Departments of Pediatric Radiology, Erciyes University Faculty of Medicine, Kayseri, Turkey.
Departments of Pediatric Endocrinology, Erciyes University Faculty of Medicine, Kayseri, Turkey.
Turk J Pediatr. 2022;64(4):671-682. doi: 10.24953/turkjped.2021.1876.
Metabolic syndrome (MetS) and insulin resistance (IR) are known predictors of nonalcoholic fatty liver disease (NAFLD) which is one of the significant comorbidities of obesity. Obese children with MetS and IR are reported to be more likely to have advanced liver fibrosis compared to those without MetS or IR. The aim of this study is to determine the effects of excess weight, MetS and IR on liver fibrosis assessing liver stiffness in children using ultrasound elastography and compare gray scale ultrasonographic findings of hepatic steatosis (HS) with liver fibrosis.
The study group involved 131 overweight/obese children. The control group involved 50 healthy lean children. Groups were adjusted according to body mass index (BMI) and BMI-standard deviation scores (SDS). Liver stiffness measurements which are expressed by shear wave velocity (SWV) were performed for each individual. The study group was further subgrouped as children with MetS and without MetS, with IR and without IR.
The mean SWV of liver was 1,07 ± 0,12 m/s in the control group and 1,15 ± 0,51 m/s in the study group. The difference was significant (p=0,047). SWV of liver was weakly correlated with age, BMI, BMI-SDS, Homeostatic Model Assessment-Insulin Resistance and high-density lipoprotein cholesterol. The mean SWV of the liver in the study group for children without MetS was 1,1 ± 0,44 m/s, with MetS was 1,23 ± 0,70 m/s. The difference was not significant (p=0,719). The mean SWV of the liver in the study group for children without IR was 1,02 ± 0,29 m/s, with IR was 1,24 ± 0,61 m/s. The difference was not significant (p=0,101). In multivariate regression analysis, the only independent factor affecting liver stiffness was BMI-SDS (OR:2,584, 95% CI: 1,255- 5,318, p=0,010).
Obesity itself, regardless of MetS or IR seems to be the major problem affecting liver stiffness in this study. However, large scale longitudinal studies might clarify this issue.
代谢综合征（MetS）和胰岛素抵抗（IR）是已知的非酒精性脂肪性肝病（NAFLD）的预测因子，而 NAFLD 是肥胖的重要合并症之一。与没有 MetS 或 IR 的肥胖儿童相比，患有 MetS 和 IR 的肥胖儿童更有可能出现晚期肝纤维化。本研究旨在通过超声弹性成像评估肝脏硬度来确定超重、MetS 和 IR 对儿童肝纤维化的影响，并比较肝脂肪变性（HS）的灰阶超声表现与肝纤维化的关系。
研究组纳入了 131 名超重/肥胖儿童。对照组纳入了 50 名健康的瘦儿童。根据体重指数（BMI）和 BMI 标准差评分（SDS）对两组进行调整。对每位个体进行剪切波速度（SWV）的肝脏硬度测量。研究组进一步分为患有 MetS 和不患有 MetS、患有 IR 和不患有 IR 的儿童亚组。
对照组的平均 SWV 为 1.07 ± 0.12 m/s，研究组为 1.15 ± 0.51 m/s。差异具有统计学意义（p=0.047）。SWV 与年龄、BMI、BMI-SDS、稳态模型评估-胰岛素抵抗和高密度脂蛋白胆固醇呈弱相关。无 MetS 的研究组儿童的平均 SWV 为 1.1 ± 0.44 m/s，有 MetS 的为 1.23 ± 0.70 m/s。差异无统计学意义（p=0.719）。无 IR 的研究组儿童的平均 SWV 为 1.02 ± 0.29 m/s，有 IR 的为 1.24 ± 0.61 m/s。差异无统计学意义（p=0.101）。在多元回归分析中，唯一影响肝硬度的独立因素是 BMI-SDS（OR：2.584，95%CI：1.255-5.318，p=0.010）。
在本研究中，肥胖本身，无论是否伴有 MetS 或 IR，似乎是影响肝硬度的主要问题。然而，大规模的纵向研究可能会澄清这个问题。
