用于脂肪性肝病患者分类的酒精性肝病/非酒精性脂肪性肝病指数
Alcoholic Liver Disease/Nonalcoholic Fatty Liver Disease Index for Classification of Patients with Steatotic Liver Disease.
作者信息
Roy Akash, De Arka, Kulkarni Anand V, Jajodia Surabhi, Goenka Usha, Tewari Awanish, Sonthalia Nikhil, Goenka Mahesh K
机构信息
Institute of Gastrosciences and Liver Transplantation, Apollo Multispeciality Hospitals, Kolkata, India.
Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
出版信息
J Obes Metab Syndr. 2024 Sep 30;33(3):222-228. doi: 10.7570/jomes23063. Epub 2024 Aug 5.
BACKGROUND
Steatotic liver disease (SLD) encompasses metabolic dysfunction-associated steatotic liver disease (MASLD) and alcohol-associated liver disease (AALD) at extremes as well as an overlap group termed MASLD with increased alcohol intake (MetALD). The Alcoholic Liver Disease/Nonalcoholic Fatty Liver Disease Index (ANI) was proposed to differentiate ALD from nonalcoholic fatty liver disease (NAFLD). We analysed the performance of the ANI in differentiating within the SLD spectrum.
METHODS
In a cross-sectional study at a tertiary care center, 202 adults (>18 years) who were prospectively diagnosed with SLD defined by magnetic resonance imaging-proton density fat fraction >6.4% were enrolled. Alcohol consumption (AC) was recorded according to thresholds for significant AC: 140-350 g/week (or 20-50 g/day) for females and 210-420 g/week (or 30-60 g/day) for males. The ANI was calculated, and area under the receiver operating characteristic curve (AUROC) was generated.
RESULTS
Of 202 patients (47 years [interquartile range, IQR, 38 to 55], 23.75% females, 77% obese, 42.1% with diabetes, 38.1% hypertensive, 28.7% statin use), 40.5% were ever-alcohol consumers; 120 (59%), 50 (24.7%), and 32 (15.8%) were MASLD (ANI, -3.7 [IQR, -7 to -1.6]; MetALD, - 1.45 [IQR, -2.4 to 0.28]; and AALD, 0.71 [IQR, -1.3 to 4.8], respectively; <0.05 for all). The AUROC of the ANI for MASLD and AALD was 0.79 (IQR, 0.72 to 0.84; cut-off <-3.5) and 0.80 (IQR, 0.74 to 0.86; cut-off >-1.49), respectively. The ANI outperformed aspartate transaminase/alanine transaminase (AST/ALT) ratio (AUROC=0.75 [IQR, 0.69 to 0.81]) and gamma glutamyl transpeptidase (GGT) (AUROC=0.74 [IQR, 0.67 to 0.80]). Addition of GGT did not improve model performance (AUC=0.004; =0.33).
CONCLUSION
AC is common in MASLD. The ANI distinguishes MASLD and AALD, with individual cut-offs within the intermediate zone indicating MetALD. ANI also outperforms AST/ALT ratio or GGT.
背景
脂肪性肝病（SLD）包括代谢功能障碍相关脂肪性肝病（MASLD）和极端情况下的酒精性肝病（AALD），以及一个称为酒精摄入量增加的MASLD（MetALD）的重叠组。提出了酒精性肝病/非酒精性脂肪性肝病指数（ANI）以区分ALD与非酒精性脂肪性肝病（NAFLD）。我们分析了ANI在SLD范围内进行区分的性能。
方法
在一家三级医疗中心进行的一项横断面研究中，纳入了202名年龄大于18岁的成年人，他们经磁共振成像质子密度脂肪分数>6.4%前瞻性诊断为SLD。根据显著酒精摄入量的阈值记录酒精消耗量（AC）：女性为每周140 - 350克（或每天20 - 50克），男性为每周210 - 420克（或每天30 - 60克）。计算ANI，并生成受试者工作特征曲线下面积（AUROC）。
结果
202名患者（年龄47岁[四分位间距，IQR，38至55岁]，23.75%为女性，77%肥胖，42.1%患有糖尿病，38.1%患有高血压，28.7%使用他汀类药物）中，40.5%曾饮酒；120名（59%）为MASLD（ANI，-3.7[IQR，-7至-1.6]）；50名（24.7%）为MetALD（ANI，-1.45[IQR，-2.4至0.28]）；32名（15.8%）为AALD（ANI，0.71[IQR，-1.3至4.8]），所有组间比较P<0.05。ANI区分MASLD和AALD的AUROC分别为0.79（IQR，0.72至0.84；临界值<-3.5）和0.80（IQR，0.74至0.86；临界值>-1.49）。ANI的表现优于天冬氨酸转氨酶/丙氨酸转氨酶（AST/ALT）比值（AUROC = 0.75[IQR，0.69至0.81]）和γ-谷氨酰转肽酶（GGT）（AUROC = 0.74[IQR，0.67至0.80]）。添加GGT并未改善模型性能（AUC = 0.004；P = 0.33）。
结论
AC在MASLD中很常见。ANI可区分MASLD和AALD，中间区域的个体临界值表明为MetALD。ANI也优于AST/ALT比值或GGT。
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