Diagnostic value of alcoholic liver disease (ALD)/nonalcoholic fatty liver disease (NAFLD) index combined with γ-glutamyl transferase in differentiating ALD and NAFLD = Diagnostic value of alcoholic liver disease (ALD)/nonalcoholic fatty liver disease (NAFLD) index combined with γ-glutamyl transferase in differentiating ALD and NAFLD

다국어 초록 (Multilingual Abstract)

Background/Aims: This study aimed to verify the reliability of the alcoholic liver disease (ALD)/nonalcoholic fatty liver disease (NAFLD) index (ANI) for distinguishing ALD in patients with hepatic steatosis from NAFLD, and to investigate whether ANI combined with γ-glutamyl transferase (GGT) would enhance the accuracy of diagnosis in China. Methods: A hundred thirty-nine cases of fatty liver disease (FLD) were divided into two groups of ALD and NAFLD. The ANI was calculated with an online calculator. All indicators and ANI values were analyzed using statistical methods. Results: ANI was significantly higher in patients with ALD than in those with NAFLD (7.11 ± 5.77 vs. .3.09 ± 3.89, p < 0.001). With a cut-off value of .0.22, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC) of diagnosed ALD cases was 87.1%, 92.5%, and 0.934 (95% confidence interval [CI], 0.879 to 0.969), respectively. The corresponding values for aspartate aminotransferase (AST)/alanine transaminase (ALT), mean corpuscular volume (MCV), and GGT were 75.29%, 72.94%, and 0.826 (95% CI, 0.752 to 0.885); 94.34%, 83.02%, and 0.814 (95% CI, 0.739 to 0.875) and 80.23%, 79.25%, and 0.815 (95% CI, 0.740 to 0.876), respectively. ANI AUROC was significantly higher than the AST/ ALT, MCV, or GGT AUROCs (all p < 0.001), moreover, ANI showed better diagnostic performance. The combination of ANI and GGT showed a better AUROC than ANI alone (0.976 vs. 0.934, p = 0.016). The difference in AUROCs between AST/ALT, MCV, and GGT was not statistically significant (all p > 0.05). Conclusions: ANI can help distinguish ALD from NAFLD with high accuracy; when ANI was combined with GGT, its effectiveness improved further.

참고문헌 (Reference)

1 Dunn W, "Utility of a new model to diagnose an alcohol basis for steatohepatitis" 131 : 1057-1063, 2006

2 Frazier TH, "Treatment of alcoholic liver disease" 4 : 63-81, 2011

3 Robles-Diaz M, "The value of serum aspartate aminotransferase and gamma-glutamyl transpetidase as biomarkers in hepatotoxicity" 35 : 2474-2482, 2015

4 Sorbi D, "The ratio of aspartate aminotransferase to alanine aminotransferase: potential value in differentiating nonalcoholic steatohepatitis from alcoholic liver disease" 94 : 1018-1022, 1999

5 Ono K, "The pathogenesis of decreased aspartate aminotransferase and alanine aminotransferase activity in the plasma of hemodialysis patients: the role of vitamin B6 deficiency" 43 : 405-408, 1995

6 Cylwik B, "The distribution of serum folate concentration and red blood cell indices in alcoholics" 59 : 1-8, 2013

7 McCullough AJ, "The clinical features, diagnosis and natural history of nonalcoholic fatty liver disease" 8 : 521-533, 2004

8 van Beek JH, "The association of alcohol intake with gamma-glutamyl transferase (GGT) levels: evidence for correlated genetic effects" 134 : 99-105, 2014

9 Cohen JA, "The SGOT/SGPT ratio: an indicator of alcoholic liver disease" 24 : 835-838, 1979

10 Wang XF, "Relationship between alcohol consumption and clinical manifestation of patients with fatty liver:a single-center study" 10 : 276-279, 2011

11 Becker U, "Prediction of risk of liver disease by alcohol intake, sex, and age: a prospective population study" 23 : 1025-1029, 1996

12 Yeh MM, "Pathological features of fatty liver disease" 147 : 754-764, 2014

13 Kaiser JP, "PKCepsilon plays a causal role in acute ethanol-induced steatosis" 482 : 104-111, 2009

14 de Ledinghen V, "Non-invasive diagnosis of liver steatosis using controlled attenuation parameter (CAP) and transient elastography" 32 : 911-918, 2012

15 Pulzi FB, "New clinical score to diagnose nonalcoholic steatohepatitis in obese patients" 3 : 3-, 2011

16 Macchia T, "Mitochondrial aspartate aminotransferase isoenzyme: a biochemical marker for the clinical management of alcoholics?" 263 : 79-96, 1997

17 Mundle G, "Influence of age, alcohol consumption and abstinence on the sensitivity of carbohydrate-deficient transferrin, gamma-glutamyltransferase and mean corpuscular volume" 34 : 760-766, 1999

18 Brunt EM, "Histopathology of nonalcoholic fatty liver disease" 16 : 5286-5296, 2010

19 The Chinese National Workshop on Fatty Liver and Alcoholic Liver Disease for the Chinese Liver Disease Associ-ation, "Guidelines for management of nonalcoholic fatty liver disease: an updated and revised edition" 18 : 163-166, 2010

20 The Chinese National Workshop on Fatty Liver and Alcoholic Liver Disease for the Chinese Liver Disease Association, "Guidelines for management of alcoholic liver disease: an up dated and revised edition" 18 : 167-170, 2010

21 Day CP, "Genes or environment to determine alcoholic liver disease and non-alcoholic fatty liver disease" 26 : 1021-1028, 2006

22 Whitfield JB, "Gamma glutamyl transferase" 38 : 263-355, 2001

23 Fragasso A, "Functional vitamin B12 deficiency in alcoholics: an intriguing finding in a retrospective study of megaloblastic anemic patients" 21 : 97-100, 2010

24 Mandayam S, "Epidemiology of alcoholic liver disease" 24 : 217-232, 2004

25 Fan JG, "Epidemiology of alcoholic and nonalcoholic fatty liver disease in China" 28 (28): 11-17, 2013

26 Lomonaco R, "Effect of adipose tissue insulin resistance on metabolic parameters and liver histology in obese patients with nonalcoholic fatty liver disease" 55 : 1389-1397, 2012

27 Yao SK, "Differential diagnosis between alcoholic liver disease and nonalcoholic fatty liver disease" 18 : 1456-1460, 2010

28 Hernaez R, "Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: a meta-analysis" 54 : 1082-1090, 2011

29 Liu YS, "Determination of serum carbohydrate-deficient transferrin in the diagnosis of alcoholic liver disease" 4 : 265-268, 2005

30 Kleiner DE, "Design and validation of a histological scoring system for nonalcoholic fatty liver disease" 41 : 1313-1321, 2005

31 Kumar M, "Controlled attenuation parameter for non-invasive assessment of hepatic steatosis: does etiology affect performance?" 28 : 1194-1201, 2013

32 Das SK, "Comparison of haematological parameters in patients with non-alcoholic fatty liver disease and alcoholic liver disease" 52 : 175-181, 2011

33 Toshikuni N, "Clinical differences between alcoholic liver disease and nonalcoholic fatty liver disease" 20 : 8393-8406, 2014

34 Anton RF, "Carbohydrate-deficient transferrin and gamma-glutamyltransferase for the detection and monitoring of alcohol use: results from a multisite study" 26 : 1215-1222, 2002

35 Loomba R, "Association between diabetes, family history of diabetes, and risk of nonalcoholic steatohepatitis and fibrosis" 56 : 943-951, 2012

36 Litten RZ, "Alcohol biomarkers in applied settings: recent advances and future research opportunities" 34 : 955-967, 2010