筛选了 FLI 和 HSI 的有效性。
计算了 201 例 1 型糖尿病患者的 FLI 和 HSI。邀请了 40 名 FLI/HSI 值对应不同肝脂肪变性风险的患者进行肝脏磁共振研究。采用同相位/反相位磁共振技术。从受试者工作特征曲线下面积评估指标的准确性。
12 例（30.0%）患者存在肝脂肪变性。对于 FLI，灵敏度为 90%；特异性为 74%；阳性似然比为 3.46；阴性似然比为 0.14；阳性预测值为 0.64；阴性预测值为 0.93。对于 HSI，灵敏度为 86%；特异性为 66%；阳性似然比为 1.95；阴性似然比为 0.21；阳性预测值为 0.50；阴性预测值为 0.92。FLI 的受试者工作特征曲线下面积为 0.86（95%置信区间 [0.72；0.99]）；HSI 为 0.75 [0.58；0.91]。肝脂肪与肝酶、腰围、甘油三酯和 C 反应蛋白相关。FLI 与 C 反应蛋白、肝酶和血压相关。HSI 与腰围和 C 反应蛋白相关。FLI≥60 和 HSI≥36 与代谢综合征和肾病显著相关。
所测试的指标，尤其是 FLI，可以作为 1 型糖尿病患者肝脂肪含量和代谢综合征的替代标志物。
