Department of Paediatric Endocrinology and Diabetes, Bristol Royal Hospital for Children, Bristol, UK.
Arch Dis Child. 2011 Nov;96(11):1003-7. doi: 10.1136/adc.2010.190975. Epub 2010 Nov 19.
To examine transaminitis in obese children, its association with glucose metabolism and the metabolic syndrome and the response to weight loss through lifestyle modification.
216 children (90 male), aged 2.9-17.6 (median 12.4 years) with median body mass index (BMI) SD score (SDS) of 3.36 (range 1.92-6.22) attending a hospital obesity clinic in Bristol (UK) underwent an oral glucose tolerance test (OGTT) with fasting lipid and liver profile. Auxological measures included weight, height, waist circumference, percentage body fat. Parental history of type 2 diabetes (T2DM) was recorded. The 2007 International Diabetes Federation definition of metabolic syndrome was used. 90 children undergoing a trial of lifestyle modification to improve weight were re-assessed at 12 months.
34/216 (16%) children had raised alanine aminotransferase (ALT) (>40 IU/l) with greater prevalence in boys (23% vs 10%, p=0.01) and in those with a parental history of T2DM (30% vs 13.2% p=0.019). Patients with transaminitis were more likely to fulfil the criteria for metabolic syndrome (p<0.001) and have subtle abnormalities in glucose metabolism during an OGTT with elevated glucose levels at 90 (p=0.041) and 120 (p=0.014) min and a greater glucose area-under-the-curve (p=0.014). Improvement in BMI SDS over 1 year correlated with improvement in ALT levels (τ = -0.29, p<0.001).
Prevalence of transaminitis is significant in obese children and is associated with components of the metabolic syndrome. Lifestyle-based improvement in BMI SDS offers an effective tool for correcting transaminitis and should remain the central component of therapy.
研究肥胖儿童的肝转氨酶升高情况，及其与葡萄糖代谢和代谢综合征的关系，以及通过生活方式改变减轻体重对其的影响。
216 名儿童（90 名男性），年龄 2.9-17.6 岁（中位数 12.4 岁），体重指数（BMI）中位数标准差评分（SDS）为 3.36（范围 1.92-6.22），在英国布里斯托尔的一家医院肥胖诊所接受口服葡萄糖耐量试验（OGTT），并检测空腹血脂和肝功能。人体测量学指标包括体重、身高、腰围、体脂百分比。记录父母 2 型糖尿病（T2DM）的病史。采用 2007 年国际糖尿病联合会代谢综合征的定义。90 名接受生活方式改善体重试验的儿童在 12 个月时进行重新评估。
216 名儿童中有 34 名（16%）丙氨酸氨基转移酶（ALT）升高（>40IU/l），男孩中更为常见（23%比 10%，p=0.01），有 T2DM 家族史的儿童中更为常见（30%比 13.2%，p=0.019）。肝转氨酶升高的患者更有可能符合代谢综合征的标准（p<0.001），并且在 OGTT 中有葡萄糖代谢的细微异常，90 分钟（p=0.041）和 120 分钟（p=0.014）时血糖升高，血糖曲线下面积增加（p=0.014）。1 年内 BMI SDS 的改善与 ALT 水平的改善相关（τ=-0.29，p<0.001）。
肥胖儿童中肝转氨酶升高的发生率较高，与代谢综合征的各个组成部分有关。基于生活方式的 BMI SDS 改善为纠正肝转氨酶升高提供了有效的手段，应仍然是治疗的核心部分。
