Nonalcoholic Fatty Liver Disease in Severely Obese Adolescent and Adult Patients
Nonalcoholic Fatty Liver Disease in Severely Obese Adolescent and Adult Patients
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DOI：
10.1002/oby.20174
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发表时间：
2013-03-01
期刊：
影响因子：
6.9
通讯作者：
Holterman, Mark
中科院分区：
文献类型：
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作者：
Holterman, Ai-Xuan L.;Guzman, Grace;Holterman, Mark
目的：非酒精性脂肪性肝病（NAFLD）越来越成为成人肝移植的指征。虽然成人严重肥胖（SO，BMI >= 40 kg m(-2)）由来已久，但在青少年中却是最近才出现的。随着青少年肥胖人数的增加，NAFLD 正在成为青少年中最常见的肝脏疾病。由于 SO 成人的肥胖持续时间较长，SO 青少年和成人的 NAFLD 严重程度不同的假设得到了检验。 设计和方法：从连续手术的 SO 青少年和成人（n = 24）的前瞻性数据库中提取术前临床数据、NAFLD 活动和术中肝活检的 NASH（非酒精性脂肪性肝炎）评分。采用ELISA法评估术前空腹血清炎症介质。结果：除年龄、基线BMI、种族和性别分布外，组间血脂异常、高血压和代谢综合征的发生率和程度具有可比性。脂肪变性和炎症的组织学评分相似。青少年 NASH 发生率、肝细胞损伤评分和纤维化显着较高。这与较高的血清 C 反应蛋白和 sCD14 水平相关。结论：对于可比的 BMI 和代谢特征，SO 青少年的肝损伤更严重，全身炎症更严重，表明年轻肥胖人群中 NAFLD 病因存在差异，并且疾病进展更严重。
Objectives: Nonalcoholic fatty liver disease (NAFLD) is increasingly an indication for liver transplantation in adults. While severe obesity (SO, BMI >= 40 kg m(-2)) in adults is long standing, it is recent in duration in adolescents. With adolescent obesity on the rise, NAFLD is becoming the most frequent liver disease in adolescents. The hypothesis that SO adolescents and adults have different severity of NAFLD because of longer duration of obesity in SO adults was tested.Design and Methods: Preoperative clinical data, NAFLD activity and NASH (Nonalcoholic steatohepatitis) scores from intraoperative liver biopsies were extracted from a prospective database of consecutively operated SO adolescents and adults (n = 24 each). Fasting preoperative serum inflammatory mediators were evaluated by ELISA.Results: Other than age, baseline BMI, ethnicity and gender distribution, the incidence and extent of dyslipidemia, hypertension, and metabolic syndrome were comparable between groups. Histologic scores for steatosis and inflammation were similar. Adolescents have significantly higher NASH incidence, hepatocyte injury scores and fibrosis. This was associated with higher serum C-reactive protein and sCD14 levels.Conclusion: For comparable BMI and metabolic profile, SO adolescents have more advanced liver damage, more severe systemic inflammation, suggesting differences in NAFLD etiologies and more aggressive disease progression in the young obese population.