[Validity and reliability of the nonalcoholic fatty liver diseases activity score (NAS) in Korean NAFLD patients and its correlation with clinical factors].
OBJECTIVE
Nonalcoholic steatohepatitis (NASH) is commonly diagnosed using the semi-quantitative grading and staging system proposed by Brunt et al. in 1999. The Pathology Committee of the NASH established the nonalcoholic fatty liver diseases (NAFLD) activity score (NAS) in 2005. The aim of this study was to elucidate the validity and reliability of the NAS in Korean NAFLD patients.


METHODS
Fifty-six patients on whom sonography-guided liver biopsy for well-defined NAFLD was performed between 1999 and 2007 were identified retrospectively. Two pathologists evaluated each biopsy sample. NAFLD was evaluated using both the grading system developed by Brunt et al. and the NAS. Each pathologist was blinded to the patients' clinical data and scored independently. We evaluated the body mass index (BMI), liver enzymes, lipid profile, peripheral insulin resistance, leptin, insulin/c-peptide ratio, ferritin, and fasting blood glucose.


RESULTS
The patients were aged 32.1+/-12.5 years (mean+/-SD) and comprised 44 males (78.6%). Patients with different grades at the two grading systems had mild steatosis or ballooning changes with fibrosis, and 36.6% of them were borderline cases (NAS of 3 or 4). The interobserver agreement on diagnostic category was 0.748 (P<0.001) for the NAS (using weighted kappa statistics). Elevated fasting glucose, ALT, and triglyceride were associated with the NAS.


CONCLUSIONS
The simple and reproducible NAS was found to be a useful pathologic grading system in Korean NAFLD patients. However, the proportion of borderline cases based on the NAS was high. The "wait and see" strategy is necessary for evaluating the long-term prognosis.
Lee
Kyung Hun
KH
Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea.
Park
Sang Hoon
SH
Kim
Yu Jin
YJ
Huh
Kyung Rim
KR
Min
Kwang Seon
KS
Jun
Sun Young
SY
Kim
Kyoung Oh
KO
Park
Cheol Hee
CH
Hahn
Taeho
T
Yoo
Kyo Sang
KS
Kim
Jong Hyeok
JH
Lee
Myung Seok
MS
Park
Choong Kee
CK
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D044466:Asian People; D001786:Blood Glucose / Q000032:analysis; D005234:Fatty Liver / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005293:Ferritins / Q000097:blood; D005355:Fibrosis; D006801:Humans; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D056910:Republic of Korea; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014280:Triglycerides / Q000097:blood; D014463:Ultrasonography; D054928:Validation Studies as Topic
D001786:Blood Glucose; D014280:Triglycerides; D005293:Ferritins; D000410:Alanine Transaminase