Lee Eun Hye, Kim Ji Young, Yang Hye Ran
Department of Pediatrics, Nowon Eulji Medical Center, Eulji University, Daejeon, South Korea.
Department of Radiology, Seoul National University Bundang Hospital, Seongnam, South Korea.
Front Pediatr. 2021 Jun 10;9:685795. doi: 10.3389/fped.2021.685795. eCollection 2021.
To investigate the association between ectopic fat content in the liver and pancreas, obesity-related metabolic components, and histological findings of non-alcoholic fatty liver disease (NAFLD) in children. This cross-sectional study investigated 63 children with biopsy-proven NAFLD who underwent magnetic resonance imaging (MRI), anthropometry, laboratory tests, and body composition analysis. Clinical and metabolic parameters, MRI-measured hepatic fat fraction (HFF) and pancreatic fat fraction (PFF), and histological findings were analyzed. In a total of 63 children (48 boys, median age 12.6 years, median body mass index -score 2.54), HFF was associated with histological steatosis [10.4, 23.7, and 31.1% in each steatosis grade, < 0.001; Spearman's rho coefficient (rs) = 0.676; < 0.001] and NAFLD activity score (rs = 0.470, < 0.001), but not with lobular inflammation, hepatocyte ballooning, and hepatic fibrosis. PFF was not associated with any histological features of the liver. Waist circumference-to-height ratio and body fat percentage were associated with the steatosis grade ( = 0.006 and = 0.004, respectively). Alanine aminotransferase was not associated with steatosis but was associated with lobular inflammation ( = 0.008). Lobular inflammation was also associated with high total cholesterol and low-density lipoprotein cholesterol and metabolic syndrome ( = 0.015, = 0.036, and = 0.038, respectively). Hepatic steatosis on MRI was only associated with the histological steatosis grade, while elevated serum levels of liver enzymes and lipids were related to the severity of lobular inflammation. Therefore, MRI should be interpreted in conjunction with the anthropometric and laboratory findings in pediatric patients.
探讨儿童肝脏和胰腺异位脂肪含量、肥胖相关代谢成分与非酒精性脂肪性肝病（NAFLD）组织学表现之间的关联。这项横断面研究调查了63例经活检证实为NAFLD的儿童，这些儿童接受了磁共振成像（MRI）、人体测量、实验室检查和身体成分分析。分析了临床和代谢参数、MRI测量的肝脏脂肪分数（HFF）和胰腺脂肪分数（PFF）以及组织学表现。在总共63例儿童（48名男孩，中位年龄12.6岁，中位体重指数评分2.54）中，HFF与组织学脂肪变性相关[各脂肪变性等级分别为10.4%、23.7%和31.1%，<0.001；Spearman等级相关系数（rs）=0.676；<0.001]以及NAFLD活动评分（rs = 0.470，<0.001），但与小叶炎症、肝细胞气球样变和肝纤维化无关。PFF与肝脏的任何组织学特征均无关联。腰围身高比和体脂百分比与脂肪变性等级相关（分别为=0.006和=0.004）。丙氨酸氨基转移酶与脂肪变性无关，但与小叶炎症相关（=0.008）。小叶炎症还与高总胆固醇、低密度脂蛋白胆固醇和代谢综合征相关（分别为=0.015、=0.036和=0.038）。MRI上的肝脏脂肪变性仅与组织学脂肪变性等级相关，而血清肝酶和脂质水平升高与小叶炎症的严重程度相关。因此，对于儿科患者，应结合人体测量和实验室检查结果来解读MRI。
