Wan Fuzhen, Pan Feng, Ayonrinde Oyekoya T, Adams Leon A, Mori Trevor A, Beilin Lawrence J, O'Sullivan Therese A, Olynyk John K, Oddy Wendy H
Menzies Institute for Medical Research, University of Tasmania.
Medical School, The University of Western Australia, Perth, Western Australia; Department of Gastroenterology, Fiona Stanley Fremantle Hospital Group, Murdoch, Western Australia.
Dig Liver Dis. 2021 Jun;53(6):746-752. doi: 10.1016/j.dld.2020.11.037. Epub 2020 Dec 14.
The incidence of non-alcoholic fatty liver disease (NAFLD) is increasing in young populations. However, there are inadequate data regarding diagnosis of NAFLD. We aimed to validate three scoring systems against a previous standard of suprailiac skinfold thickness for diagnosing NAFLD in population-based adolescents.
Seventeen-year-old adolescents (n = 899), participating in the Raine Study, attended a cross-sectional follow-up. NAFLD was diagnosed using liver ultrasound. Scores for Fatty liver index (FLI), Hepatic Steatosis Index (HSI) and Zhejiang University index (ZJU index) were calculated. Diagnostic accuracy of these diagnostic tests was evaluated through discrimination and calibration.
NAFLD was diagnosed 9% in males and 15% in females. The three scoring systems demonstrated better discrimination performance for NAFLD in males (AUC was FLI:0.82, HSI: 0.83 and ZJU index: 0.83) compared to females (AUC was FLI: 0.67, HSI: 0.67 and ZJU index: 0.67). Suprailiac skinfold performed better than the scoring systems (overall AUC: 0.82; male AUC:0.88; female AUC:0.73). FLI had best calibration performance.
Suprailiac skinfold thickness was a better predictor of ultrasound-diagnosed NAFLD than the three diagnostic scoring systems investigated. The higher performance characteristics of the algorithmic scoring systems in males compared with females may have implications for use in population assessments.
非酒精性脂肪性肝病（NAFLD）在年轻人群中的发病率正在上升。然而，关于NAFLD诊断的数据并不充分。我们旨在针对基于人群的青少年中诊断NAFLD的先前标准——髂上皮肤褶厚度，验证三种评分系统。
参与Raine研究的17岁青少年（n = 899）参加了横断面随访。通过肝脏超声诊断NAFLD。计算脂肪肝指数（FLI）、肝脂肪变性指数（HSI）和浙江大学指数（ZJU指数）的得分。通过区分度和校准评估这些诊断测试的诊断准确性。
男性NAFLD诊断率为9%，女性为15%。与女性（FLI的AUC为0.67、HSI为0.67、ZJU指数为0.67）相比，这三种评分系统在男性中对NAFLD表现出更好的区分性能（FLI的AUC为0.82、HSI为0.83、ZJU指数为0.83）。髂上皮肤褶比评分系统表现更好（总体AUC：0.82；男性AUC：0.88；女性AUC：0.73）。FLI具有最佳的校准性能。
与所研究的三种诊断评分系统相比，髂上皮肤褶厚度是超声诊断NAFLD的更好预测指标。算法评分系统在男性中的性能特征高于女性，这可能对人群评估中的应用产生影响。
