Rudolph Bryan, Selig Tyler, Li Yingjie, Ovchinsky Nadia, Kogan-Liberman Debora, Liszewski Mark C, Levin Terry, Ewart Michelle, Liu Qiang, Viswanathan Shankar, Lin Juan, Xue Xiaonan, Burk Robert D, Strickler Howard D
Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Hospital at Montefiore, Bronx, NY.
Albert Einstein College of Medicine, Bronx, NY.
JPGN Rep. 2021 May;2(2):e077. doi: 10.1097/PG9.0000000000000077.
The relationship between vitamin D deficiency (VDD) and pediatric nonalcoholic fatty liver disease (NAFLD) remains uncertain due to conflicting results and few studies with histologic endpoints. We therefore used multiple imaging and histologic NAFLD endpoints to more comprehensively assess the association between VDD and NAFLD in a large pediatric population.
Data were obtained from an ongoing pediatric NAFLD study in Bronx, NY. Briefly, overweight and obese children aged 2-18 years with alanine aminotransferase (ALT) levels ≥ 35 U/L were serially enrolled. Liver biopsy was obtained in accordance with clinical guidelines. All participants had liver imaging, namely, controlled attenuation parameter (CAP; Echosens, France) to assess steatosis and, to assess fibrosis, vibration controlled transient elastography (VCTE; FibroScan™, Echosens, France) and acoustic radiation force impulse (ARFI; Philips, Netherlands) imaging. Levels of 25-hydroxyvitamin D were measured serologically.
N=276 (88%) of 315 participants had 25-OH vitamin D results, of whom 241 (87%) were Hispanic, 199 (72%) were male, and 92 (33%) underwent liver biopsy. VDD was univariately associated with high waist circumference (p=0.004), high-density lipoprotein level (p=0.01), season (p=0.009), and CAP score (p=0.01). In multivariate analysis, only waist circumference (p=0.0002) and biopsy inflammation grade (p=0.03) were associated with VDD, though the latter had not approximated statistical significance in univariate analysis (p=0.56). There was no association between VDD and hepatic steatosis, ballooning, NAFLD Activity Score, ARFI or VCTE elasticity scores.
VDD was not associated with NAFLD defined by imaging and histologic endpoints, except for a possible relation with histologic inflammation grade.
由于研究结果相互矛盾且很少有以组织学为终点的研究，维生素D缺乏（VDD）与儿童非酒精性脂肪性肝病（NAFLD）之间的关系仍不明确。因此，我们使用多种影像学和组织学NAFLD终点，在一大群儿童中更全面地评估VDD与NAFLD之间的关联。
数据来自纽约布朗克斯正在进行的一项儿童NAFLD研究。简而言之，连续纳入2至18岁、丙氨酸氨基转移酶（ALT）水平≥35 U/L的超重和肥胖儿童。根据临床指南进行肝活检。所有参与者均进行肝脏成像，即使用受控衰减参数（CAP；法国Echosens公司）评估脂肪变性，并使用振动控制瞬时弹性成像（VCTE；FibroScan™，法国Echosens公司）和声辐射力脉冲（ARFI；荷兰飞利浦公司）成像评估纤维化。血清学检测25-羟维生素D水平。
315名参与者中有276名（88%）获得了25-OH维生素D检测结果，其中241名（87%）为西班牙裔，199名（72%）为男性，92名（33%）接受了肝活检。VDD与高腰围（p=0.004）、高密度脂蛋白水平（p=0.01）、季节（p=0.009）和CAP评分（p=0.01）单因素相关。在多因素分析中，只有腰围（p=0.0002）和活检炎症分级（p=0.03）与VDD相关，尽管后者在单因素分析中未达到统计学意义（p=0.56）。VDD与肝脂肪变性、气球样变、NAFLD活动评分、ARFI或VCTE弹性评分之间无关联。
除了可能与组织学炎症分级有关外，VDD与由影像学和组织学终点定义的NAFLD无关。
