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

作者：Hyysalo Jenni^*; Mannisto Ville T; Zhou You; Arola Johanna; Karja Vesa; Leivonen Marja; Juuti Anne; Jaser Nabil; Lallukka Susanna; Kakela Pirjo; Venesmaa Sari; Simonen Marko; Saltevo Juha; Moilanen Leena; Korpi Hyovalti Eeva; Keinanen Kiukaanniemi Sirkka; Oksa Heikki; Orho Melander Marju; Valenti Luca; Fargion Silvia; Pihlajamaki Jussi; Peltonen Markku; Yki Jarvinen Hannele

来源：Journal of Hepatology, 2014, 60(4): 839-846.

DOI：10.1016/j.jhep.2013.12.009

• Metabolic syndrome
• Type 2 diabetes
• Alanine aminotransferase
• Aspartate aminotransferase
• Non-alcoholic fatty liver disease
• Non-alcoholic steatohepatitis

Background %26 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. %26lt;br%26gt;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 (%26apos;NASH score%26apos;). We also defined the cut-off for NASH for a previously validated NAFLD liver fat score to diagnose NASH in the same cohort (%26apos;NASH liver fat score%26apos;). 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. %26lt;br%26gt;Results: The final %26apos;NASH Score%26apos; 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 %26apos;NASH liver fat score%26apos; were 0.734 (0.664, 0.805) and 0.737 (0.687, 0.787), respectively. Using %26apos;NASH liver fat score%26apos; and %26apos;NASH Score%26apos;, 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 %26apos;NASH liver fat score%26apos; and 3.6% (0.2-7.7%) using ` NASH Score%26apos;. %26lt;br%26gt;Conclusions: The population prevalence of NASH in 45-74 year old Finnish subjects is similar to 5%.

• 出版日期2014-4