Ali Ahmad Hassan, Petroski Gregory F, Diaz-Arias Alberto A, Al Juboori Alhareth, Wheeler Andrew A, Ganga Rama R, Pitt James B, Spencer Nicole M, Hammoud Ghassan M, Rector R Scott, Parks Elizabeth J, Ibdah Jamal A
Division of Gastroenterology and Hepatology, University of Missouri, Columbia, MO 65212, USA.
Biostatistics and Research Design Unit, School of Medicine, University of Missouri, Columbia, MO 65212, USA.
J Clin Med. 2021 Jul 27;10(15):3311. doi: 10.3390/jcm10153311.
We assessed the relationship between serum alkaline phosphatase (ALP) and liver fibrosis by histology, in addition to other noninvasive parameters, in obese patients undergoing metabolic surgery. Patients scheduled for elective bariatric surgery were prospectively recruited from a bariatric clinic. An intraoperative liver biopsy was performed, and liver histology was evaluated by a pathologist blinded to the patients' data. The endpoint was significant fibrosis defined as fibrosis stage ≥ 2. Independent predictors of fibrosis were identified by logistic regression. Two hundred ten patients were recruited. Liver histology revealed steatosis in 87.1%, steatohepatitis in 21.9%, and significant fibrosis in 10%. Independent predictors of significant fibrosis were ALP (Odds Ratio (OR) 1.03; 95% Confidence interval (CI), 1.01-1.05), alanine aminotransferase (OR 1.02; 95% CI, 1.01-1.03), HbA1c (OR 1.58; 95% CI, 1.20-2.09), and body mass index (OR 1.06; 95% CI, 1.00-1.13). A tree-based model was developed to predict significant fibrosis, with a receiver operating characteristic (ROC) area of 0.845, sensitivity of 0.857, specificity of 0.836, and accuracy of 0.931. The applicability of serum ALP as an independent biomarker of liver fibrosis should be considered in obesity surgery patients, and in the broader context of obese patients with nonalcoholic fatty liver disease.
我们通过组织学评估了接受代谢手术的肥胖患者血清碱性磷酸酶（ALP）与肝纤维化之间的关系，以及其他非侵入性参数。从减肥诊所前瞻性招募计划接受择期减肥手术的患者。进行术中肝活检，并由对患者数据不知情的病理学家评估肝组织学。终点为定义为纤维化分期≥2的显著纤维化。通过逻辑回归确定纤维化的独立预测因素。共招募了210名患者。肝组织学显示87.1%有脂肪变性，21.9%有脂肪性肝炎，10%有显著纤维化。显著纤维化的独立预测因素为ALP（比值比（OR）1.03；95%置信区间（CI），1.01 - 1.05）、丙氨酸氨基转移酶（OR 1.02；95%CI，1.01 - 1.03）、糖化血红蛋白（OR 1.58；95%CI，1.20 - 2.09）和体重指数（OR 1.06；95%CI，1.00 - 1.13）。开发了一种基于树的模型来预测显著纤维化，其受试者操作特征（ROC）曲线下面积为0.845，敏感性为0.857，特异性为0.836，准确性为0.931。在肥胖手术患者以及更广泛的非酒精性脂肪性肝病肥胖患者背景下，应考虑血清ALP作为肝纤维化独立生物标志物的适用性。
