Division of Gastroenterology, Duke University, Durham, NC 27710, USA.
Clin Gastroenterol Hepatol. 2012 Jul;10(7):786-94. doi: 10.1016/j.cgh.2012.01.020. Epub 2012 Feb 14.
BACKGROUND & AIMS: Physiological changes that occur during puberty might affect pathologic features of nonalcoholic fatty liver disease (NAFLD). We investigated associations between pubertal development and clinical and histopathologic features of NAFLD.
We studied 186 children (age <18 years, 143 boys) with biopsy-proven NAFLD. The population was divided into 3 groups on the basis of Tanner stage (prepuberty, puberty, and postpuberty). Clinical characteristics and histologic features were compared among groups. Multivariable regression models were used to adjust for potential confounders.
After adjusting for other factors, hyperuricemia and low levels of high-density-lipoprotein cholesterol were more prevalent among children who entered puberty with lower levels of quantitative insulin sensitivity check index (P < .05). The degree of steatosis, numbers of Mallory-Denk bodies, and diagnostic categories of NAFLD differed among groups (P < .05). There were potential sex differences in associations between stages of puberty and lobular inflammation, hepatocyte ballooning, and borderline steatohepatitis of zone 3; these were therefore not included in multivariable analyses of the overall population. After adjustment for different sets of confounders, patients at or beyond puberty were less likely to have high-grade steatosis, severe portal inflammation, borderline steatohepatitis (zone 1), or a high stage of fibrosis than patients who had not entered puberty (P < .05). On the contrary, the prevalence of Mallory-Denk body was greater among postpuberty subjects (P = .06).
Steatosis, portal inflammation, and fibrosis are less severe during or after puberty than before puberty among subjects with NAFLD. Postpubescent individuals have a lower prevalence of borderline steatohepatitis of zone 1 but are more likely to have Mallory-Denk bodies. These findings indicate that puberty affects the pathologic features of NAFLD.
青春期发生的生理变化可能会影响非酒精性脂肪性肝病（NAFLD）的病理特征。我们研究了青春期发育与 NAFLD 的临床和组织病理学特征之间的关系。
我们研究了 186 名经活检证实为 NAFLD 的儿童（年龄<18 岁，143 名男性）。根据 Tanner 分期（青春期前、青春期和青春期后）将人群分为 3 组。比较各组间的临床特征和组织学特征。使用多变量回归模型调整潜在混杂因素。
在调整其他因素后，进入青春期时定量胰岛素敏感性检查指数（QUICKI）水平较低的儿童中，高尿酸血症和高密度脂蛋白胆固醇水平较低更为常见（P<0.05）。各组间的脂肪变性程度、Mallory-Denk 小体数量和 NAFLD 的诊断分类不同（P<0.05）。在青春期各阶段与小叶炎症、肝细胞气球样变和 3 区交界性脂肪性肝炎之间的关联存在潜在的性别差异；因此，这些差异未纳入全人群的多变量分析。在调整不同组别的混杂因素后，与未进入青春期的患者相比，处于或超过青春期的患者发生高级别脂肪变性、严重门脉炎症、交界性脂肪性肝炎（1 区）或高纤维化分期的可能性较小（P<0.05）。相反，青春期后患者 Mallory-Denk 小体的发生率更高（P=0.06）。
与青春期前相比，NAFLD 患者在青春期或青春期后，脂肪变性、门脉炎症和纤维化程度较轻。青春期后个体的 1 区交界性脂肪性肝炎的患病率较低，但更有可能发生 Mallory-Denk 小体。这些发现表明青春期会影响 NAFLD 的病理特征。
