Ezaizi Yamen, Kabbany Mohammad Nasser, Conjeevaram Selvakumar Praveen Kumar, Sarmini Muhammed Talal, Singh Amandeep, Lopez Rocio, Nobili Valerio, Alkhouri Naim
Department of Pediatric Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA.
Department of Pediatrics, Akron Children's Hospital, Akron, OH, USA.
JHEP Rep. 2019 Jul 9;1(4):259-264. doi: 10.1016/j.jhepr.2019.06.005. eCollection 2019 Oct.
BACKGROUND & AIM: There is currently no agreement on the screening strategy for non-alcoholic fatty liver disease (NAFLD) in children at risk. The North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) recommends screening for NAFLD using alanine aminotransferase (ALT) in obese/overweight children, while the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) recommends using both ALT and abdominal ultrasound. The aim of this study was to assess the prevalence of suspected NAFLD in obese children based on the 2 screening strategies.
Consecutive overweight/obese children seen at a weight-management program were included. Each child underwent a liver ultrasound and had ALT level measured at first visit. Two screening strategies were compared: the NASPGHAN strategy using ALT ≫2x the gender specific cut-off and the ESPGHAN strategy using elevated ALT ≫45 IU/L and/or fatty liver on ultrasound. Univariate and multivariate analyses were performed to assess predictors of low ALT in individuals with evidence of suspected NAFLD on ultrasound.
Overweight/obese children were included. NAFLD was suspected as follows: 26% based on the NASPGHAN strategy, and 58% based on the ESPGHAN strategy. Fatty liver was present on ultrasound in 53% of our cohort. ALT was ≫2x the gender specific cut-off in only 26% of children with fatty liver on ultrasound. Univariate and multivariate analyses indicated that children with fatty infiltration on ultrasound and low ALT were less likely to have metabolic syndrome, insulin resistance, or hypertriglyceridemia.
By relying on ALT values alone to screen for NAFLD, suspected NAFLD might be missed in many children who are at risk. Children with fatty infiltration on ultrasound and low ALT may be less likely to have metabolic syndrome, insulin resistance or hypertriglyceridemia.
Using the combination of elevated alanine aminotransferase and fatty infiltration on ultrasound increases the detection rate of suspected non-alcoholic fatty liver disease in at-risk children. Notably, a significant percentage of children with fatty infiltration on ultrasound have low alanine aminotransferase (≪52/44). Children with fatty infiltration on ultrasound and low alanine aminotransferase may be less likely to have features of the metabolic syndrome.
目前对于有风险的儿童非酒精性脂肪性肝病（NAFLD）的筛查策略尚无共识。北美小儿胃肠病、肝病和营养学会（NASPGHAN）建议对肥胖/超重儿童使用丙氨酸氨基转移酶（ALT）筛查NAFLD，而欧洲小儿胃肠病、肝病和营养学会（ESPGHAN）建议同时使用ALT和腹部超声。本研究的目的是基于这两种筛查策略评估肥胖儿童疑似NAFLD的患病率。
纳入在体重管理项目中连续就诊的超重/肥胖儿童。每个儿童在首次就诊时接受肝脏超声检查并测量ALT水平。比较了两种筛查策略：NASPGHAN策略使用ALT＞性别特异性临界值的2倍，ESPGHAN策略使用ALT升高＞45 IU/L和/或超声显示脂肪肝。进行单因素和多因素分析以评估超声有疑似NAFLD证据的个体中ALT降低的预测因素。
纳入了超重/肥胖儿童。疑似NAFLD的情况如下：基于NASPGHAN策略为26%，基于ESPGHAN策略为58%。超声检查显示53%的队列存在脂肪肝。在超声显示有脂肪肝的儿童中，仅26%的儿童ALT＞性别特异性临界值的2倍。单因素和多因素分析表明，超声有脂肪浸润且ALT降低的儿童患代谢综合征、胰岛素抵抗或高甘油三酯血症的可能性较小。
仅依靠ALT值筛查NAFLD可能会遗漏许多有风险的儿童中的疑似NAFLD。超声有脂肪浸润且ALT降低的儿童患代谢综合征、胰岛素抵抗或高甘油三酯血症的可能性可能较小。
联合使用丙氨酸氨基转移酶升高和超声脂肪浸润可提高有风险儿童疑似非酒精性脂肪性肝病的检出率。值得注意的是，超声有脂肪浸润的儿童中有相当比例的丙氨酸氨基转移酶降低（＜52/44）。超声有脂肪浸润且丙氨酸氨基转移酶降低的儿童患代谢综合征特征的可能性可能较小。
