Giorgio Valentina, Mosca Antonella, Alterio Arianna, Alisi Anna, Grieco Antonio, Nobili Valerio, Miele Luca
*Department of Pediatrics, Fondazione Policlinico Universitario Agostino Gemelli, Università Cattolica del Sacro Cuore †Hepatometabolic Disease Unit, Bambino Gesù Children Hospital, Rome, Italy.
J Pediatr Gastroenterol Nutr. 2017 Aug;65(2):150-155. doi: 10.1097/MPG.0000000000001614.
Hemoglobin (Hb) and red blood cell distribution width (RDW) have been reported to be a risk marker of metabolic syndrome and nonalcoholic fatty liver disease (NAFLD). No study exists on pediatric populations. We aimed to determine the association between hematological parameters, and the severity of disease in children with biopsy-proven NAFLD.
A total of 117 children (85 boys, mean age 12 years) with ultrasound evidence of NAFLD undergoing liver biopsy for diagnosis of nonalcoholic steatohepatitis (NASH), were prospectively enrolled between January 2011 and May 2013 in the setting of a tertiary care center. Children were screened for routine hematological and metabolic parameters, and causes of liver steatosis other than nonalcoholic were excluded, before liver biopsy was performed.
A total of 41 NAFLD (boys 29, mean age 11.2 years) and 76 NASH (boys 56, mean age 12.8 years) children were studied. Alanine transaminase levels were significantly higher in NASH group compared with NAFLD group (P = 0.05), and homeostatic model assessment of insulin resistance and triglycerides levels (P = 0.03 and 0.02, respectively). Regarding hematological components: red cell count, Hb, hematocrit, and RDW values were all significantly higher in NASH group compared with NAFLD group (P < 0.05 for each parameter).
Children with NASH were more likely to have high levels of RDW compared to those with steatosis only. Moreover, NASH was associated with higher red cell count, Hb, and hematocrit. If confirmed in future follow-up studies, hematological parameters may be introduced in algorithms for NASH risk prediction.
据报道，血红蛋白（Hb）和红细胞分布宽度（RDW）是代谢综合征和非酒精性脂肪性肝病（NAFLD）的风险标志物。目前尚无关于儿科人群的研究。我们旨在确定血液学参数与经活检证实的儿童NAFLD疾病严重程度之间的关联。
2011年1月至2013年5月期间，在一家三级医疗中心前瞻性纳入了117名有NAFLD超声证据且接受肝活检以诊断非酒精性脂肪性肝炎（NASH）的儿童（85名男孩，平均年龄12岁）。在进行肝活检之前，对儿童进行常规血液学和代谢参数筛查，并排除非酒精性以外的肝脂肪变性原因。
共研究了41名NAFLD儿童（男孩29名，平均年龄11.2岁）和76名NASH儿童（男孩56名，平均年龄12.8岁）。NASH组的丙氨酸转氨酶水平显著高于NAFLD组（P = 0.05），胰岛素抵抗稳态模型评估和甘油三酯水平（分别为P = 0.03和0.02）。关于血液学成分：NASH组的红细胞计数、Hb、血细胞比容和RDW值均显著高于NAFLD组（每个参数P < 0.05）。
与仅患有脂肪变性的儿童相比，患有NASH的儿童更有可能具有高水平的RDW。此外，NASH与较高的红细胞计数、Hb和血细胞比容相关。如果在未来的随访研究中得到证实，血液学参数可能会被引入NASH风险预测算法中。
