Department of Pediatrics, Hanyang University College of Medicine, Seoul, Korea.
Department of Pathology, Konyang University College of Medicine, Daejeon, Korea.
J Korean Med Sci. 2018 Jan 29;33(5):e34. doi: 10.3346/jkms.2018.33.e34.
Histologically, nonalcoholic steatohepatitis (NASH) is categorized into adult-type (type 1) and pediatric-type (type 2). The origination of the histological difference between the two types and how they differ clinically remain uncertain. We aimed to understand the incidence and clinical characteristics of the two types of NASH in Korean children, and to investigate the association between their pathological type and clinical characteristics, using anthropometric and laboratory data.
In 38 children with confirmed NASH, we investigated hepatic pathological findings, and correlating factors between pathological type and laboratory and anthropometric data (weight percentile, body mass index (BMI) z-score, and blood pressure percentile). Adult-type NASH was noted in 21 patients and pediatric-type in 17 patients.
Age, sex, BMI, transaminase levels, and insulin resistance were not significantly different between the two groups. Triglyceride (TG) levels were higher in adult-type NASH (P = 0.033). Hematocrit and albumin levels were lower in adult-type NASH (P = 0.016 and 0.013, respectively). Hepatic fibrosis was more common in pediatric-type. The fibrosis scores in patients with adult-type were mostly 0 and 1, whereas the score was 3 in patients with pediatric-type (P = 0.024, 0.004, and < 0.010, respectively). Anthropometric data, liver function, and insulin resistance scores did not differ between the two pathological NASH types. TG, hematocrit, and albumin may be potential factors to predict pathological types. Fibrosis was observed more frequently in pediatric-type NASH.
Monitoring children with pediatric-type NASH for progression to fibrosis or cirrhosis is recommended.
非酒精性脂肪性肝炎（NASH）从组织学上可分为成人型（1 型）和儿童型（2 型）。这两种类型的组织学差异的起源以及它们在临床上的差异尚不确定。我们旨在了解韩国儿童中两种 NASH 的发生率和临床特征，并使用人体测量学和实验室数据研究其病理类型与临床特征之间的关系。
在 38 例确诊为 NASH 的儿童中，我们调查了肝脏的病理发现，并将病理类型与实验室和人体测量学数据（体重百分位数、体重指数（BMI）z 评分和血压百分位数）之间的相关因素进行了关联分析。成人型 NASH 患者 21 例，儿童型 NASH 患者 17 例。
两组间年龄、性别、BMI、转氨酶水平和胰岛素抵抗无显著差异。成人型 NASH 的甘油三酯（TG）水平较高（P = 0.033）。成人型 NASH 的红细胞压积和白蛋白水平较低（P = 0.016 和 0.013）。儿童型 NASH 更常见肝纤维化。成人型患者的纤维化评分多为 0 和 1，而儿童型患者的评分则为 3（P = 0.024、0.004 和 <0.010）。成人型和儿童型 NASH 患者的人体测量学数据、肝功能和胰岛素抵抗评分无差异。TG、红细胞压积和白蛋白可能是预测病理类型的潜在因素。儿童型 NASH 更易发生纤维化。
建议对儿童型 NASH 患者进行纤维化或肝硬化进展的监测。
