Pediatric Endocrinology, University of California San Diego and Rady Children's Hospital San Diego, San Diego, California.
Pediatric Pathology, University of California San Diego and Rady Children's Hospital San Diego, San Diego, California.
Pediatr Diabetes. 2019 Feb;20(1):41-47. doi: 10.1111/pedi.12798. Epub 2018 Dec 9.
Obesity and type 2 diabetes (T2D) is risk factors for non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH). In children with T2D and liver biopsies, we investigated correlations between NAFLD/NASH and transaminase activity, A1c, lipids, and histologic changes in repeat biopsies.
Liver histology of children with T2D was evaluated using the NASH CRN scoring system and NAFLD Activity Score (NAS). We included results ≤6 months from biopsy and A1c nearest biopsy.
Thirty-eight subjects (21 females, 17 males, 63.2% Hispanic, 15.8% Caucasian) had T2D diagnosed at 13.4 ± 2.7 years, 78.9% using metformin and 50% on insulin. Histological diagnosis of NAFLD occurred at mean age 14.3 ± 2.3 years, notable for NASH in 61%. Steatosis grade was higher in children with NASH than those without (mean 2.6 ± 0.7 vs 2.1 ± 0.5 (P < 0.001). Stage 3 fibrosis was noted only in subjects with NASH (26%). ALT was higher in NASH vs those without (112 ± 56 vs 85 ± 112, P = 0.016). NAS correlated with A1c (r = 0.51, P < 0.01) and triglycerides (r = 0.5, P < 0.01), and inversely with high-density lipoprotein (HDL) (r = -0.42, P = 0.04). Males had lower HDL and higher triglycerides (P < 0.04). In eight subjects with repeat biopsies, NAS was equal (37.5%) or improved (62.5%), and steatosis decreased (68.1% to 32.8%, P = 0.027).
In children with T2D and NAFLD, NASH is common. Having advanced fibrosis in 26% of NASH cases at this age is concerning. Better control of lipids, weight, and diabetes may help avoid worsening in NAS.
肥胖症和 2 型糖尿病（T2D）是导致非酒精性脂肪性肝病（NAFLD）和非酒精性脂肪性肝炎（NASH）的危险因素。在患有 T2D 并进行肝活检的儿童中，我们研究了 NAFLD/NASH 与转氨酶活性、A1c、脂质以及重复活检中的组织学变化之间的相关性。
使用 NASH CRN 评分系统和 NAFLD 活动评分（NAS）评估儿童的肝组织学。我们纳入了距活检最近的 A1c 检查和活检结果≤6 个月的结果。
38 名受试者（21 名女性，17 名男性，63.2%为西班牙裔，15.8%为白种人）的 T2D 确诊年龄为 13.4±2.7 岁，78.9%使用二甲双胍，50%使用胰岛素。NAFLD 的组织学诊断发生在平均年龄为 14.3±2.3 岁，值得注意的是，61%的儿童患有 NASH。与无 NASH 相比，患有 NASH 的儿童的脂肪变性程度更高（平均 2.6±0.7 与 2.1±0.5（P<0.001）。仅在患有 NASH 的受试者中观察到 3 期纤维化（26%）。NASH 组的 ALT 高于无 NASH 组（112±56 与 85±112，P=0.016）。NAS 与 A1c（r=0.51，P<0.01）和甘油三酯（r=0.5，P<0.01）呈正相关，与高密度脂蛋白（HDL）呈负相关（r=-0.42，P=0.04）。男性的 HDL 较低，甘油三酯较高（P<0.04）。在 8 名接受重复活检的患者中，NAS 相等（37.5%）或改善（62.5%），脂肪变性减少（68.1%至 32.8%，P=0.027）。
在患有 T2D 和 NAFLD 的儿童中，NASH 很常见。在这个年龄段，26%的 NASH 病例中存在晚期纤维化令人担忧。更好地控制血脂、体重和糖尿病可能有助于避免 NAS 恶化。
