A population-based study on the prevalence of NASH using scores validated against liver histology

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• 作者：Jenni Hyysalo¹ ; ² ; ^&dagger ; ; ^{jenni.hyysalo@gmail.com" class="auth_mail} ; Ville T. Mä ; nnistö ; ³ ; ^&dagger ; ; You Zhou² ; Johanna Arola⁴ ; Vesa Kä ; rjä ; ⁴ ; Marja Leivonen⁵ ; Anne Juuti⁵ ; Nabil Jaser⁵ ; Susanna Lallukka¹ ; ² ; Pirjo Kä ; kelä ; ⁶ ; Sari Venesmaa⁶ ; Marko Simonen³ ; Juha Saltevo⁷ ; ⁹ ; Leena Moilanen³ ; Eeva Korpi-Hyö ; valti¹² ; Sirkka Keinä ; nen-Kiukaanniemi¹³ ; ¹⁴ ; Heikki Oksa¹⁵ ; Marju Orho-Melander¹⁰ ; Luca Valenti¹¹ ; Silvia Fargion¹¹ ; Jussi Pihlajamä ; ki³ ; ⁸ ; ^&Dagger ; ; Markku Peltonen⁷ ; ^&Dagger ; ; Hannele Yki-Jä ; rvinen¹ ; ² ; ^&Dagger ;
• 关键词：1H-MRS ; proton magnetic resonance spectroscopy ; ALT ; alanine aminotransferase ; AUROC ; area under the ROC curve ; AST ; aspartate aminotransferase ; BP ; blood pressure ; BMI ; body mass index ; CH2 ; methylene ; CVD ; cardiovascular disease ; CK18 ; cytokeratin 18 ; fP ; fasting plasma ; fS ; fasting serum ; HbA1c ; glycosylated hemoglobin 1c ; HBV ; hepatitis B ; HCV ; hepatitis C ; HDL ; high density lipoprotein ; HOMA ; homeostatic model assesment ; IQR ; interquartile range ; LDL ; low-density lipoprotein ; MetS ; metaboli
• 刊名：Journal of Hepatology
• 出版年：April, 2014
• 年：2014
• 卷：60
• 期：4
• 页码：839-846
• 全文大小：748 K

文摘

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Background & Aims

Non-alcoholic steatohepatitis (NASH) is a leading cause of chronic liver disease in Western countries. Diagnosis of NASH requires a liver biopsy. We estimated the prevalence of NASH non-invasively in a population-based study using scores validated against liver histology.

Methods

Clinical characteristics, PNPLA3 genotype at rs738409, and serum cytokeratin 18 fragments were measured in 296 consecutive bariatric surgery patients who underwent a liver biopsy to discover and validate a NASH score (鈥楴ASH score鈥?. We also defined the cut-off for NASH for a previously validated NAFLD liver fat score to diagnose NASH in the same cohort (鈥楴ASH liver fat score鈥?. Both scores were validated in an Italian cohort comprising of 380, mainly non-bariatric surgery patients, who had undergone a liver biopsy for NASH. The cut-offs were utilized in the Finnish population-based D2D-study involving 2849 subjects (age 45-74 years) to estimate the population prevalence of NASH.

Results

The final 鈥楴ASH Score鈥?model included PNPLA3 genotype, AST and fasting insulin. It predicted NASH with an AUROC 0.774 (0.709, 0.839) in Finns and 0.759 (0.711, 0.807) in Italians (NS). The AUROCs for 鈥楴ASH liver fat score鈥?were 0.734 (0.664, 0.805) and 0.737 (0.687, 0.787), respectively. Using 鈥楴ASH liver fat score鈥?and 鈥楴ASH Score鈥? the prevalences of NASH in the D2D study were 4.2% (95% CI: 3.4, 5.0) and 6.0% (5.0, 6.9%). Sensitivity analysis was performed by taking into account stochastic false-positivity and false-negativity rates in a Bayesian model. This analysis yielded population prevalences of NASH of 3.1% (95% stimulation limits 0.2-6.8%) using 鈥楴ASH liver fat score鈥?and 3.6% (0.2-7.7%) using 鈥楴ASH Score鈥?

Conclusions

The population prevalence of NASH in 45-74 year old Finnish subjects is 鈭?%.