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研究生:劉品崧
研究生(外文):Pin Sung Liu
論文名稱:探討以代謝症候群作為非酒精性脂肪肝嚴重程度之預測因子─以彰化社區整合式篩檢為例
論文名稱(外文):The Metabolic Syndrome Factors as Independent Predictors for Severity of Non-Alcoholic Fatty Liver Disease Detected by Ultrasonography Based on Changhua Community-based Integrated Screening Program
指導教授:邱月暇
指導教授(外文):Y. H. Chiu
學位類別:碩士
校院名稱:長庚大學
系所名稱:醫務管理學系
學門:商業及管理學門
學類:醫管學類
論文種類:學術論文
論文出版年:2016
畢業學年度:104
語文別:中文
論文頁數:90
中文關鍵詞:非酒精性脂肪肝代謝症候群預測模型
外文關鍵詞:Non-alcohol fatty liver disease(NAFLD)Metabolic Syndromepredict model
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研究背景:肝癌長年居於我國癌症十大死因,從過去研究得知肝癌與飲酒及病毒性肝炎相關,近年來研究發現非酒精性脂肪肝(Non-alcohol fatty liver disease, NAFLD)也有顯著造成肝硬化、肝癌及心血管疾病之風險。然而臺灣目前仍缺乏以一般社區民眾為對象的非酒精性脂肪肝流行病學及危險因子之探討,且近年國內肥胖及代謝症候群的盛行率上升,代表可能潛在NAFLD的盛行隨之增加。本研究欲利用整合式篩檢資料庫來分析一般社區民眾的NAFLD盛行狀況及危險因子分析,並希望以成本效益觀點建立NAFLD預測模式。
材料與方法:本研究欲使用彰化縣整合式社區篩檢 (Changhua Integrate Community Screening, CHICS) 資料庫,以2008~2014年以二階段法邀請接受腹部超音波掃描的民眾個人資料、血清檢驗數據及腹部超音波結果(分為4等級:無、輕度、中度及重度脂肪肝),分析NAFLD的盛行狀況,使用Ordinal Logistic Regression Model探討危險因子與NAFLD嚴重程度的相關,並以Area Under ROC Curve (AUROC)作為模型預測效益,配合篩檢驗成本進行成本效益分析,
結果:排除無超音波掃描結果、掃描結果為肝硬化、肝癌、有飲酒習慣或已戒酒者,最後共納入10, 315位民眾為本研究樣本。41.3%的樣本經超音波偵測出具有NAFLD,且依性別、年齡及健康狀況而有所不同。在調整年齡、性別、抽菸及嚼檳榔習慣後,本研究模型發現尿酸異常(aOR=1.51,95% CI:1.32-1.74)、腰圍過粗(aOR=3.48,95% CI:2.98-4.08)、TG升高(aOR=1.63,95% CI:1.41-2.87)、HDL降低(aOR=1.55,95% CI:1.36-1.78)、血壓升高(aOR=1.34,95% CI:1.15-1.56)、血糖升高(aOR=1.68,95% CI:1.46-1.96) 與脂肪肝嚴重程度具有正向關係,而AAR指數升高(aOR=0.18,95% CI:0.14-0.24)、B型肝炎(aOR=0.80,95% CI:0.69-0.94)、C型肝炎(aOR=0.43,95% CI:0.34-0.53)呈現反向關係。多變項模式對於中、重度NAFLD的預測能力AUROC為0.803,敏感度=78.8%,特異度=67.9%。
結論:透過本研究發現AAR指標、尿酸、B、C型肝炎、代謝症候群及其包含之5項因子對於NAFLD嚴重程度具有良好的預測能力,其中腰圍過胖是一個重要的關鍵,希望藉此提供健康照護政策之參考。
Background: The nationwide HBV vaccination successfully reduced the incidences of HCC and HBV infection in Taiwan, but the non-alcoholic fatty liver disease (NAFLD) impact on hepatocellular carcinoma (HCC) was thought highly respect for prevention recently, which associated with metabolic syndrome (MetS). However, NAFLD detecting by abdominal ultrasonography (AUS) must highly depends on professional clinical manpower for general population approach. Therefore, our study aim is to generate predictors for NAFLD, which based on the association between metabolic factors and NAFLD severity.
Material & Methods: Changhua County had conducted a community-based integrated screening (CHCIS) program that provided HCC and other neoplastic diseases (breast, colorectal, oral , and cervical cancers) and chronic diseases (hyperlipidemia, hypertension, and hyperglycemia) screening which was launched since 2005. Following CHICS, AUS was designed and targeted at residents aged 40-69 years. The NAFLD severity was diagnosed into 4 levels (normal, mild, moderate, and severe) by clinical gastroenterology physicians using abdominal sonography. The biomarkers and questionnaire were implemented for personal information collection, including life style. The ordinal logistic regression was conducted to analyze the relationship between the NAFLD severity level and Metabolic Syndrome components. Using Area-Under ROC Curve (AUROC) and model factors’ exam cost for Cost-effectiveness analysis.
Result: Excluding the patients which no AUS result, diagnosed liver cirrhosis or Hepatocellular Carcinoma, and alcohol drinking, total 10,315 subjects were recruited. The overall NAFLD prevalence is 41.3%. After adjustment for age, gender, smoking and betel nuts chewing habits, compared with normal, the significant included higher UA (aOR=1.51, 95% CI: 1.32-1.74) and Metabolic Syndrome components included higher waist (aOR=3.48, 95% CI: 2.98-4.08), elevated TG (aOR=1.63, 95% CI:1.41-2.87), lower HDL (aOR=1.55,95% CI: 1.36-1.78), elevated blood pressure (aOR=1.34, 95% CI: 1.15-1.56), elevated blood sugar (aOR=1.68, 95% CI: 1.46-1.96), but inverse relationship with AAR (AST/ALT) (aOR=0.18, 95% CI: 0.14-0.24), HBV, HCV in multivariate model, which showed in mild and moderate/severe, but striking association was demonstrated in moderate/severe. AUROC of multivariate model is 0.803, with sensitivity=0.788 and specificity=0.679. C-E Plane method suggest a model with demographic background, waist, TG and AAR is cost-effectiveness combination, with AUROC is 0.780, with sensitivity=0.820 and specificity=0.620.
Conclusion: The high prevalence of NAFLD was revealed in general Taiwanese adults. Those Metabolic factors could successfully predict the severity of NAFLD for Taiwanese general population.
  指導教授推薦書
  論文口試委員審定書
  致謝 iii
  中文摘要iv
  英文摘要 vi
  目錄 viii
  圖目錄 x
  表目錄 xi
  第一章、 研究背景與目的 1
  第二章、 文獻探討 3
    第一節、 NAFLD之定義 3
    第二節、 NAFLD流行病學狀況探討 4
    第三節、 NAFLD的診斷方式 8
    第四節、 NAFLD自然病史與預後 10
    第五節、 NAFLD與相關危險因子探討 12
    第六節、 NAFLD之預測模型 15
  第三章、 研究材料與方法 19
    第一節、 研究族群與選樣流程 19
    第二節、 研究變項操作型定義 28
    第三節、 統計分析方法 29
    第四節、 模型選擇、配適度檢定與預測模型驗證 33
    第五節、 成本效益評估 36
  第四章、 研究結果 37
    第一節、 NAFLD盛行狀況 39
    第二節、 相關危險因子探討 44
    第三節、 預測模型建構 49
    第四節、 預測模型內在信度與驗證 55
    第五節、 成本效益分析 56
    第五章、 討論 62
  第六章、 結論 67
  參考文獻  68

 圖目錄
  圖一、彰化社區整合式篩檢訪談使用結構式問卷─個人生活型態 22
  圖二、彰化社區整合式篩檢訪談使用結構式問卷─個人病史 23
  圖三、彰化社區整合式篩檢檢查檢驗項目紀錄單 24
  圖四、彰化縣整合式篩檢肝癌高危險群二階段邀請流程 27
  圖五、彰化社區整合式篩腹部超音波檢查報告單 28
  圖六、研究樣本選擇流程圖 40
  圖七、研究樣本非酒精性脂肪肝盛行於不同性別及年齡層間分布 45

 表目錄
  表一、研究樣本描述性統計 37
  表二、研究樣本背景特性與脂肪肝嚴重程度描述性統計 40
  表三、研究樣本非酒精性脂肪肝盛行於不同性別及年齡層間分布 43
  表四、單變項Proportional Odds Assumption假設檢定 45
  表五、單變項與經調整單變項Ordinal Logistic Regression分析 48
  表六、不同模式選擇模式建立多變項模型之結果比較 50
  表七、多變項模型建立過程之模型擬合度與AUROC分析 52
  表八、多變項Logistic Regression分析 54
  表九、模型分割驗證所估計預測效果比較 55
  表十、彰化社區整合式篩檢檢驗檢查項目成本彙整表 58
  表十一、多變項模型逐步模型成本效益分析 59
  表十二、不同模型組合之成本、效益、模型預測能力比較 61
Adams, L. A., Lymp, J. F., St. Sauver, J., Sanderson, S. O., Lindor, K. D., Feldstein, A., & Angulo, P. (2005). The natural history of nonalcoholic fatty liver disease: A population-based cohort study. Gastroenterology, 129(1), 113-121.
Angulo, P. (2002). Nonalcoholic fatty liver disease. N Engl J Med, 346(16), 1221-1231.
Angulo, P., Bugianesi, E., Bjornsson, E. S., Charatcharoenwitthaya, P., Mills, P. R., Barrera, F., . . . George, J. (2013). Simple noninvasive systems predict long-term outcomes of patients with nonalcoholic fatty liver disease. Gastroenterology, 145(4), 782-789 e784.
Angulo, P., Keach, J. C., Batts, K. P., & Lindor, K. D. (1999). Independent predictors of liver fibrosis in patients with nonalcoholic steatohepatitis. Hepatology, 30(6), 1356-1362.
Argo, C. K., Northup, P. G., Al-Osaimi, A. M., & Caldwell, S. H. (2009). Systematic review of risk factors for fibrosis progression in non-alcoholic steatohepatitis. J Hepatol, 51(2), 371-379.
Bae, J. C., Rhee, E. J., Lee, W. Y., Park, S. E., Park, C. Y., Oh, K. W., . . . Kim, S. W. (2011). Combined effect of nonalcoholic fatty liver disease and impaired fasting glucose on the development of type 2 diabetes: A 4-year retrospective longitudinal study. Diabetes Care, 34(3), 727-729.
Bedogni, G., Bellentani, S., Miglioli, L., Masutti, F., Passalacqua, M., Castiglione, A., & Tiribelli, C. (2006). The fatty liver index: A simple and accurate predictor of hepatic steatosis in the general population. BMC Gastroenterol, 6, 33.
Bedogni, G., Miglioli, L., Masutti, F., Tiribelli, C., Marchesini, G., & Bellentani, S. (2005). Prevalence of and risk factors for nonalcoholic fatty liver disease: The dionysos nutrition and liver study. Hepatology, 42(1), 44-52.
Beyoglu, D., & Idle, J. R. (2013). The metabolomic window into hepatobiliary disease. J Hepatol, 59(4), 842-858.
Browning, J. D., Szczepaniak, L. S., Dobbins, R., Nuremberg, P., Horton, J. D., Cohen, J. C., . . . Hobbs, H. H. (2004). Prevalence of hepatic steatosis in an urban population in the united states: Impact of ethnicity. Hepatology, 40(6), 1387-1395.
Bruix, J., & Sherman, M. (2011). Management of hepatocellular carcinoma: An update. Hepatology, 53(3), 1020-1022.
Byrne, C. D., & Targher, G. (2015). Nafld: A multisystem disease. J Hepatol, 62(1 Suppl), S47-64.
Caldwell, S., & Argo, C. (2010). The natural history of non-alcoholic fatty liver disease. Dig Dis, 28(1), 162-168.
Chalasani, N., Younossi, Z., Lavine, J. E., Diehl, A. M., Brunt, E. M., Cusi, K., . . . Sanyal, A. J. (2012). The diagnosis and management of non-alcoholic fatty liver disease: Practice guideline by the american association for the study of liver diseases, american college of gastroenterology, and the american gastroenterological association. Hepatology, 55(6), 2005-2023.
Chang, K. W., Chen, H. L., Chien, Y. H., Chen, T. C., & Yeh, C. T. (2011). Slc25a13 gene mutations in taiwanese patients with non-viral hepatocellular carcinoma. Mol Genet Metab, 103(3), 293-296.
Chang, M. H., Chen, C. J., Lai, M. S., Hsu, H. M., Wu, T. C., Kong, M. S., . . . Chen, D. S. (1997). Universal hepatitis b vaccination in taiwan and the incidence of hepatocellular carcinoma in children. Taiwan childhood hepatoma study group. N Engl J Med, 336(26), 1855-1859.
Chang, M. H., You, S. L., Chen, C. J., Liu, C. J., Lee, C. M., Lin, S. M., . . . Taiwan Hepatoma Study, G. (2009). Decreased incidence of hepatocellular carcinoma in hepatitis b vaccinees: A 20-year follow-up study. J Natl Cancer Inst, 101(19), 1348-1355.
Chang, Y., Jung, H. S., Yun, K. E., Cho, J., Cho, Y. K., & Ryu, S. (2013). Cohort study of non-alcoholic fatty liver disease, nafld fibrosis score, and the risk of incident diabetes in a korean population. Am J Gastroenterol, 108(12), 1861-1868.
Chen, C. H., Huang, M. H., Yang, J. C., Nien, C. K., Yang, C. C., Yeh, Y. H., & Yueh, S. K. (2006). Prevalence and risk factors of nonalcoholic fatty liver disease in an adult population of taiwan: Metabolic significance of nonalcoholic fatty liver disease in nonobese adults. J Clin Gastroenterol, 40(8), 745-752.
Chen, C. H., Huang, M. H., Yang, J. C., Nien, C. K., Yang, C. C., Yeh, Y. H., & Yueh, S. K. (2007). Prevalence and etiology of elevated serum alanine aminotransferase level in an adult population in taiwan. J Gastroenterol Hepatol, 22(9), 1482-1489.
Chen, C. H., Lin, S. T., Yang, C. C., Yeh, Y. H., Kuo, C. L., & Nien, C. K. (2008). The accuracy of sonography in predicting steatosis and fibrosis in chronic hepatitis c. Dig Dis Sci, 53(6), 1699-1706.
Chen, D. S. (1993). From hepatitis to hepatoma: Lessons from type b viral hepatitis. Science, 262(5132), 369-370.
Chen, J., Talwalkar, J. A., Yin, M., Glaser, K. J., Sanderson, S. O., & Ehman, R. L. (2011). Early detection of nonalcoholic steatohepatitis in patients with nonalcoholic fatty liver disease by using mr elastography. Radiology, 259(3), 749-756.
Chen, T. H., Chen, C. J., Yen, M. F., Lu, S. N., Sun, C. A., Huang, G. T., . . . Duffy, S. W. (2002). Ultrasound screening and risk factors for death from hepatocellular carcinoma in a high risk group in taiwan. Int J Cancer, 98(2), 257-261.
Cheung, C. L., Lam, K. S., Wong, I. C., & Cheung, B. M. (2014). Non-invasive score identifies ultrasonography-diagnosed non-alcoholic fatty liver disease and predicts mortality in the USA. BMC Med, 12, 154.
Chung, G. E., Kim, D., Kwark, M. S., Kim, W., Yim, J. Y., Kim, Y. J., & Yoon, J. H. (2015). Visceral adipose tissue area as an independent risk factor for elevated liver enzyme in nonalcoholic fatty liver disease. Medicine (Baltimore), 94(9), e573.
Dassanayake, A. S., Kasturiratne, A., Rajindrajith, S., Kalubowila, U., Chakrawarthi, S., De Silva, A. P., . . . de Silva, H. J. (2009). Prevalence and risk factors for non-alcoholic fatty liver disease among adults in an urban sri lankan population. J Gastroenterol Hepatol, 24(7), 1284-1288.
Donato, F., Tagger, A., Gelatti, U., Parrinello, G., Boffetta, P., Albertini, A., . . . Nardi, G. (2002). Alcohol and hepatocellular carcinoma: The effect of lifetime intake and hepatitis virus infections in men and women. Am J Epidemiol, 155(4), 323-331.
EASL. (2015). Easl-aleh clinical practice guidelines: Non-invasive tests for evaluation of liver disease severity and prognosis. J Hepatol, 63(1), 237-264.
EASL. (2016). Easl-easd-easo clinical practice guidelines for the management of non-alcoholic fatty liver disease. J Hepatol.
Ekstedt, M., Franzen, L. E., Mathiesen, U. L., Thorelius, L., Holmqvist, M., Bodemar, G., & Kechagias, S. (2006). Long-term follow-up of patients with nafld and elevated liver enzymes. Hepatology, 44(4), 865-873.
Fabbrini, E., Sullivan, S., & Klein, S. (2010). Obesity and nonalcoholic fatty liver disease: Biochemical, metabolic, and clinical implications. Hepatology, 51(2), 679-689.
Farrell, G. C., van Rooyen, D., Gan, L., & Chitturi, S. (2012). Nash is an inflammatory disorder: Pathogenic, prognostic and therapeutic implications. Gut Liver, 6(2), 149-171.
Fukuda, T., Hamaguchi, M., Kojima, T., Hashimoto, Y., Ohbora, A., Kato, T., . . . Fukui, M. (2015). The impact of non-alcoholic fatty liver disease on incident type 2 diabetes mellitus in non-overweight individuals. Liver Int.
Graeter, T., Niedermayer, P. C., Mason, R. A., Oeztuerk, S., Haenle, M. M., Koenig, W., . . . group, E. M.-S. (2015). Coffee consumption and nafld: A community based study on 1223 subjects. BMC Res Notes, 8, 640.
Hamaguchi, M., Kojima, T., Itoh, Y., Harano, Y., Fujii, K., Nakajima, T., . . . Okanoue, T. (2007). The severity of ultrasonographic findings in nonalcoholic fatty liver disease reflects the metabolic syndrome and visceral fat accumulation. Am J Gastroenterol, 102(12), 2708-2715.
Hamaguchi, M., Kojima, T., Takeda, N., Nakagawa, T., Taniguchi, H., Fujii, K., . . . Ida, K. (2005). The metabolic syndrome as a predictor of nonalcoholic fatty liver disease. Ann Intern Med, 143(10), 722-728.
Hanley, J. A., & McNeil, B. J. (1982). The meaning and use of the area under a receiver operating characteristic (roc) curve. Radiology, 143(1), 29-36.
Harrison, S. A., Oliver, D., Arnold, H. L., Gogia, S., & Neuschwander-Tetri, B. A. (2008). Development and validation of a simple nafld clinical scoring system for identifying patients without advanced disease. Gut, 57(10), 1441-1447.
Hernaez, R., Lazo, M., Bonekamp, S., Kamel, I., Brancati, F. L., Guallar, E., & Clark, J. M. (2011). Diagnostic accuracy and reliability of ultrasonography for the detection of fatty liver: A meta-analysis. Hepatology, 54(3), 1082-1090.
Hjelkrem, M., Stauch, C., Shaw, J., & Harrison, S. A. (2011). Validation of the non-alcoholic fatty liver disease activity score. Aliment Pharmacol Ther, 34(2), 214-218.
Hossain, N., Afendy, A., Stepanova, M., Nader, F., Srishord, M., Rafiq, N., . . . Younossi, Z. (2009). Independent predictors of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol, 7(11), 1224-1229, 1229 e1221-1222.
Hsiao, P. J., Kuo, K. K., Shin, S. J., Yang, Y. H., Lin, W. Y., Yang, J. F., . . . Yu, M. L. (2007). Significant correlations between severe fatty liver and risk factors for metabolic syndrome. J Gastroenterol Hepatol, 22(12), 2118-2123.
Jan, C. F., Chen, C. J., Chiu, Y. H., Chen, L. S., Wu, H. M., Huang, C. C., . . . Chen, T. H. (2006). A population-based study investigating the association between metabolic syndrome and hepatitis b/c infection (keelung community-based integrated screening study no. 10). Int J Obes (Lond), 30(5), 794-799.
Joseph, A. E., Saverymuttu, S. H., al-Sam, S., Cook, M. G., & Maxwell, J. D. (1991). Comparison of liver histology with ultrasonography in assessing diffuse parenchymal liver disease. Clin Radiol, 43(1), 26-31.
Kasturiratne, A., Weerasinghe, S., Dassanayake, A. S., Rajindrajith, S., de Silva, A. P., Kato, N., . . . de Silva, H. J. (2013). Influence of non-alcoholic fatty liver disease on the development of diabetes mellitus. J Gastroenterol Hepatol, 28(1), 142-147.
Kim, D., Choi, S. Y., Park, E. H., Lee, W., Kang, J. H., Kim, W., . . . Kim, W. R. (2012). Nonalcoholic fatty liver disease is associated with coronary artery calcification. Hepatology, 56(2), 605-613.
Kleiner, D. E., Brunt, E. M., Van Natta, M., Behling, C., Contos, M. J., Cummings, O. W., . . . Nonalcoholic Steatohepatitis Clinical Research, N. (2005). Design and validation of a histological scoring system for nonalcoholic fatty liver disease. Hepatology, 41(6), 1313-1321.
Koehler, E. M., Plompen, E. P., Schouten, J. N., Hansen, B. E., Darwish Murad, S., Taimr, P., . . . Janssen, H. L. (2016). Presence of diabetes mellitus and steatosis is associated with liver stiffness in a general population: The rotterdam study. Hepatology, 63(1), 138-147.
Lazo, M., Hernaez, R., Eberhardt, M. S., Bonekamp, S., Kamel, I., Guallar, E., . . . Clark, J. M. (2013). Prevalence of nonalcoholic fatty liver disease in the united states: The third national health and nutrition examination survey, 1988-1994. Am J Epidemiol, 178(1), 38-45.
Lee, S. S., Park, S. H., Kim, H. J., Kim, S. Y., Kim, M. Y., Kim, D. Y., . . . Yu, E. S. (2010). Non-invasive assessment of hepatic steatosis: Prospective comparison of the accuracy of imaging examinations. J Hepatol, 52(4), 579-585.
Liu, C.-C., Hung, C.-L., Shih, S.-C., Ko, H.-J., Lu, Y.-T., Wu, Y.-J., . . . Chang, R.-E. (2010). Age-related differences in the clinical presentation, associated metabolic abnormality, and estimated cardiovascular risks from nonalcoholic fatty liver disease: A cross-sectional study from health evaluation center in taiwan. International Journal of Gerontology, 4(4), 184-191.
Lodato, F., Mazzella, G., Festi, D., Azzaroli, F., Colecchia, A., & Roda, E. (2006). Hepatocellular carcinoma prevention: A worldwide emergence between the opulence of developed countries and the economic constraints of developing nations. World J Gastroenterol, 12(45), 7239-7249.
Loomba, R., Wolfson, T., Ang, B., Hooker, J., Behling, C., Peterson, M., . . . Sirlin, C. (2014). Magnetic resonance elastography predicts advanced fibrosis in patients with nonalcoholic fatty liver disease: A prospective study. Hepatology, 60(6), 1920-1928.
Ludwig, U., Holzner, D., Denzer, C., Greinert, A., Haenle, M. M., Oeztuerk, S., . . . Study, E. (2015). Subclinical and clinical hypothyroidism and non-alcoholic fatty liver disease: A cross-sectional study of a random population sample aged 18 to 65 years. BMC Endocr Disord, 15, 41.
Marchesini, G., Bugianesi, E., Forlani, G., Cerrelli, F., Lenzi, M., Manini, R., . . . Rizzetto, M. (2003). Nonalcoholic fatty liver, steatohepatitis, and the metabolic syndrome. Hepatology, 37(4), 917-923.
McPherson, S., Stewart, S. F., Henderson, E., Burt, A. D., & Day, C. P. (2010). Simple non-invasive fibrosis scoring systems can reliably exclude advanced fibrosis in patients with non-alcoholic fatty liver disease. Gut, 59(9), 1265-1269.
Pastori, D., Loffredo, L., Perri, L., Baratta, F., Scardella, L., Polimeni, L., . . . Angelico, F. (2015). Relation of nonalcoholic fatty liver disease and framingham risk score to flow-mediated dilation in patients with cardiometabolic risk factors. Am J Cardiol, 115(10), 1402-1406.
Raszeja-Wyszomirska, J., Szymanik, B., Lawniczak, M., Kajor, M., Chwist, A., Milkiewicz, P., & Hartleb, M. (2010). Validation of the bard scoring system in polish patients with nonalcoholic fatty liver disease (nafld). BMC Gastroenterol, 10, 67.
Salomao, M., Yu, W. M., Brown, R. S., Jr., Emond, J. C., & Lefkowitch, J. H. (2010). Steatohepatitic hepatocellular carcinoma (sh-hcc): A distinctive histological variant of hcc in hepatitis c virus-related cirrhosis with associated nafld/nash. Am J Surg Pathol, 34(11), 1630-1636.
Sertoglu, E., Ercin, C. N., Celebi, G., Gurel, H., Kayadibi, H., Genc, H., . . . Dogru, T. (2014). The relationship of serum uric acid with non-alcoholic fatty liver disease. Clin Biochem, 47(6), 383-388.
Shah, A. G., Lydecker, A., Murray, K., Tetri, B. N., Contos, M. J., Sanyal, A. J., & Nash Clinical Research, N. (2009). Comparison of noninvasive markers of fibrosis in patients with nonalcoholic fatty liver disease. Clin Gastroenterol Hepatol, 7(10), 1104-1112.
Shibata, M., Kihara, Y., Taguchi, M., Tashiro, M., & Otsuki, M. (2007). Nonalcoholic fatty liver disease is a risk factor for type 2 diabetes in middle-aged japanese men. Diabetes Care, 30(11), 2940-2944.
Sirota, J. C., McFann, K., Targher, G., Johnson, R. J., Chonchol, M., & Jalal, D. I. (2013). Elevated serum uric acid levels are associated with non-alcoholic fatty liver disease independently of metabolic syndrome features in the united states: Liver ultrasound data from the national health and nutrition examination survey. Metabolism, 62(3), 392-399.
Starley, B. Q., Calcagno, C. J., & Harrison, S. A. (2010). Nonalcoholic fatty liver disease and hepatocellular carcinoma: A weighty connection. Hepatology, 51(5), 1820-1832.
Stepanova, M., & Younossi, Z. M. (2012). Independent association between nonalcoholic fatty liver disease and cardiovascular disease in the us population. Clin Gastroenterol Hepatol, 10(6), 646-650.
Sterling, R. K., Lissen, E., Clumeck, N., Sola, R., Correa, M. C., Montaner, J., . . . Investigators, A. C. (2006). Development of a simple noninvasive index to predict significant fibrosis in patients with hiv/hcv coinfection. Hepatology, 43(6), 1317-1325.
Steyerberg, E. w. (2009). Clinical prediction models a practical approach to development, validation, and updating. New York: Spinger.
Stolk, R. P., Wink, O., Zelissen, P. M., Meijer, R., van Gils, A. P., & Grobbee, D. E. (2001). Validity and reproducibility of ultrasonography for the measurement of intra-abdominal adipose tissue. Int J Obes Relat Metab Disord, 25(9), 1346-1351.
Strauss, S., Gavish, E., Gottlieb, P., & Katsnelson, L. (2007). Interobserver and intraobserver variability in the sonographic assessment of fatty liver. AJR Am J Roentgenol, 189(6), W320-323.
Sumida, Y., Yoneda, M., Hyogo, H., Itoh, Y., Ono, M., Fujii, H., . . . Okanoue, T. (2012). Validation of the fib4 index in a japanese nonalcoholic fatty liver disease population. BMC Gastroenterol, 12, 2.
Tacke, F., & Yoneyama, H. (2013). From nafld to nash to fibrosis to hcc: Role of dendritic cell populations in the liver. Hepatology, 58(2), 494-496.
Targher, G., Bertolini, L., Rodella, S., Tessari, R., Zenari, L., Lippi, G., & Arcaro, G. (2007). Nonalcoholic fatty liver disease is independently associated with an increased incidence of cardiovascular events in type 2 diabetic patients. Diabetes Care, 30(8), 2119-2121.
Treeprasertsuk, S., Leverage, S., Adams, L. A., Lindor, K. D., St Sauver, J., & Angulo, P. (2012). The framingham risk score and heart disease in nonalcoholic fatty liver disease. Liver Int, 32(6), 945-950.
Tsai, C. H., Li, T. C., & Lin, C. C. (2008). Metabolic syndrome as a risk factor for nonalcoholic fatty liver disease. South Med J, 101(9), 900-905.
Uchil, D., Pipalia, D., Chawla, M., Patel, R., Maniar, S., Narayani, & Juneja, A. (2009). Non-alcoholic fatty liver disease (nafld)--the hepatic component of metabolic syndrome. J Assoc Physicians India, 57, 201-204.
Wang, R., Wang, G., Zhang, N., Li, X., & Liu, Y. (2013). Clinical evaluation and cost-effectiveness analysis of serum tumor markers in lung cancer. Biomed Res Int, 2013, 195692.
Wong, V. W., Chu, W. C., Wong, G. L., Chan, R. S., Chim, A. M., Ong, A., . . . Chan, H. L. (2012). Prevalence of non-alcoholic fatty liver disease and advanced fibrosis in hong kong chinese: A population study using proton-magnetic resonance spectroscopy and transient elastography. Gut, 61(3), 409-415.
Wong, V. W., Vergniol, J., Wong, G. L., Foucher, J., Chan, H. L., Le Bail, B., . . . de Ledinghen, V. (2010). Diagnosis of fibrosis and cirrhosis using liver stiffness measurement in nonalcoholic fatty liver disease. Hepatology, 51(2), 454-462.
Wong, V. W. S., Wong, G. L. H., Yip, G. W. K., Lo, A. O. S., Limquiaco, J., Chu, W. C. W., . . . Chan, H. L. Y. (2011). Coronary artery disease and cardiovascular outcomes in patients with non-alcoholic fatty liver disease. Gut, 60(12), 1721-1727.
Wu, G. H., Chen, L. S., Chang, K. J., Hou, M. F., Chen, S. C., Liu, T. J., . . . Chen, T. H. (2006). Evolution of breast cancer screening in countries with intermediate and increasing incidence of breast cancer. J Med Screen, 13 Suppl 1, S23-27.
Yang, B. L., Wu, W. C., Fang, K. C., Wang, Y. C., Huo, T. I., Huang, Y. H., . . . Lee, S. D. (2015). External validation of fatty liver index for identifying ultrasonographic fatty liver in a large-scale cross-sectional study in taiwan. PLoS One, 10(3), e0120443.
Yasui, K., Hashimoto, E., Komorizono, Y., Koike, K., Arii, S., Imai, Y., . . . Welfare of, J. (2011). Characteristics of patients with nonalcoholic steatohepatitis who develop hepatocellular carcinoma. Clin Gastroenterol Hepatol, 9(5), 428-433; quiz e450.
Yeh, C. J., Chang, H. Y., & Pan, W. H. (2011). Time trend of obesity, the metabolic syndrome and related dietary pattern in taiwan: From nahsit 1993-1996 to nahsit 2005-2008. Asia Pac J Clin Nutr, 20(2), 292-300.
Yeh, M. M., & Brunt, E. M. (2007). Pathology of nonalcoholic fatty liver disease. Am J Clin Pathol, 128(5), 837-847.
Yeh, Y. P., Hu, T. H., Cho, P. Y., Chen, H. H., Yen, A. M., Chen, S. L., . . . Changhua Community-Based Abdominal Ultrasonography Screening, G. (2014). Evaluation of abdominal ultrasonography mass screening for hepatocellular carcinoma in taiwan. Hepatology, 59(5), 1840-1849.
Yoneda, M., Fujii, H., Sumida, Y., Hyogo, H., Itoh, Y., Ono, M., . . . Japan Study Group of Nonalcoholic Fatty Liver, D. (2011). Platelet count for predicting fibrosis in nonalcoholic fatty liver disease. J Gastroenterol, 46(11), 1300-1306.
Youden, W. J. (1950). Index for rating diagnostic tests. Cancer, 3(1), 32-35.
Younossi, Z. M., Otgonsuren, M., Henry, L., Venkatesan, C., Mishra, A., Erario, M., & Hunt, S. (2015). Association of nonalcoholic fatty liver disease (nafld) with hepatocellular carcinoma (hcc) in the united states from 2004 to 2009. Hepatology, 62(6), 1723-1730.
Younossi, Z. M., Stepanova, M., Negro, F., Hallaji, S., Younossi, Y., Lam, B., & Srishord, M. (2012). Nonalcoholic fatty liver disease in lean individuals in the united states. Medicine (Baltimore), 91(6), 319-327.
Younossi, Z. M., Stepanova, M., Rafiq, N., Makhlouf, H., Younoszai, Z., Agrawal, R., & Goodman, Z. (2011). Pathologic criteria for nonalcoholic steatohepatitis: Interprotocol agreement and ability to predict liver-related mortality. Hepatology, 53(6), 1874-1882.
Zhou, Y. J., Li, Y. Y., Nie, Y. Q., Huang, C. M., & Cao, C. Y. (2012). Natural course of nonalcoholic fatty liver disease in southern china: A prospective cohort study. J Dig Dis, 13(3), 153-160.
Zois, C. D. (2010). Steatosis and steatohepatitis in postmortem material from northwestern greece. World J Gastroenterol, 16(31), 3944.
王, 濟. 郭., 志剛. (2004). Logistic 迴歸模型: 方法及應用: 五南圖書出版股份有限公司.

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