Kim Hyun Jin, Kim Ju Young, Lee Yoo Min, Hong Yong Hee, Kang Ben, Choe Byung-Ho, Yi Dae Yong, Lee Eun Hye, Kim Soon Chul, Choi You Jin, Jang Hyo-Jeong, Choi So Yoon
Department of Pediatrics, Chungnam National University Hospital, College of Medicine, Chungnam National University, Daejeon, Republic of Korea.
Department of Pediatrics, Daejeon Eulji Medical Center, Eulji University School of Medicine, Daejeon, Republic of Korea.
Front Pediatr. 2025 Feb 26;13:1527605. doi: 10.3389/fped.2025.1527605. eCollection 2025.
Although antinuclear antibody (ANA) is frequently observed in patients with metabolic dysfunction-associated steatotic liver disease (MASLD), its clinical significance in children remains unclear and controversial. In this study, we investigated the prevalence of ANA positivity and the factors associated with it in pediatric MASLD patients without concurrent autoimmune hepatitis.
We retrospectively reviewed the medical records of patients aged 4-18 years diagnosed with MASLD and tested for ANA from January 2015 to December 2020 at 10 hospitals in Korea. All statistical analyses were carried out using SPSS 26.0 and -values <0.05 were considered statistically significant.
Out of the 439 patients included, ANAs were present in 89 (20.3%); 51 (57.3%) patients had ANA titer <1:80; 22 (24.7%), <1:160; 10 (11.2%), <1:320; and 6 (6.7%), <1:640. Compared to ANA-negative patients, aspartate aminotransferase (AST, = 0.003) and alanine aminotransferase (ALT, = 0.007) levels were significantly higher in ANA-positive patients. The ALT to Platelet Ratio Index (APRI) score was also associated with the ANA-positive patients ( = 0.005). To predict ANA positivity using APRI, the area under receiver operating characteristic (AUROC) curve was 0.597 ( = 0.004), and the APRI cutoff value of >0.893 could predict ANA, with sensitivity and specificity of 42.7% and 72.9%, respectively.
ANA positivity in pediatric MASLD is associated with greater liver enzyme elevation and increased risk of fibrosis, highlighting the need for careful monitoring in ANA-positive patients.
尽管在代谢功能障碍相关脂肪性肝病（MASLD）患者中经常观察到抗核抗体（ANA），但其在儿童中的临床意义仍不明确且存在争议。在本研究中，我们调查了无自身免疫性肝炎并发的儿童MASLD患者中ANA阳性的患病率及其相关因素。
我们回顾性分析了2015年1月至2020年12月期间在韩国10家医院诊断为MASLD并检测ANA的4至18岁患者的病历。所有统计分析均使用SPSS 26.0进行，P值<0.05被认为具有统计学意义。
在纳入的439例患者中，89例（20.3%）存在ANA；51例（57.3%）患者的ANA滴度<1:80；22例（24.7%）<1:160；10例（11.2%）<1:320；6例（6.7%）<1:640。与ANA阴性患者相比，ANA阳性患者的天冬氨酸转氨酶（AST，P = 0.003）和丙氨酸转氨酶（ALT，P = 0.007）水平显著更高。ALT与血小板比值指数（APRI）评分也与ANA阳性患者相关（P = 0.005）。为了使用APRI预测ANA阳性，受试者工作特征（AUROC）曲线下面积为0.597（P = 0.004），APRI临界值>0.893可预测ANA，敏感性和特异性分别为42.7%和72.9%。
儿童MASLD中的ANA阳性与更高的肝酶升高和纤维化风险增加相关，突出了对ANA阳性患者进行仔细监测的必要性。
