Miwa Takao, Tajirika Satoko, Imamura Nanako, Adachi Miho, Horita Ryo, Hanai Tatsunori, Ng Cheng Han, Siddiqui Mohammad Shadab, Fukao Taku, Shimizu Masahito, Yamamoto Mayumi
Health Administration Center Gifu University Gifu Japan.
Department of Gastroenterology/Internal Medicine, Graduate School of Medicine Gifu University Gifu Japan.
JGH Open. 2024 Jun 17;8(6):e13110. doi: 10.1002/jgh3.13110. eCollection 2024 Jun.
The application of indices in the context of metabolic dysfunction-associated steatotic liver disease (MASLD) remains unexplored. We aimed to validate the ability of alanine aminotransferase (ALT), fatty liver index (FLI), and hepatic steatosis index (HSI) to identify MASLD during health checkups.
We recruited 627 participants and utilized their health checkup data and ultrasound to assess the potential of using ALT, FLI, and HSI as indices for MASLD; this was indicated by the area under the curve (AUC) and restricted cubic spline (RCS) model. The optimal, rule-out (sensitivity ≥90%), and rule-in (specificity ≥90%) cutoff values of each index for identifying MASLD were reported.
Among participants with a median age of 46 years, the prevalence of MASLD was 28% in total (38% in males and 18% in females). RCS models confirmed a linear association between indices and MASLD. ROC analyses indicated that the AUC of ALT in identifying MASLD was 0.79 for the total cohort, 0.81 for males, and 0.69 for females. The optimal, rule-out, and rule-in cutoff values for ALT were 21, 13, and 29, respectively. Similarly, the AUC of FLI/HSI in identifying MASLD was 0.90/0.88 for the total cohort, 0.86/0.85 for males, and 0.93/0.90 for females. Considering the reference cutoff values, distinct cutoff values were observed between the sexes for FLI, while HSI had similar cutoff values.
This study demonstrated that ALT > 30 IU/L is a reasonable cutoff value to rule-in MASLD. ALT, FLI, and HSI are reliable indices for identifying MASLD during health checkups.
代谢功能障碍相关脂肪性肝病（MASLD）背景下各项指标的应用仍未得到充分研究。我们旨在验证丙氨酸氨基转移酶（ALT）、脂肪肝指数（FLI）和肝脂肪变指数（HSI）在健康体检中识别MASLD的能力。
我们招募了627名参与者，并利用他们的健康体检数据和超声来评估使用ALT、FLI和HSI作为MASLD指标的潜力；这通过曲线下面积（AUC）和限制立方样条（RCS）模型来表示。报告了各指标识别MASLD的最佳、排除（敏感性≥90%）和纳入（特异性≥90%）临界值。
在中位年龄为46岁的参与者中，MASLD的总体患病率为28%（男性为38%，女性为18%）。RCS模型证实了各项指标与MASLD之间存在线性关联。ROC分析表明，ALT识别MASLD的AUC在总队列中为0.79，男性为0.81，女性为0.69。ALT的最佳、排除和纳入临界值分别为21、13和29。同样，FLI/HSI识别MASLD的AUC在总队列中为0.90/0.88，男性为0.86/0.85，女性为0.93/0.90。考虑到参考临界值，FLI在性别之间观察到不同的临界值，而HSI的临界值相似。
本研究表明，ALT>30 IU/L是纳入MASLD的合理临界值。ALT、FLI和HSI是健康体检中识别MASLD的可靠指标。
