Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Obesity (Silver Spring). 2021 Jan;29(1):171-176. doi: 10.1002/oby.22999. Epub 2020 Nov 13.
Longitudinal studies on childhood predictors of nonalcoholic fatty liver disease (NAFLD) progression are lacking. The objective of this study was to determine whether baseline clinical or laboratory measures predict liver disease outcomes in a pediatric NAFLD cohort.
A retrospective study of patients with presumed NAFLD was conducted using baseline and follow-up clinical and laboratory measures. Disease outcomes were defined using the mean serum alanine aminotransferase (ALT) levels from 24 to 36 months after the first visit. Logistic regression assessed the relationship between ALT progression/regression and predictor variables. Multivariable regression determined the best model for predicting the ALT outcome. Markov process modeling explored the likelihood for a patient to transition between ALT states.
Of a total of 816 patients identified, 144 had sufficient data. Regression was seen in 26%, whereas 30% progressed. No baseline clinical or laboratory measurements had a significant effect on disease outcomes. Markov modeling demonstrated that subjects were more likely to either remain in their baseline ALT group or worsen rather than improve.
Routinely obtained baseline clinical or laboratory measures cannot help risk-stratify youth with presumed NAFLD in terms of long-term outcomes. Close clinical, radiographic, and histologic evaluation of patients is warranted to determine those at risk of progression.
缺乏关于儿童时期非酒精性脂肪性肝病（NAFLD）进展预测因素的纵向研究。本研究旨在确定基线临床或实验室指标是否可预测儿科 NAFLD 患者的肝病结局。
对疑似 NAFLD 患者进行回顾性研究，使用基线和随访的临床及实验室指标。采用初次就诊后 24 至 36 个月的平均血清丙氨酸氨基转移酶（ALT）水平定义疾病结局。Logistic 回归分析评估 ALT 进展/缓解与预测变量之间的关系。多变量回归确定预测 ALT 结局的最佳模型。Markov 过程模型探索患者在 ALT 状态之间转变的可能性。
共确定了 816 例患者，其中 144 例有足够的数据。26%的患者出现了缓解，30%的患者出现了进展。基线临床或实验室检查均不能显著影响疾病结局。Markov 模型表明，患者更有可能保持基线 ALT 组或恶化，而不是改善。
常规获得的基线临床或实验室指标无法根据长期结局对疑似 NAFLD 的青少年进行风险分层。需要对患者进行密切的临床、影像学和组织学评估，以确定哪些患者有进展的风险。
