Shi Mengte, Liu Peining, Li Jushuang, Su Yue, Zhou Xinhe, Wu Chenwei, Chen Xia, Zheng Chao
Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China.
Department of Child Health Care, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
J Diabetes. 2021 Sep;13(9):744-753. doi: 10.1111/1753-0407.13169. Epub 2021 Mar 21.
The aim of this study is to evaluate the performance of three existing prediction scores which are applicable to adults for identifying nonalcoholic fatty liver disease (NAFLD) in Chinese children.
We used data from routine check-up based medical records of 1845 children to validate the performance of three existing scoring systems including the hepatic steatosis index (HSI), Zhejiang University index (ZJU index), and triglyceride-glucose index (TyG index) in detection of NAFLD in children. Propensity score matching was applied to adjust for potential confounding effects in both training and validation cohorts. The area under the curve (AUC) of the receiver operating characteristic curve analysis was utilized to assess the performance of the three scoring systems.
Children with NAFLD had higher scores of HSI, ZJU index, and TyG index when compared with the control group (children without NAFLD). Elevated HSI, ZJU index, and TyG index scores were significantly associated with the presence of pediatric NAFLD since adjusted odds ratio and 95% CI with per interquartile range elevation of the HSI, ZJU index, and TyG index were 32.81 (20.48, 52.55), 26.31 (16.97, 40.79), and 1.83 (1.57, 2.13), respectively. In terms of discrimination of NAFLD in children, the AUC of the HSI, ZJU index, and TyG index depending on the validation cohort were 0.964, 0.960, and 0.769, respectively.
The HSI and ZJU index could be appropriate noninvasive biomarkers in distinguishing NAFLD in children from their controls with satisfied accuracy, which would emphasize the clinical and public health policy relevance of pediatric NAFLD. Our findings need to be confirmed by additional longitudinal studies.
本研究旨在评估三种适用于成人的现有预测评分系统在中国儿童中识别非酒精性脂肪性肝病（NAFLD）的性能。
我们使用了1845名儿童基于常规体检病历的数据，以验证三种现有评分系统，包括肝脂肪变性指数（HSI）、浙江大学指数（ZJU指数）和甘油三酯-葡萄糖指数（TyG指数）在检测儿童NAFLD方面的性能。采用倾向评分匹配法来调整训练队列和验证队列中的潜在混杂效应。利用受试者工作特征曲线分析的曲线下面积（AUC）来评估这三种评分系统的性能。
与对照组（无NAFLD的儿童）相比，患有NAFLD的儿童HSI、ZJU指数和TyG指数得分更高。HSI、ZJU指数和TyG指数得分升高与儿童NAFLD的存在显著相关，因为HSI、ZJU指数和TyG指数每升高一个四分位数间距，调整后的比值比和95%可信区间分别为32.81（20.48，52.55）、26.31（16.97，40.79）和1.83（1.57，2.13）。就儿童NAFLD的鉴别而言，根据验证队列，HSI、ZJU指数和TyG指数的AUC分别为0.964、0.960和0.769。
HSI和ZJU指数可能是区分儿童NAFLD与对照的合适的非侵入性生物标志物，具有令人满意的准确性，这将强调儿童NAFLD在临床和公共卫生政策方面的相关性。我们的研究结果需要通过额外的纵向研究来证实。
