Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.
Department of Surgical Oncological and Oral Sciences, Division of General and Oncological Surgery, University of Palermo, Palermo, Italy.
Biomed Res Int. 2020 Apr 26;2020:5023157. doi: 10.1155/2020/5023157. eCollection 2020.
Bariatric surgery patients have a higher prevalence of nonalcoholic fatty liver (NAFL) than the general population; however, its assessment and the accurate staging of fibrosis are often complicated because noninvasive tests are not very accurate in patients with morbid obesity, and liver biopsy cannot be performed as a routine exam. The aim of this study was to evaluate (A) the histological prevalence of NAFL, nonalcoholic steatohepatitis (NASH), and fibrosis in patients undergoing bariatric surgery; (B) the reliability of ultrasound (US) in diagnosing NAFL; and (C) the reliability of various fibrosis scoring systems for defining fibrosis.
US and intraoperative liver biopsy results were reviewed in 57 bariatric surgery patients. NAFL, NASH, and fibrosis were diagnosed according to the Kleiner scoring system. US diagnosis of liver steatosis was based on the bright liver. Fibrosis scores used were (i) the BMI, AST/ALT Ratio, Diabetes (BARD) scoring system; (ii) the nonalcoholic fatty liver disease (NAFLD) fibrosis score; and (iii) the fibrosis-4 (FIB-4) index.
The prevalence of NAFL was 81%, NASH 61.4%, and fibrosis 94% (F3 5.7%, cirrhosis 2.8%). The sensitivity of US was 95%, specificity 50%, and likelihood ratio (LR+, LR-) 1.91 and 0.1. The reliability of fibrosis scores for ≥ 2 were as follows: BARD score: sensitivity 46%, specificity 54%, and area under the receiver-operating characteristics (AUROC) curve 0.5; NAFLD score: sensitivity 30%, specificity 89%, and AUROC 0.5; and FIB-4: sensitivity 68%, specificity 67%, and AUROC 0.7.
In bariatric surgery patients, the prevalence of NAFL was 81%, NASH 61.4%, and fibrosis 94%. US is able to rule out the presence of NAFL, while the commonly used scores may be inaccurate in defining fibrosis in patients with morbid obesity.
与普通人群相比，肥胖症患者中非酒精性脂肪肝（NAFL）的患病率更高；然而，由于非侵入性检查在病态肥胖患者中并不十分准确，并且不能将肝活检作为常规检查，因此其评估和纤维化的准确分期常常很复杂。本研究旨在评估：（A）接受减肥手术的患者中 NAFL、非酒精性脂肪性肝炎（NASH）和纤维化的组织学患病率；（B）超声（US）诊断 NAFL 的可靠性；以及（C）各种纤维化评分系统定义纤维化的可靠性。
回顾了 57 例减肥手术患者的 US 和术中肝活检结果。根据 Kleiner 评分系统诊断 NAFL、NASH 和纤维化。US 诊断肝脏脂肪变性基于肝脏明亮度。使用的纤维化评分系统包括：（i）体重指数、AST/ALT 比值、糖尿病（BARD）评分系统；（ii）非酒精性脂肪性肝病（NAFLD）纤维化评分；和（iii）纤维化-4（FIB-4）指数。
NAFL 的患病率为 81%，NASH 为 61.4%，纤维化为 94%（F3 为 5.7%，肝硬化为 2.8%）。US 的灵敏度为 95%，特异性为 50%，阳性似然比（LR+，LR-）为 1.91 和 0.1。纤维化评分≥2 的可靠性如下：BARD 评分：灵敏度为 46%，特异性为 54%，受试者工作特征（ROC）曲线下面积（AUROC）为 0.5；NAFLD 评分：灵敏度为 30%，特异性为 89%，AUROC 为 0.5；FIB-4：灵敏度为 68%，特异性为 67%，AUROC 为 0.7。
在减肥手术患者中，NAFL 的患病率为 81%，NASH 为 61.4%，纤维化为 94%。US 能够排除 NAFL 的存在，而常用的评分系统可能无法准确定义病态肥胖患者的纤维化。
