Keskin Murat, Arsoy Hanife Aysegul, Kara Ozlem, Sarandol Emre, Beyaz Aylin, Koca Nizameddin, Yilmaz Yusuf
Department of Gastroenterology and Hepatology, KTO Karatay University Faculty of Medicine, Konya, Türkiye.
Department of Pediatric Gastroenterology, Hepatology and Nutrition, University of Health Sciences Bursa, Yüksek İhtisas Training and Research Hospital, Bursa, Türkiye.
Turk J Gastroenterol. 2025 Feb 3;36(3):152-161. doi: 10.5152/tjg.2025.24760.
BACKGROUND/AIMS: Metabolic dysfunction-associated steatotic liver disease (MASLD) in adolescents, including non-obese phenotypes, is an increasingly important public health issue. The current study investigated the use of controlled attenuation parameter (CAP) and liver stiffness measurement (LSM) as non-invasive tools, along with fibroblast growth factor-21 (FGF-21) and cytokeratin-18 (CK-18), in non-obese MASLD, obese MASLD, and healthy control groups, exploring metabolic and hepatic profiles in these groups.
This cross-sectional study recruited 195 adolescents aged 9-18 years, stratified into controls (n = 92), non-obese MASLD (n = 32), and obese MASLD (n = 39) groups according to FibroScan and MASLD diagnostic criteria. FibroScan measured LSM and CAP, while enzyme-linked immunosorbent assay kit (ELISA) was used to analyze serum FGF-21 and CK-18 levels. Anthropometric, metabolic, and liver enzyme parameters were assessed.
Metabolic dysfunction-associated steatotic liver disease groups had higher LSM than controls. Fibroblast growth factor-21 levels were significantly higher in MASLD groups, especially in obese MASLD, while CK-18 levels showed variability without significant group differences. Obese MASLD adolescents had marked metabolic dysfunction with higher insulin, homeostasis model assessment for insulin resistance, triglycerides, and liver enzymes compared to non-obese MASLD and controls.
Fibroblast growth factor-21 has emerged as a potential biomarker for assessing metabolic dysfunction in MASLD, while LSMs from FibroScan provide valuable insights into fibrosis risk. Elevated FGF-21 levels and FibroScan parameters reflect their potential usefulness in non-invasive assessment of MASLD severity, particularly in obese adolescents. However, further longitudinal studies are needed to establish their roles in predicting disease progression and guiding clinical management.
背景/目的：青少年代谢功能障碍相关脂肪性肝病（MASLD），包括非肥胖表型，是一个日益重要的公共卫生问题。本研究调查了受控衰减参数（CAP）和肝脏硬度测量（LSM）作为非侵入性工具，以及成纤维细胞生长因子-21（FGF-21）和细胞角蛋白-18（CK-18）在非肥胖MASLD、肥胖MASLD和健康对照组中的应用，探索这些组的代谢和肝脏特征。
这项横断面研究招募了195名9至18岁的青少年，根据FibroScan和MASLD诊断标准分为对照组（n = 92）、非肥胖MASLD组（n = 32）和肥胖MASLD组（n = 39）。FibroScan测量LSM和CAP，同时使用酶联免疫吸附测定试剂盒（ELISA）分析血清FGF-21和CK-18水平。评估人体测量、代谢和肝酶参数。
代谢功能障碍相关脂肪性肝病组的LSM高于对照组。MASLD组中FGF-21水平显著更高，尤其是在肥胖MASLD组，而CK-18水平显示出变异性，组间无显著差异。与非肥胖MASLD组和对照组相比，肥胖MASLD青少年存在明显的代谢功能障碍，胰岛素、胰岛素抵抗稳态模型评估、甘油三酯和肝酶水平更高。
成纤维细胞生长因子-21已成为评估MASLD代谢功能障碍的潜在生物标志物，而FibroScan的LSM为纤维化风险提供了有价值的见解。FGF-21水平升高和FibroScan参数反映了它们在非侵入性评估MASLD严重程度方面的潜在用途，特别是在肥胖青少年中。然而，需要进一步的纵向研究来确定它们在预测疾病进展和指导临床管理中的作用。
