基于临床变量的肝脂肪变性和肝纤维化预测使用大型国家调查数据库。

IF 2.7 4区 医学 Q2 Medicine
Yanal Alnimer, Touleen Alnimer
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引用次数: 0

摘要

背景:振动控制瞬态弹性成像(VCTA)和控制衰减参数(CAP)在诊断非酒精性脂肪肝患者的肝纤维化和脂肪变性方面更为常用。然而,关于与这些疾病密切相关的临床变量以及哪些患者需要接受筛查的可靠数据有限。方法:我们使用2017-2018年国家健康与营养检查调查数据库来确定与肝脂肪变性和晚期纤维化密切相关的临床预测因素。这些组之间的基线比较是基于广泛接受的截止值。进行线性和逻辑回归以确定临床变量与肝脂肪变性和纤维化之间的关联。我们使用自适应套索回归、梯度增强模型和决策树来确定与这些结果密切相关的临床变量。使用Naïve Byes分类器和决策树计算肝脂肪变性和纤维化的预测概率。结果:32%的人群有肝脂肪变性的证据,以294 dB/m作为临界值。年龄、血清甘油三酯和体重指数的增加与肝脂肪变性的增加有统计学意义相关;相比之下,在多变量线性回归模型中,女性的肝脏脂肪变性值比男性低15点,具有统计学意义。在适应性套索回归中,血清LDL、吸烟、收缩压和舒张压与肝脏脂肪变性关系不大。另一方面,基于决策树分析和梯度增强模型,性别、烟草使用、代谢能量消耗和血清甘油三酯与肝纤维化的相关性最小。在决策树中,体重指数高于30和HbA1c高于5.7的人有72%的可能性发生肝脂肪变性,而体重指数低于30的人有14%的可能性发生肝脂肪变性。另一方面,体重指数超过41的人患肝纤维化的可能性为38%。结论:体重指数、血红蛋白A1c、血清甘油三酯水平、性别和年龄可以很好地预测肝脂肪变性,而体重指数、血压、血小板计数、血红蛋白A1c、血清LDL或HDL与肝纤维化高度相关,应作为VCTE/CAP转诊前的初步筛查工具。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

Prediction of Liver Steatosis and Fibrosis Based on Clinical Variables Using a Large National Survey Database.

Prediction of Liver Steatosis and Fibrosis Based on Clinical Variables Using a Large National Survey Database.

Prediction of Liver Steatosis and Fibrosis Based on Clinical Variables Using a Large National Survey Database.

Prediction of Liver Steatosis and Fibrosis Based on Clinical Variables Using a Large National Survey Database.

Background: Vibration-controlled transient elastography (VCTA) and controlled attenuation parameter (CAP) are used more frequently to diagnose liver fibrosis and steatosis among nonalcoholic fatty liver disease patients. However, limited robust data are available on the clinical variables strongly related to these disorders and who needs to be referred for screening.

Methods: We used the National Health and Nutritional Examination Survey 2017-2018 database to identify the clinical predictors strongly related to liver steatosis and advanced fibrosis. Baseline comparisons among these groups were made based on widely accepted cutoffs. Linear and logistic regressions were performed to identify the associations between the clinical variables and liver steatosis and fibrosis. We used adaptive lasso regression, gradient-boosted model, and decision trees to determine clinical variables strongly related to these outcomes. A Naïve Byes classifier and decision trees were used to calculate the predicted probabilities of liver steatosis and fibrosis.

Results: 32% of our population had evidence of liver steatosis using 294 dB/m as a cutoff. An increase in age, serum triglyceride, and body mass index were associated with a statistically significant increase in liver steatosis; in contrast, females had statistically significantly lower values for liver steatosis by 15 points in the multivariable linear regression model. Serum LDL, smoking, and systolic and diastolic blood pressure are poorly associated with liver steatosis in the adaptive lasso regression. On the other hand, sex, tobacco use, metabolic energy expenditure, and serum triglyceride are the least associated with liver fibrosis based on decision tree analysis and a gradient-boosted model. In decision trees, people with a body mass index above 30 and HbA1c above 5.7 have a 72% likelihood of liver steatosis compared to 14% for people with a body mass index below 30. On the other hand, people with a body mass index above 41 have a 38% likelihood of liver fibrosis.

Conclusion: Body mass index, hemoglobin A1c, serum triglyceride level, sex, and age could provide a good prediction for liver steatosis, while body mass index, blood pressure, platelet counts, hemoglobin A1c, serum LDL, or HDL are highly associated with liver fibrosis and should be used as an initial screening tool prior referral for VCTE/CAP.

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来源期刊
CiteScore
4.80
自引率
0.00%
发文量
0
审稿时长
37 weeks
期刊介绍: Canadian Journal of Gastroenterology and Hepatology is a peer-reviewed, open access journal that publishes original research articles, review articles, and clinical studies in all areas of gastroenterology and liver disease - medicine and surgery. The Canadian Journal of Gastroenterology and Hepatology is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
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