Feng Gong, He Na, Zhou Yi-Fan, Li Xue-Ping, Niu Chunyan, Liu Man-Ling, Zhang Ke-Lin, Li Ya, Li Ya-Ming, Zheng Ming-Hua, Mi Man
Xi'an Medical University, Xi'an, China.
The First Affiliated Hospital of Xi'an Medical University, Xi'an, China.
Clin Biochem. 2019 Feb;64:18-23. doi: 10.1016/j.clinbiochem.2018.11.011. Epub 2018 Nov 29.
To increase the accuracy of non-invasive diagnosis of nonalcoholic fatty liver disease (NAFLD), clinical and laboratory NAFLD indicators were integrated into a diagnostic formula.
A total of 141 patients with clinically diagnosed NAFLD and 30 healthy controls were enrolled. We collected case history, body weight, height and mass index (BMI), alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma glutamyl transpeptidase, blood urea nitrogen and blood uric acid (UA), serum creatinine, plasma total cholesterol, triglyceride, low density lipoprotein, glycosylated hemoglobin, fasting plasma glucose, fasting insulin, ultrasonic tests, Fibroscans, and other data. Linear correlation, multiple linear regressions, and receiver operating characteristic (ROC) curve methods were used to process and analyze the collected data. The performance of Fibroscan and our diagnostic formula was compared in reference to the findings of liver biopsy.
The identified NAFLD diagnostic indices consisted of BMI, ALT, AST and UA. A regression formula was proposed as: CAP = 113.163 + 0.252 * ALT + 6.316 * BMI. Diagnosis of the area under the ROC curve was 0.927, the sensitivity was 87.68%, and specificity was 90%. The cutoff was 277.67 (p < 0.01). The accuracy of the NAFLD diagnosis with the proposed formula was significantly higher than FibroScan (82.6% vs 69.6%; p = 0.005).
NAFLD diagnosis with the proposed formula demonstrated both high sensitivity and specificity, and its accuracy was significantly higher than FibroScan. This formula only utilized non-invasive clinical and laboratory findings and the calculation was simple. It can be conveniently used for clinical diagnosis of NAFLD.
为提高非酒精性脂肪性肝病（NAFLD）无创诊断的准确性，将临床及实验室NAFLD指标整合为一个诊断公式。
共纳入141例临床诊断为NAFLD的患者及30例健康对照。收集病史、体重、身高、体重指数（BMI）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、γ-谷氨酰转肽酶、血尿素氮、血尿酸（UA）、血清肌酐、血浆总胆固醇、甘油三酯、低密度脂蛋白、糖化血红蛋白、空腹血糖、空腹胰岛素、超声检查、FibroScan等数据。采用线性相关、多元线性回归及受试者工作特征（ROC）曲线方法对收集的数据进行处理和分析。参照肝活检结果比较FibroScan与我们的诊断公式的性能。
确定的NAFLD诊断指标包括BMI、ALT、AST和UA。提出回归公式为：CAP = 113.163 + 0.252 * ALT + 6.316 * BMI。ROC曲线下面积诊断值为0.927，灵敏度为87.68%，特异度为90%。截断值为277.67（p < 0.01）。所提公式诊断NAFLD的准确性显著高于FibroScan（82.6%对69.6%；p = 0.005）。
所提公式诊断NAFLD具有高灵敏度和特异度，且准确性显著高于FibroScan。该公式仅利用无创临床及实验室检查结果，计算简单，可方便地用于NAFLD临床诊断。
