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首页> 外文期刊>Journal of the Endocrine Society. >SUN-606 Identification of NASH Using Data from NHANES III
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SUN-606 Identification of NASH Using Data from NHANES III

机译：Sun-606使用来自Nhanes III的数据的纳什识别

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Nonalcoholic steatohepatitis (NASH) is a serious liver condition marked by hepatic steatosis (HS), cell damage and inflammation. Patients with NASH are at risk for developing cirrhosis and hepatic cancer. Currently, the definitive method of diagnosing NASH is by liver biopsy. To avoid the costs and risks associated with biopsy procedures, there has been considerable effort to develop a non-invasive method of identifying patients with NASH. However, none of these methods has become accepted as a “gold standard.” Our objective was to compare three non-invasive methods of identifying NASH by using data from NHANES III (1988-1994) to determine variables associated with published formulas to identify NASH. We used ultrasound data to identify subjects with moderate - severe HS. Among those with HS, we identified the NASH population using either the HAIR score, the NASH liver fat score, or the Gholam score. The HAIR score was developed in a sample of obese patients, is based on hypertension, insulin resistance and alanine transaminase (ALT) levels, and had an AUROC of 0.9, a sensitivity of 0.8, and a specificity of 0.89. The NASH liver fat score was developed in a Finnish population undergoing gastric bypass, and validated in an Italian population of liver biopsy patients. This score incorporates metabolic syndrome, type 2 diabetes, serum insulin, AST, and ALT. In the Finnish and Italian populations, respectively, it had AUROCs of 0.73 and 0.74, sensitivities of 59.5 and 92.9, and specificities of 79.7 and 32.7. The Gholam score was developed in a sample of obese patients and uses aspartate aminotransferase (AST) and type 2 diabetes diagnosis. It had an AUROC of 0.82, a sensitivity of 0.76, and a specificity of 0.66. We performed multinomial logistic regression to compare each NASH population to the normal population (those with no or only mild HS). We identified 1236 subjects as having NASH by at least one method. 18% of these were identified by all 3 methods, while 20% were identified by 2 methods. All three methods identified significant risk factors for NASH (p0.05) as being overweight or obese, having elevated AST or ALT levels, and having elevated C-peptide, serum glucose, or serum triglyceride levels. However, the HAIR and Gholam methods also identified being Mexican-American as a significant risk factor, with the NASH liver fat score did not. Being a former alcohol drinker and not meeting guidelines for physical activity were significant risk factors when using the NASH liver fat score. Further refinement of a noninvasive method for identifying NASH is required. Considerable care must be taken in interpreting risk factors, because the results differ depending which method is used. This could have implications in clinical practice as well, where patients and their risk factors may be mis-identified if formulas are used and not liver biopsy.
机译：非酒精性脱脂性炎（NASH）是由肝脏脂肪变性（HS），细胞损伤和炎症标志的严重肝脏病症。患有纳什的患者面临肝硬化和肝癌的风险。目前，诊断纳什的明确方法是通过肝脏活组织检查。为避免与活组织检查程序相关的成本和风险，有很大努力制定鉴定纳什患者的非侵入性方法。然而，这些方法都没有被接受为“黄金标准”。我们的目标是通过使用来自Nhanes III（1988-1994）的数据来比较识别NASH的三种非侵入性方法，以确定与已发布的公式相关的变量以识别纳什。我们使用超声数据来识别具有中等严重HS的主体。在那些与HS中，我们使用头发分数，鼻窦脂肪评分或Gholam分数鉴定了纳什人口。肥胖患者样品中发育的头发分数，基于高血压，胰岛素抵抗和丙氨酸转氨酶（ALT）水平，并具有0.9的氧化氢，灵敏度为0.8，比0.89的特异性。纳什肝脂肪得分是在临床植物旁路的芬兰人群中开发的，并在意大利肝活检患者中验证。该评分包含代谢综合征，2型糖尿病，血清胰岛素，AST和ALT。在芬兰语和意大利人群中，分别具有0.73和0.74的菌射，灵敏度为59.5和92.9，特异性为79.7和32.7。 Gholam评分是在肥胖患者的样本中开发的，并使用天冬氨酸氨基转移酶（AST）和2型糖尿病诊断。它具有0.82的氧化氢，敏感性为0.76，特异性为0.66。我们进行了多项式逻辑回归，以将每个纳什人口与正常人群进行比较（那些没有或仅轻度HS）。我们将1236个受试者确定为至少一种方法纳入。所有3种方法中鉴定了其中的18％，而20％的方法由2种方法鉴定。所有三种方法都确定了腹部（P <0.05）的显着危险因素，因为具有升高的AST或ALT水平，并且具有升高的C肽，血清葡萄糖或血清甘油三酯水平。然而，头发和古康兰方法也被认为是墨西哥美国作为一个重要的风险因素，纳什肝脏脂肪得分没有。作为前酒精饮酒者而不是满足纳什肝脏脂肪评分时的身体活动准则是显着的风险因素。需要进一步改进用于识别纳什的非侵入性方法。必须在解释风险因素时进行相当大的小心，因为结果根据哪种方法不同。这也可能对临床实践产生影响，如果使用公式而不是肝活组织检查，可能会错误识别患者及其危险因素。

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