Pediatrics Department, Cairo University, Cairo, Egypt.
Pediatr Diabetes. 2010 Nov;11(7):462-70. doi: 10.1111/j.1399-5448.2009.00627.x.
Children with type 1 diabetes mellitus (T1DM) are frequently investigated for hepatic abnormalities. This study was carried out to report on the prevalence of hepatic abnormalities in diabetic children and adolescents and to highlight the possible etiology and appropriate management.
The study included 692 children (333 were males) with T1DM attending the Diabetes Unit at Cairo University Pediatric Hospital. Their mean age was 9.65 ± 4.18 yr. All children were subjected to clinical examination for hepatomegaly, determination of alanine aminotransferase (ALT) and antibodies to hepatitis C virus (anti-HCV), and abdominal ultrasonography. All children with clinical, laboratory or ultrasound abnormality were counseled about proper glycemic control and followed up. If abnormalities persisted, more detailed investigations were carried out. HCV RNA was done for anti-HCV positive children.
Sixty (8.7%) were found to have one or more abnormalities: clinical hepatomegaly in 13 (1.9%), elevated ALT in 27 (3.9%), anti-HCV in 25 (3.6%) and abnormal hepatic ultrasound in 31 (4.5%). Forty percent of anti-HCV positive children were HCV-RNA positive. Glycogenic hepatopathy was diagnosed in three cases by liver biopsy. Abnormalities were reversible in 37/60 after proper glycemic control.
Although diabetic children are at risk of acquisition of HCV, poor glycemic control is the key factor that predisposes to hepatomegaly, elevated ALT and abnormal ultrasound findings. A 4 to 8-wk therapeutic trial of proper glycemic control is recommended prior to more invasive diagnostic procedures.
儿童 1 型糖尿病（T1DM）常伴有肝脏异常。本研究旨在报告糖尿病儿童和青少年肝脏异常的发生率，并强调其可能的病因和适当的治疗方法。
该研究纳入了 692 名（333 名为男性）在开罗大学儿科医院糖尿病科就诊的 T1DM 患儿。他们的平均年龄为 9.65 ± 4.18 岁。所有患儿均接受了临床检查（肝肿大）、丙氨酸氨基转移酶（ALT）和丙型肝炎病毒抗体（抗-HCV）测定以及腹部超声检查。对所有有临床、实验室或超声异常的患儿进行了适当的血糖控制和随访。如果异常持续存在，则进行更详细的检查。对抗-HCV 阳性患儿进行了 HCV RNA 检测。
60 例（8.7%）患儿存在 1 种或多种异常：临床肝肿大 13 例（1.9%）、ALT 升高 27 例（3.9%）、抗-HCV 阳性 25 例（3.6%）和肝脏超声异常 31 例（4.5%）。40%抗-HCV 阳性患儿 HCV RNA 阳性。3 例经肝活检诊断为糖原贮积病。经适当的血糖控制后，60 例中的 37 例异常得到逆转。
尽管糖尿病患儿易感染 HCV，但血糖控制不佳是导致肝肿大、ALT 升高和超声异常的关键因素。建议在进行更具侵袭性的诊断程序之前，先进行 4 至 8 周的适当血糖控制治疗试验。
