Carreau Anne-Marie, Pyle Laura, Garcia-Reyes Yesenia, Rahat Haseeb, Vigers Tim, Jensen Thomas, Scherzinger Ann, Nadeau Kristen J, Cree-Green Melanie
Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Clin Endocrinol (Oxf). 2019 Oct;91(4):544-552. doi: 10.1111/cen.14062. Epub 2019 Aug 16.
Nonalcoholic fatty liver disease (NAFLD) is common in obese adolescents with polycystic ovary syndrome (PCOS), but there are no inexpensive ways to accurately identify NAFLD in PCOS. The objective was to develop a simple clinical score to screen for NAFLD risk in obese adolescents with PCOS.
This is a secondary analysis of 3 cross-sectional studies on metabolic characterization of obese adolescents with PCOS. 108 overweight and obese adolescents with PCOS (BMI > 90th percentile, age 12-19 years) were enrolled from 2012 to 2018.
Magnetic resonance imaging was used to quantify hepatic fat fraction (HFF). A development cohort of 87 girls were divided by presence of NAFLD (HFF > 5.5%). A logistic regression model with the outcome of NAFLD and candidate predictor variables was fit. A simplified model (PCOS-HS index) was created using backwards stepdown elimination. Validation was performed using 200 bootstrapped sample and in a second cohort of 21 PCOS participants.
52% of the development cohort had NAFLD. The PCOS-HS index that included BMI percentile, waist circumference, ALT and SHBG had an AUCROC of 0.81, sensitivity 82%, specificity 69%, negative predictive value (NPV) 78% and positive predictive value 74%, using a threshold of 0.44 to predict HS. A threshold of 0.15 ruled out NAFLD with a NPV 90%. In the validation cohort, the model showed an accuracy of 81%, sensitivity of 91% and specificity of 70%.
We developed a clinical index to identify NAFLD in girls with PCOS who would need further evaluation and treatment.
非酒精性脂肪性肝病（NAFLD）在患有多囊卵巢综合征（PCOS）的肥胖青少年中很常见，但目前尚无廉价方法能准确识别PCOS患者中的NAFLD。本研究旨在开发一种简单的临床评分系统，用于筛查患有PCOS的肥胖青少年的NAFLD风险。
这是一项对3项关于患有PCOS的肥胖青少年代谢特征的横断面研究的二次分析。2012年至2018年纳入了108名超重和肥胖的PCOS青少年（BMI>第90百分位数，年龄12 - 19岁）。
采用磁共振成像定量肝脏脂肪分数（HFF）。将87名女孩的开发队列按是否存在NAFLD（HFF>5.5%）进行分组。构建一个以NAFLD为结果变量、候选预测变量为自变量的逻辑回归模型。采用向后逐步淘汰法创建一个简化模型（PCOS - HS指数）。使用200个自抽样样本以及在另一组21名PCOS参与者中进行验证。
开发队列中52%的人患有NAFLD。包含BMI百分位数、腰围、谷丙转氨酶（ALT）和性激素结合球蛋白（SHBG）的PCOS - HS指数，其曲线下面积（AUCROC）为0.81，敏感性为82%，特异性为69%，阴性预测值（NPV）为78%，阳性预测值为74%，使用阈值0.44来预测HS。阈值0.15排除NAFLD时NPV为90%。在验证队列中，该模型的准确率为81%，敏感性为91%，特异性为70%。
我们开发了一种临床指数，用于识别患有PCOS且需要进一步评估和治疗的女孩中的NAFLD。
