Anicic Mirna Natalija, Dumic Katja, Kolega Mrkic Lucija, Spehar Uroic Anita, Krnic Nevena, Zidanic Martina, Coric Marijana, Vukovic Jurica
Department of Pediatrics, University Hospital Centre Zagreb, Kispaticeva 12, Zagreb, 10 000, Croatia.
School of Medicine, University of Zagreb, Zagreb, Croatia.
BMC Pediatr. 2025 Aug 4;25(1):592. doi: 10.1186/s12887-025-05914-z.
Children and adolescents with type 1 diabetes mellitus (T1DM) occasionally develop liver disorders. Glycogenic hepatopathy and non-alcoholic fatty liver disease are the most common conditions found in patients with poor glycemic control. The main purpose of the study was to determine the frequency of liver disorders in children and adolescents with T1DM and to investigate a correlation with chronic complications or associated autoimmune diseases. The second aim was to investigate if glycogenic hepatopathy and non-alcoholic fatty liver disease could be differentiated non-invasively with MRI among patients with T1DM.
In 154 patients with T1DM age 2-20 years, clinical exam, laboratory tests and abdominal ultrasound were performed. Liver MRI and biopsy were performed in selected patients.
Over the study period, 154 patients with T1DM were investigated (77 females and 77 males, ages 2-20, mean 14.2 ± 3.2 years, T1DM duration 1-18 years, mean 7.7 ± 4.1 years, BMI 20.6 ± 3.7 kg/m). Intensive therapy with insulin analogues was used in 121 (78.6%), and 33 patients (21.4%) were treated via insulin pumps. We did not observe delayed puberty. We have found hepatomegaly in 9.7% patients, elevated transaminases in 18.8%, ultrasound-enlarged liver in 21.7% and 27.3% with abnormal echogenicity. MRI and liver biopsy were performed in 9 patients. A liver biopsy revealed 8 patients with glycogenic hepatopathy and only one with non-alcoholic fatty liver disease. MRI showed a good association with pathohistological findings (P < 0.001). We did not establish a correlation between hepatic complications and chronic complications or associated autoimmune diseases.
Liver disorders in patients with T1DM are not as rare as previously thought, and glycogenic hepatopathy is the most common. A combination of liver enzymes and a liver ultrasound exam is a good initial screening and follow-up method for the evaluation of liver disorders. MRI represents a good non-invasive tool for the distinction between glycogen and fat accumulation, and might postpone liver biopsy beyond initial workup.
1型糖尿病（T1DM）儿童和青少年偶尔会出现肝脏疾病。糖原性肝病和非酒精性脂肪性肝病是血糖控制不佳患者中最常见的病症。本研究的主要目的是确定T1DM儿童和青少年肝脏疾病的发生率，并调查其与慢性并发症或相关自身免疫性疾病的相关性。第二个目的是研究在T1DM患者中，能否通过磁共振成像（MRI）对糖原性肝病和非酒精性脂肪性肝病进行无创鉴别。
对154例年龄在2至20岁的T1DM患者进行了临床检查、实验室检测和腹部超声检查。对部分患者进行了肝脏MRI检查和活检。
在研究期间，共调查了154例T1DM患者（77例女性和77例男性，年龄2至20岁，平均14.2±3.2岁，T1DM病程1至18年，平均7.7±4.1年，体重指数20.6±3.7kg/m²）。121例（78.6%）患者使用胰岛素类似物强化治疗，33例（21.4%）患者通过胰岛素泵治疗。我们未观察到青春期发育延迟。我们发现9.7%的患者肝脏肿大，18.8%的患者转氨酶升高，21.7%的患者超声显示肝脏增大，27.3%的患者回声异常。对9例患者进行了肝脏MRI检查和活检。肝脏活检显示8例患者患有糖原性肝病，仅1例患有非酒精性脂肪性肝病。MRI显示与病理组织学结果具有良好的相关性（P<0.001）。我们未发现肝脏并发症与慢性并发症或相关自身免疫性疾病之间存在相关性。
T1DM患者的肝脏疾病并不像以前认为的那样罕见，糖原性肝病最为常见。肝酶检查和肝脏超声检查相结合是评估肝脏疾病的良好初始筛查和随访方法。MRI是区分糖原和脂肪堆积的良好无创工具，可能会在初始检查之外推迟肝脏活检。
