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World J Hepatol. Oct 27, 2010; 2(10): 374-383
Published online Oct 27, 2010. doi: 10.4254/wjh.v2.i10.374
Published online Oct 27, 2010. doi: 10.4254/wjh.v2.i10.374
Table 1 The pathological criteria for the diagnosis of nonalcoholic fatty liver disease
Matteoni’s classification[45] | ||||
Type | Histological findings | Liver related deaths (mean observation period) | Diagnosis | |
8.17 years[31] | 18.5 years[32] | |||
Type 1 | Fatty liver alone | 1.70% | 2.70% | non-NASH |
Type 2 | Fat accumulation and lobular inflammation | |||
Type 3 | Fat accumulation and ballooning degeneration | 11.00% | 17.50% | NASH |
Type 4 | Type 3 and either Mallory-Denk body or fibrosis | |||
NAFLD activity score (NAS)[47] | ||||
Item | Definition | Score | Diagnosis | |
Steatosis | < 5% | 0 | Total score | |
5%-33% | 1 | 0-2: non-NASH | ||
> 33%-66% | 2 | 3-4: borderline | ||
> 66% | 3 | 5-8: NASH | ||
Lobular inflammation | No foci | 0 | ||
< 2 foci per 200 × field | 1 | |||
2-4 foci per 200 × field | 2 | |||
> 4 foci per 200 × field | 3 | |||
Ballooning | None | 0 | ||
Few balloon cells | 1 | |||
Many cells/prominent ballooning | 2 |
Table 2 Noninvasive biomarkers previously studied or currently under evaluation
Insulin resistance | Inflammation and apoptosis |
HOMA-IR | TNF-α |
Leptin | hsCRP |
Adiponectin | CK-18 fragments |
TNF-α/adiponectin ratio | |
Hepatic fibrosis | Interleukin-6 |
Hyaluronic acid | CC-chemokine ligand-2 |
Type IV collagen 7S | |
TGFβ | Endocrine |
DHEA-S | |
Oxidative stress | |
Ferritin | Imaging studies |
TBARS | US elastography |
Oxidized-LDL | Fibroscan |
Total antioxidant response | ARFI |
Total lipid peroxide levels | Contrast enhanced US |
Thioredoxin | MRI (SPIO, Gd-EOB-DTPA) |
Advanced glycation end products |
Table 3 Panel markers for nonalcoholic steatohepatitis diagnosis
Index | Author (Nation) | Paper | Parameter | Patient selection | N | AUROC |
HAIR score | Dixon JB (Australia) | Gastroenterology 2001 | HTN, ALT, insulin resistance (1/QUICKI) | patients with BMI | 105 | 0.900 |
> 35 undergoing | ||||||
laparoscopic banding | ||||||
Palekar NA (USA) | Liver Int 2006 | Age, female, BMI, AST, AST/ALT ratio, HA | biopsy proven NAFLD | 80 | 0.763 | |
NashTest (NT) | Poynard T (France) | BMC Gastroenterol 2006 | Age, sex, height, weight, TG, AST, ALT, TC, α2-macroglobulin, apolipoprotein A1, haptoglobin, γGT, T-Bil | biopsy proven NAFLD | 257 | 0.790 |
Gholam (USA) | Am J Gastroenterol 2007 | AST, DM | Severely obese subjects (BMI ≥ 40 kg/m2) undergoing Rouxen-Y gastric bypass surgery | 97 | 0.820 | |
NASH clinical scoring system | Campos GM (USA) | Hepatology 2008 | HTN, DM, AST, ALT, sleep apnea, non-black | Patients undergoing laparoscopic banding | 200 | |
NAFIC score | Sumida Y (Japan) | J Gastroenterol, in press | Ferritin, fasting insulin, type IV collagen 7S | Biopsy proven NAFLD | 1771 | 0.8511 |
4422 | 0.7822 |
Table 4 Panel markers for fibrosis in nonalcoholic fatty liver disease
Index | Author (Nation) | Paper | Parameter | Patient selection | N | Stage | AUROC |
Angulo P (USA) | Hepatology 1999 | Obesity1, age, AST/ALT ratio, DM | NASH | 144 | F0-2 vs F3-4 | ||
BAAT | Ratziu V (France) | Gastroenterology 2000 | BMI, age, ALT, TG | Patients with BMI>25, raised transaminse | 93 | F0-1 vs F2-4 | 0.840 |
FibroTest (FT) | Ratziu V (France) | BMC Gastroenterol 2006 | Age, sex, α2-macroglobulin, , apolipoprotein A1, haptoglobin, T-Bil, γGT | Biopsy proven NAFLD | 267 | F0-2 vs F3-4 | 0.840 |
N score | Miyaaki H (Japan) | Liver Int 2008 | Female, age, DM, HT | Biopsy proven NAFLD | 182 | F0-2 vs F3-4 | 0.780 |
NAFLD fibrosis score | Angulo P (USA, UK, Australia, Italy) | Hepatology 2007 | Age, BMI, AST/ALT ratio, IFG/DM, platelet count, albumin | Biopsy proven NAFLD | 4802 | F0-2 vs F3-4 | 0.8802 |
2533 | 0.8203 | ||||||
ELF panel | Guha IN (UK) | Hepatology 2008 | TIMP1, HA, P3NP | Biopsy proven NAFLD | 192 | F0 vs F1-4 | 0.820 |
F0-1 vs F2-4 | 0.900 | ||||||
F0-2 vs F3-4 | 0.930 | ||||||
BARD score | Harrison SA (USA) | Gut 2008 | BMI, AST/ALT, DM | Biopsy proven NAFLD | 827 | F0-2 vs F3-4 | 0.8102 |
0.7803 | |||||||
FIB4 index | Shah (USA) | Clin Gastroenterol Hepatol 2009 | Age, AST, ALT, PLT | Biopsy proven NAFLD | 541 | F0-2 vs F3-4 | 0.802 |
FibroMeter | Calès (France) | J Hepatol 2009 | Glucose , AST, ferritin, PLT, ALT, BW, age | Biopsy proven NAFLD | 235 | F0-1 vs F2-4 | 0.9362 |
0.9523 | |||||||
PAF | Hossain (USA) | Clin Gastroenterol Hepatol 2009 | Male , Caucasian, DM, ALT, AST | Biopsy proven NAFLD | 432 | F0-1 vs F2-4 | 0.742 |
Table 5 NAFIC score[80]
Variables | Cut-off values | Score values |
Ferritin (Female/Male) (ng/mL) | 200/300 | 1 point |
Insulin (μU/mL) | 10 | 1 point |
Type IV collagen 7S (ng/mL) | 5.0 | 2 point |
- Citation: Sumida Y, Eguchi Y, Ono M. Current status and agenda in the diagnosis of nonalcoholic steatohepatitis in Japan. World J Hepatol 2010; 2(10): 374-383
- URL: https://www.wjgnet.com/1948-5182/full/v2/i10/374.htm
- DOI: https://dx.doi.org/10.4254/wjh.v2.i10.374