Clinical correlates of histopathology in pediatric nonalcoholic steatohepatitis.
Clinical correlates of histopathology in pediatric nonalcoholic steatohepatitis.
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DOI：
10.1053/j.gastro.2008.08.050
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发表时间：
2008-12
期刊：
影响因子：
29.4
通讯作者：
Nonalcoholic Steatohepatitis Clinical Research Network
中科院分区：
文献类型：
--
作者：
Patton HM;Lavine JE;Van Natta ML;Schwimmer JB;Kleiner D;Molleston J;Nonalcoholic Steatohepatitis Clinical Research Network
非酒精性脂肪性肝病（NAFLD）是美国儿童中最常见的肝病。非侵入性方法区分NAFLD和非酒精性脂肪性肝炎（NASH）可能会减少对肝活检的要求或预测进展风险增加的患者。对从NASH临床研究网络（NASH CRN）招募的儿童（6-17岁）中前瞻性获得的数据进行分析，以确定儿科NAFLD的临床病理学相关性。所有参与者在临床数据的6个月内接受了肝脏活检，并由中央病理学委员会进行审查。176名儿童（平均年龄12.4岁，77%为男性）有资格入选。使用有序逻辑回归分析，AST（OR 1.017/U/L，95% CI 1.004-1.031）和GGT（OR 1.016/U/L，95% CI 1.000-1.033）升高与NASH严重程度升高独立相关。AST升高（OR 1.015/U/L，95% CI 1.006-1.024）、白色细胞计数升高（OR 1.22/1000/mm 3，95% CI 1.07-1.38）和红细胞压积降低（OR 0.87/ %，95% CI 0.79-0.96）与纤维化严重程度升高独立相关。AST和ALT模型的ROC下面积分别为0.75（95% CI=0.66-0.84）和0.74（95% CI 0.63-0.85），用于区分脂肪变性与更晚期形式的NASH和桥接纤维化与较低程度的纤维化。常规实验室检查的某些组成部分可以预测NAFLD模式和纤维化严重程度，但在评估儿科NAFLD时没有足够的鉴别力来取代肝活检。
Nonalcoholic fatty liver disease (NAFLD) is the most prevalent liver disease in American children. Noninvasive means to discriminate between NAFLD and nonalcoholic steatohepatitis (NASH) might diminish requirement for liver biopsy or predict those at increased risk for progression. Data obtained prospectively from children (aged 6–17 yrs) enrolled in the NASH Clinical Research Network (NASH CRN) were analyzed to identify clinical-pathological correlates of pediatric NAFLD. All participants underwent liver biopsy within 6 months of clinical data that was reviewed by a central pathology committee. 176 children (mean age 12.4 years, 77% male) were eligible for inclusion. Using ordinal logistic regression analysis, increasing AST (OR 1.017 per U/L, 95% CI 1.004–1.031) and GGT (OR 1.016 per U/L, 95% CI 1.000–1.033) were independently associated with increasing severity of NASH. Increasing AST (OR 1.015 per U/L, 95% CI 1.006–1.024), increasing white blood cell count (OR 1.22 per 1000/mm3, 95% CI 1.07–1.38), and decreasing hematocrit (OR 0.87 per %, 95% CI 0.79–0.96) were independently associated with increasing severity of fibrosis. Area under the ROC for a model with AST and ALT was 0.75 (95% CI=0.66–0.84) and 0.74 (95% CI 0.63–0.85) for distinguishing steatosis from more advanced forms of NASH and bridging fibrosis from lesser degrees of fibrosis, respectively. Certain components of routine laboratory tests are predictive of NAFLD pattern and fibrosis severity, but do not have adequate discriminate power to replace liver biopsy in evaluating pediatric NAFLD.
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