Viral Hepatitis
Copyright ©2007 Baishideng Publishing Group Co.
World J Gastroenterol. Feb 14, 2007; 13(6): 837-844
Published online Feb 14, 2007. doi: 10.3748/wjg.v13.i6.837
Table 1 General and biochemical characteristics of patients with suspected NAFLD
CharacteristicEntire cohort(n = 83)Definitive NASH(n = 45)Borderline NASH(n = 24)Simple steatosis(n = 9)Normal tissue(n = 5)
Male gender54.2%62.2%50.0%44.4%20.0%
Age (yr)48.9 ± 9.147.8 ± 8.848.7 ± 6.253.1 ± 10.152.4 ± 19.2
Body mass index (kg/m2)30.3 ± 4.830.2 ± 4.131.1 ± 6.529.5 ± 3.728.0 ± 3.0
Waist circumference (cm)99 ± 9101 ± 8100 ± 994 ± 1093 ± 11
Waist/hip ratio0.93 (0.01-1.08)0.95 (0.09-1.08)0.93 (0.09-1.02)0.8 (0.74-1.05)0.86 (0.01-0.87)
Hypertension33.7%28.9%50%22.2%20%
Systolic blood pressure (mmHg)122 ± 13124 ± 13121 ± 13121 ± 16115 ± 11
Diastolic blood pressure (mmHg)77 ± 1080 ± 976 ± 1171 ± 1072 ± 9
Diabetes mellitus14.5%13.3%16.7%22.2%0%
Fasting glucose (mg/dL)103 ± 22102 ± 21105 ± 25109 ± 2593 ± 7
Fasting insulin (μU/mL)124 (1-298)34 (3-298)21 (1-281)20 (1-110)11 (1-16)
HOMA index3.0 (0.2-16.5)3.1 (0.3-16.5)2.9 (0.3-8.1)2.6 (0.2-4.9)2.3 (1.6-3.8)
Hyperlipidemia history83.1%80.0%91.7%77.8%80%
Total cholesterol (mg/dL)213 ± 40213 ± 44224 ± 31190 ± 27199 ± 49
Triglycerides (mg/dL)1149 (38-424)151 (38-424)164 (90-398)102 (49-286)149 (44-182)
Metabolic syndrome34.9%37.8%33.3%33.3%20.0%
Lp(a) (mg/dL)110 (2-157)9 (2-98)20 (2-157)6 (2-68)19 (5-32)
Microalbuminuria (μg/mL)11.0 (0.2-48.4)4.2 (0.2-48.4)0.7 (0.2-3.8)0.65 (0.3-8.9)0.4 (0.2-1.0)
AST (IU/L)142 (16-102)44 (18-95)33 (16-102)32 (17-65)28 (19-91)
ALT (IU/L)160 (10-184)68 (23-184)47 (12-146)47 (19-84)35 (10-149)
AST/ALT ratio0.68 (0.34-1.90)0.65 (0.34-0.95)0.71 (0.45-1.42)0.77 (0.59-1.21)0.8 (0.6-1.9)
ALP (UI/L)182 (19-154)84 (44-152)85 (43-132)94 (19-154)76 (61-131)
GGT (UI/L)147 (15-526)52 (16-526)29 (15-199)65 (22-164)73 (17-124)
LDH (UI/L)1196 (132-379)198 (143-375)193 (132-295)184 (163-379)171 (152-340)
Total Bilirubin (mg/dL)10.7 (0.1-2.5)0.7 (0.1-2.5)0.6 (0.1-1.7)0.5 (0.1-0.8)0.8 (0.4-2.1)
HbA1c5.6 (4.6-9.9)%5.7 (4.7-9.9)%5.5 (4.6-7.7)%5.6 (5.1-7.4)%5.5 (5.4-6.2)%
Transferrin saturation19 (2-48)%20 (2-48)%17 (5-29)%23.5 (11-44)%18 (8-28)%
Ferritin (ng/mL)177 (6-406)93 (6-399)69 (12-297)96 (10-406)23 (9-61)
Positive ANA21.6%23.9%20.8%0%40.0%
Positive AMA1.2%2.1%0%0%0%
Positive ASMA7.2%4.3%4.4%0%20.0%
Positive LKM-10%0%0%0%0%
Table 2 Histological findings in 83 patients with suspected NAFLD
VariableDefinitionScoreEntire cohort(n = 83) (%)Definitive NASH(n = 45) (%)Borderline NASH(n = 24) (%)Simple steatosis(n = 9) (%)Normal tissue(n = 5) (%)
Steatosis< 5%08.4008.300100
5%-33%139.8013.3075.001000
> 33%-66%230.1046.7016.7000
> 66%321.7040.00000
Lobular inflammation (foci per 200 × field)No foci015.700088.90100
< 2 foci126.508.9070.8011.100
2-4 foci243.4064.4029.2000
> 4 foci314.5026.70000
BallooningNone0120055.60100
Few balloon cells124.106.7070.9044.400
Many cells/prominent ballooning263.9093.3029.1000
Fibrosis stageNone054.2033.3066.70100100
Mild, zone 3, perisinusoidal1A8.4011.108.3000
Moderate, zone 3, perisinusoidal1B3.606.70000
Portal/periportal1C13.3015.6016.6000
Perisinusoidal and portal/periportal213.3022.204.2000
Bridging fibrosis37.2011.104.2000
Cirrhosis400000
Table 3 Imaging findings in 83 patients with suspected NAFLD
SteatosisEntire cohort(n = 83)Definitive NASH(n = 45)Borderline NASH(n = 24)Simple steatosis(n = 9)Normal tissue(n = 5)
Sonographic grade of hepatosteatosisMild44.00%27.50%50.00%77.80%100.00%
Moderate40.00%55%31.80%11.10%0%
Severe16.00%17.50%18.20%11.10%0%
Liver attenuation on CT (HU)43.8 ± 14.636.9 ± 11.949.5 ± 15.155.2 ± 6.264.1 ± 3.3
Table 4 Concentrations of serum M30-antigen and M65-antigen in the study groups
BiomarkerDefinitive NASH(n = 45)Borderline NASH(n = 24)Simple steatosis(n = 9)Normal tissue(n = 5)Healthy volunteers(n = 49)No-NASH(n = 38)1P
M30-antigen (IU/L)200.4 ± 183.169.8 ± 37.160.1 ± 36.881.0 ± 17.543.3 ± 45.969.0 ± 34.9< 0.001
2PReference category< 0.001< 0.01NS< 0.001< 0.001
M65-antigen (IU/L)362.8 ± 178.7210.6 ± 59.6215.3 ± 78.2207.0 ± 47.4150.9 ± 44.1211.2 ± 61.5< 0.001
2PReference category< 0.001< 0.01< 0.05< 0.001< 0.001
Table 5 Diagnostic performance of serum M30-antigen and M65-antigen levels for the diagnosis of definitive NASH
PatientcategorySerumbiomarkerCut-off value1(IU/L)Sensitivity(95% CI)Specificity(95% CI)Positive predictivevalue (%)Negative predictivevalue (%)Negativelikelihood ratioArea under theROC curve (95% CI)
Borderline NASHM30-antigen121.660 (44.3-74.3)95.8 (78.8-99.3)96.4056.100.420.783 (0.668-0.783)
M65-antigen241.3468.9 (53.3-81.8)83.3 (62.6-95.2)88.6058.800.370.809 (0.697-0.894)
Simple steatosisM30-antigen109.6462.2 (46.5-76.2)100 (66.2-100.0)100.0034.600.380.83 (0.703-0.918)
M65-antigen186.7793.3 (81.7-98.5)66.7 (30.1-92.1)93.3066.700.100.807 (0.677-0.902)
Normal tissueM30-antigen96.564.4 (48.8-78.1)100 (48.0-100.0)100.0023.800.360.724 (0.508-0.841)
M65-antigen227.1873.3 (58.1-85.4)80 (28.8-96.7)97.1025.000.330.809 (0.673-0.906)
Healthy controlsM30-antigen82.5275.6 (60.5-87.1)85.7 (72.7-94.0)82.9079.200.290.881 (0.798-0.938)
M65-antigen189.6491.4 (77.6-98.6)68.1 (36.1-94.2)92.0068.200.180.94 (0.839-0.980)
No-NASHM30-antigen121.660 (44.3-74.3)97.4 (86.1-99.6)96.4067.300.410.787 (0.683-0.869)
M65-antigen243.8268.9 (53.3-81.8)81.6 (65.7-92.2)81.6068.900.380.809 (0.708-0.887)
Table 6 Diagnostic performance of serum M30-antigen and M65-antigen levels in discriminating NAFLD patients with severe fibrosis from subjects with early fibrosis
Cut-off value1(IU/L)Sensitivity(95% CI) (%)Specificity(95% CI) (%)Positive predictivevalue (%)Negative predictivevalue (%)Negativelikelihood ratioArea under thecurve (95% CI)
M30-antigen121.664.7 (38.4-85.7)77.3 (65.3-86.7)42.3089.500.460.733 (0.624-0.824)
M65-antigen243.8270.6 (44.1-89.6)71.2 (58.7-81.7)38.7090.400.410.742 (0.635-0.832)
Table 7 Diagnostic value of serum biomarkers in combination with CT scans for the diagnosis of definitive NASH according to multivariate regression analysis
POdds ratio95% CISensitivity(%)Specificity(%)Positive predictivevalue (%)Negative predictivevalue (%)Accuracy(%)
CombinationCT0.0010.8910.831-0.95586.1083.3086.1083.3084.80
M30-antigen0.0021.0291.011-1.048
CombinationCT0.0030.9160.865-0.97183.3083.3085.7086.6083.30
M65-antigen0.0031.0151.005-1.025