Yodoshi Toshifumi, Orkin Sarah, Arce-Clachar Ana Catalina, Bramlage Kristin, Xanthakos Stavra A, Mouzaki Marialena, Valentino Pamela L
Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio.
Pediatr Obes. 2021 Jan;16(1):e12696. doi: 10.1111/ijpo.12696. Epub 2020 Jul 8.
Autoantibodies are frequently positive in adults with nonalcoholic fatty liver disease (NAFLD) without concurrent autoimmune hepatitis (AIH). The clinical significance of this is unknown in children.
To determine the prevalence of autoantibody positivity in pediatric NAFLD and to evaluate its association with disease severity.
Multicenter, retrospective study of patients ≤18 years of age with biopsy-confirmed NAFLD. Descriptive statistics were used and groups were compared using Wilcoxon-Mann Whitney or χ testing, and multivariable logistic regression was used for binary or ordinal outcomes.
One hundred and thirty six patients with a median age of 14 years were included. The median body mass index Z-score was 2.5 (interquartile range 2.2, 2.6). Positive antinuclear antibody (ANA), anti-smooth muscle antibody (ASMA), anti-liver-kidney microsomal antibody, or any combination of autoantibodies were observed in 22%, 14%, 0%, and 33% of patients, respectively. The proportion of patients with a steatosis score ≥2 was significantly higher in those with positive ANA (P = .045). In the multivariable regression analysis, positive ANA was associated with increased odds of steatosis score ≥2 (odds ratio, 5.91; 95% confidential interval, 1.50-23.26), after controlling for potential confounders. No other significant histology differences were seen between the groups.
Positive ANA and ASMA are common in children with NAFLD; however, anti-LKM positivity is not. ANA positivity is associated with more severe steatosis.
在无自身免疫性肝炎（AIH）并发的非酒精性脂肪性肝病（NAFLD）成人患者中，自身抗体常呈阳性。其在儿童中的临床意义尚不清楚。
确定儿童NAFLD中自身抗体阳性的患病率，并评估其与疾病严重程度的关联。
对年龄≤18岁且经活检确诊为NAFLD的患者进行多中心回顾性研究。采用描述性统计方法，使用Wilcoxon-Mann Whitney检验或χ²检验对组间进行比较，并使用多变量逻辑回归分析二元或有序结局。
纳入了136例患者，中位年龄为14岁。中位体重指数Z评分为2.5（四分位间距2.2，2.6）。分别在22%、14%、0%和33%的患者中观察到抗核抗体（ANA）、抗平滑肌抗体（ASMA）、抗肝肾微粒体抗体或任何自身抗体组合呈阳性。ANA阳性患者中脂肪变性评分≥2的患者比例显著更高（P = 0.045）。在多变量回归分析中，在控制潜在混杂因素后，ANA阳性与脂肪变性评分≥2的几率增加相关（比值比，5.91；95%置信区间，1.50 - 23.26）。两组之间未观察到其他显著的组织学差异。
ANA和ASMA阳性在NAFLD儿童中常见；然而，抗肝肾微粒体抗体阳性并不常见。ANA阳性与更严重的脂肪变性相关。
