Yang Aram, Jung Nayoung, Kim Sinae, Lee Ji-Eun
Department of Pediatrics, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
Department of Pediatrics, Inha University Hospital, Inha University College of Medicine, Incheon, South Korea.
Front Pediatr. 2022 Feb 10;10:825141. doi: 10.3389/fped.2022.825141. eCollection 2022.
The prevalence of non-alcoholic fatty liver disease (NAFLD) in children has been increasing associated with insulin resistance. However, there is a scarcity of related studies in children with NAFLD with type 2 diabetes mellitus (T2DM) compared to adults. We conducted this study to investigate the association between non-invasive diagnostic methods of liver fibrosis and T2DM in pediatric patients with NAFLD.
We enrolled a total of 152 patients aged <18 years with NAFLD, and compared their data according to the presence of T2DM. We evaluated fibrosis by transient elastography (TE, FibroScan®), and calculated the following fibrosis scores for each patient: NAFLD fibrosis score (NFS), AST: platelet ratio index (APRI), Fibrosis-4 (FIB-4) index, and pediatric NAFLD fibrosis index (PNFI).
In the NAFLD-T2DM group, the NFS and mean controlled attenuation parameter in FibroScan were significantly higher than those in the nondiabetic group. The receiver operating characteristic (ROC) curve values for predicting the presence of T2DM were 0.78 for NFS, 0.64 for FIB-4, 0.62 for PNFI, and 0.61 for APRI. The cutoff HbA1c levels for predicting fibrosis progression in APRI, NFS, and PNFI were 5.7% [area under the curve (AUC) 0.74], 6.4% (AUC 0.71), and 6.4% (AUC 0.55), respectively. In the multivariate analysis, hepatosteatosis on abdomen sonography, NFS, FibroScan F, and APRI were independently associated with T2DM risk.
We significantly characterized non-invasive fibrosis markers and elastography in pediatric NAFLD with T2DM compared with the nondiabetic group. We suggest evaluating the progression of fibrosis in the prediabetic stage in children using a combination of these non-invasive methods.
儿童非酒精性脂肪性肝病（NAFLD）的患病率与胰岛素抵抗相关且呈上升趋势。然而，与成人相比，NAFLD合并2型糖尿病（T2DM）儿童的相关研究较少。我们开展本研究以调查NAFLD儿科患者肝纤维化的非侵入性诊断方法与T2DM之间的关联。
我们共纳入152例年龄＜18岁的NAFLD患者，并根据是否存在T2DM对其数据进行比较。我们通过瞬时弹性成像（TE，FibroScan®）评估纤维化，并为每位患者计算以下纤维化评分：NAFLD纤维化评分（NFS）、AST：血小板比率指数（APRI）、纤维化-4（FIB-4）指数和儿科NAFLD纤维化指数（PNFI）。
在NAFLD-T2DM组中，FibroScan中的NFS和平均受控衰减参数显著高于非糖尿病组。预测T2DM存在的受试者操作特征（ROC）曲线值，NFS为0.78，FIB-4为0.64，PNFI为0.62，APRI为0.61。预测APRI、NFS和PNFI中纤维化进展的糖化血红蛋白（HbA1c）临界水平分别为5.7%[曲线下面积（AUC）0.74]、6.4%（AUC 0.71）和6.4%（AUC 0.55）。在多变量分析中，腹部超声检查发现的肝脂肪变性、NFS、FibroScan F和APRI与T2DM风险独立相关。
与非糖尿病组相比，我们显著明确了合并T2DM的儿科NAFLD患者的非侵入性纤维化标志物和弹性成像特征。我们建议使用这些非侵入性方法的组合来评估儿童糖尿病前期阶段的纤维化进展。
