Kummer Sebastian, Klee Dirk, Kircheis Gerald, Friedt Michael, Schaper Joerg, Häussinger Dieter, Mayatepek Ertan, Meissner Thomas
Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Moorenstr. 5, 40225, Duesseldorf, Germany.
Department of Diagnostic and Interventional Radiology, Medical Faculty, University Hospital, Moorenstr. 5, 40225, Dusseldorf, Germany.
Eur J Pediatr. 2017 Apr;176(4):529-536. doi: 10.1007/s00431-017-2876-1. Epub 2017 Feb 17.
The liver is intensely involved in glucose metabolism and is thereby closely related to diabetes pathophysiology. Adult patients with type 1 diabetes mellitus (DM) are at an increased risk for non-alcoholic fatty liver disease (NAFLD). Here, we studied the prevalence of NAFLD in a cohort of children and adolescents with type 1 DM in a tertiary care paediatric diabetes centre in Germany. We screened 93 children and adolescents with type 1 DM using ultrasound, laboratory investigations, and liver stiffness measurements (Fibroscan® [FS] and acoustic radiation force imaging [ARFI]). Of these, 82 (88.1%) had completely normal results in all examined aspects. Only one patient (1.1%) fulfilled the criteria as potential NAFLD with ALT > twice the upper limit of normal. Ten of the 93 patients (10.8%) showed any mild abnormality in at least one examined category including ALT, conventional ultrasounds and liver stiffness measurements. However, none of these ten fulfilled the NAFLD case definition criteria. Therefore, these slightly abnormal results were judged to be unspecific or at least of unknown significance in terms of NAFLD indication.
Compared to data from the general population, our results do not indicate a significantly increased prevalence of NAFLD in this cohort, and advocate against the systematic screening for NAFLD in paediatric type 1 DM. What is Known: • Non-alcoholic fatty liver disease (NAFLD) is common in adults with type 1 DM, and paediatric patients with type 1 DM in Egypt and Saudi Arabia. What is New: • Our results do not indicate a significantly increased prevalence of NAFLD in a cohort of children and adolescents with type 1 DM from Germany compared to prevalence data from the general population. • This finding advocates against the systematic screening for NAFLD in paediatric type 1 DM in western countries.
肝脏在葡萄糖代谢中起着重要作用，因此与糖尿病的病理生理学密切相关。1型糖尿病（DM）成年患者患非酒精性脂肪性肝病（NAFLD）的风险增加。在此，我们在德国一家三级儿科糖尿病中心研究了1型糖尿病儿童和青少年队列中NAFLD的患病率。我们使用超声、实验室检查和肝脏硬度测量（Fibroscan® [FS]和声学辐射力成像[ARFI]）对93名1型糖尿病儿童和青少年进行了筛查。其中，82名（88.1%）在所有检查方面结果完全正常。只有1名患者（1.1%）符合潜在NAFLD的标准，即谷丙转氨酶（ALT）>正常上限的两倍。93名患者中有10名（10.8%）在至少一项检查类别中表现出任何轻度异常，包括ALT、传统超声和肝脏硬度测量。然而，这10名患者均未符合NAFLD病例定义标准。因此，就NAFLD指征而言，这些轻微异常结果被判定为非特异性或至少意义不明。
与一般人群的数据相比，我们的结果并未表明该队列中NAFLD的患病率显著增加，并主张反对对1型糖尿病儿童进行NAFLD的系统筛查。已知信息：• 非酒精性脂肪性肝病（NAFLD）在1型糖尿病成年患者以及埃及和沙特阿拉伯的1型糖尿病儿科患者中很常见。新发现：• 与一般人群的患病率数据相比，我们的结果并未表明来自德国的1型糖尿病儿童和青少年队列中NAFLD的患病率显著增加。• 这一发现主张反对在西方国家对1型糖尿病儿童进行NAFLD的系统筛查。
