Daniluk Urszula, Kwiatek-Sredzinska Kamila, Jakimiec Piotr, Daniluk Jaroslaw, Czajkowska Aleksandra, Lebensztejn Dariusz Marek
Department of Pediatrics, Gastroenterology, Hepatology, Nutrition and Allergology, Medical University of Bialystok, 15-274 Bialystok, Poland.
Department of Gastroenterology and Internal Medicine, Medical University of Bialystok, 15-276 Bialystok, Poland.
J Clin Med. 2021 Nov 17;10(22):5359. doi: 10.3390/jcm10225359.
Inflammatory bowel disease (IBD) in children is frequently associated with liver pathology manifested as transient elevation of liver enzymes or specified liver diseases. The aim of the study was to evaluate the prevalence and the type of liver pathology in children with IBD within 2 years' follow-up after the IBD diagnosis.
We retrospectively reviewed records of children with IBD. Liver pathology was defined as elevated activity of liver enzymes (alanine transaminase (ALT) and/or gamma-glutamyl transpeptidase (GGT)) and bilirubin concentration in serum and/or as pathological changes of the organ on imaging tests (abdominal ultrasound and/or magnetic resonance cholangiopancreatography) or on liver histology performed when indicated.
Liver pathology was detected in 21 from 119 children (18%), including 7 (17%) with Crohn's disease (CD) and 14 (18%) with ulcerative colitis (UC). Specified diagnosis for liver abnormality was found in 14 of 21 children (67%), including primary sclerosing cholangitis (PSC, 19%), non-alcoholic fatty liver disease (NAFLD, 19%), autoimmune sclerosing cholangitis (ASC, 5%), autoimmune hepatitis (AIH, 5%), cholelithiasis (5%), drug-induced liver disease (9%) and viral infection (herpes simplex virus, 5%). Most patients manifested mild IBD or were in clinical remission at the time of liver pathology diagnosis. 14% of patients with liver disease (including only cases with PSC) were diagnosed before IBD, 33% at the same time, and 52% in the later period. Patients with the specified diagnosis of liver pathology were younger, had higher ALT activity and more often demonstrated liver abnormalities on imaging tests. UC patients with idiopathic elevation of liver enzymes had higher pediatric ulcerative colitis activity index scores compared to children with specified liver disease.
Liver pathology was observed in a significant percentage of children with IBD in our study. The majority of cases of hepatobiliary abnormalities were detected after diagnosis of IBD; therefore, children with IBD should undergo routine monitoring of liver enzymes.
儿童炎症性肠病（IBD）常伴有肝脏病变，表现为肝酶短暂升高或特定肝脏疾病。本研究旨在评估IBD诊断后2年内儿童肝脏病变的患病率及类型。
我们回顾性分析了IBD患儿的病历。肝脏病变定义为血清中肝酶（丙氨酸转氨酶（ALT）和/或γ-谷氨酰转肽酶（GGT））活性及胆红素浓度升高，和/或影像学检查（腹部超声和/或磁共振胰胆管造影）显示肝脏器官病变，或在必要时进行肝脏组织学检查发现病变。
119例患儿中有21例（18%）检测到肝脏病变，其中克罗恩病（CD）患儿7例（17%），溃疡性结肠炎（UC）患儿14例（18%）。21例患儿中有14例（67%）确诊肝脏异常，包括原发性硬化性胆管炎（PSC，19%）、非酒精性脂肪性肝病（NAFLD，19%）、自身免疫性硬化性胆管炎（ASC，5%）、自身免疫性肝炎（AIH，5%）、胆结石（5%）、药物性肝病（9%）和病毒感染（单纯疱疹病毒，5%）。大多数患者在肝脏病变诊断时表现为轻度IBD或处于临床缓解期。14%的肝病患者（仅包括PSC病例）在IBD诊断前确诊，33%同时确诊，52%在后期确诊。确诊肝脏病变的患者年龄更小，ALT活性更高，且在影像学检查中更常显示肝脏异常。与确诊特定肝脏疾病的儿童相比，肝酶特发性升高的UC患者的儿童溃疡性结肠炎活动指数评分更高。
在我们的研究中，相当比例的IBD患儿存在肝脏病变。大多数肝胆异常病例在IBD诊断后被发现；因此，IBD患儿应接受肝酶的常规监测。
