Non-alcoholic steatohepatitis: A non-invasive diagnosis by analysis of exhaled breath

详细信息    查看全文

• 作者：Froukje J. Verdam¹ ; ² ; Jan W. Dallinga³ ; Ann Driessen⁴ ; Charlotte de Jonge¹ ; ² ; Edwin J.C. Moonen³ ; Joep B.N. van Berkel³ ; Jakobus Luijk³ ; Nicole D. Bouvy¹ ; Wim A. Buurman¹ ; Sander S. Rensen¹ ; ^{s.rensen@maastrichtuniversity.nl} ; Jan Willem M. Greve² ; Frederik Jan van Schooten³
• 关键词：ALT ; alanine aminotransferase ; AST ; aspartate aminotransferase ; BMI ; body mass index ; NAFLD ; non-alcoholic fatty liver disease ; NASH ; non-alcoholic steatohepatitis ; VOC ; volatile organic compounds ; HbA1c ; glycated hemoglobin ; LR ; likelihood ratio ; PV ; pre
• 刊名：Journal of Hepatology
• 出版年：2013
• 出版时间：March, 2013
• 年：2013
• 卷：58
• 期：3
• 页码：543-548
• 全文大小：1028 K

文摘

| Figures/TablesFigures/Tables | ReferencesReferences

Background & Aims

Histological evaluation of a liver biopsy is the current gold standard to diagnose non-alcoholic steatohepatitis (NASH), but the procedure to obtain biopsies is associated with morbidity and high costs. Hence, only subjects at high risk are biopsied, leading to underestimation of NASH prevalence, and undertreatment. Since analysis of volatile organic compounds in breath has been shown to accurately identify subjects with other chronic inflammatory diseases, we investigated its potential as a non-invasive tool to diagnose NASH.

Methods

Wedge-shaped liver biopsies from 65 subjects (BMI 24.8-64.3 kg/m²) were obtained during surgery and histologically evaluated. The profile of volatile organic compounds in pre-operative breath samples was analyzed by gas chromatography-mass spectrometry and related to liver histology scores and plasma parameters of alanine aminotransferase (ALT) and aspartate aminotransferase (AST).

Results

Three exhaled compounds were sufficient to distinguish subjects with (n = 39) and without NASH (n = 26), with an area under the ROC curve of 0.77. The negative and positive predictive values were 82 % and 81 % . In contrast, elevated ALT levels or increased AST/ALT ratios both showed negative predictive values of 43 % , and positive predictive values of 88 % and 70 % , respectively. The breath test reduced the hypothetical percentage of undiagnosed NASH patients from 67-79 % to 10 % , and of misdiagnosed subjects from 49-51 % to 18 % .

Conclusions

Analysis of volatile organic compounds in exhaled air is a promising method to indicate NASH presence and absence. In comparison to plasma transaminase levels, the breath test significantly reduced the percentage of missed NASH patients and the number of unnecessarily biopsied subjects.