Association between metabolic syndrome and liver histology among children with nonalcoholic Fatty liver disease.
Association between metabolic syndrome and liver histology among children with nonalcoholic Fatty liver disease.
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DOI：
10.1038/ajg.2010.152
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发表时间：
2010-09
影响因子：
9.8
通讯作者：
Lavine, Joel E.
中科院分区：
文献类型：
--
作者：
Patton, Heather M.;Yates, Katherine;Unalp-Arida, Aynur;Behling, Cynthia A.;Huang, Terry T. -K.;Rosenthal, Philip;Sanyal, Arun J.;Schwimmer, Jeffrey B.;Lavine, Joel E.
非酒精性脂肪性肝炎（NASH）被认为是成人代谢综合征（MetS）的肝脏表现。新出现的数据表明，MetS也可能与儿童非酒精性脂肪性肝病（NAFLD）有关。我们试图确定MetS或其组成特征是否与NAFLD的特定组织学特征或严重程度相关。6 - 17岁的儿童和青少年被纳入非酒精性脂肪性肝炎临床研究网络（NASH CRN），并在肝活检后6个月内获得临床数据。MetS被定义为存在以下三个或三个以上的特征，通过应用年龄调整的正常值来确定：中枢性肥胖、血脂异常、空腹血糖受损和血压升高。肝活检由NASH CRN病理委员会评估。254名儿童被纳入分析，其中65名（26%）符合MetS的特定标准。在患有met的儿童中，女性在年龄和青春期平均年龄较大的比例较高。重度脂肪变性患者发生MetS的风险最大（3级脂肪变性与1级脂肪变性的比值比(OR) = 2.58, P = 0.001）。肝细胞球囊的存在也与MetS显著相关（OR = 2.10, P = 0.03）。晚期纤维化（3/4期）患者与无纤维化（0期）患者的OR为3.21 （P = 0.04）。与“非NASH”相比，边缘区1或明确NASH模式与MetS密切相关（分别为or = 4.44, P = 0.005和or = 4.07, P = 0.002）。met患儿的平均NAFLD活动评分（NAS）高于无met患儿（4.8±1.4比4.3±1.4,P = 0.01）。中心性肥胖与脂肪变性、纤维化、肝细胞水肿和NAFLD模式显著相关。胰岛素抵抗与脂肪变性、纤维化、肝细胞水肿、NAS和NAFLD模式显著相关。MetS在患有NAFLD的儿童中很常见，并且与脂肪变性、肝细胞膨胀、NAS、NAFLD模式和晚期纤维化的严重程度有关。个体代谢代谢特征，特别是中心性肥胖和胰岛素抵抗，也与NAFLD的严重程度相关。在NAFLD儿童中，应单独和共同考虑met特征，它们有助于识别更晚期疾病的儿童。
Nonalcoholic steatohepatitis (NASH) is considered the hepatic manifestation of metabolic syndrome (MetS) among adults. Emerging data suggest that MetS may be associated with nonalcoholic fatty liver disease (NAFLD) in children as well. We sought to determine whether MetS or its component features are associated with specific histological features or severity of NAFLD. Children and adolescents aged 6 – 17 years enrolled in the Nonalcoholic Steatohepatitis Clinical Research Network (NASH CRN) with clinical data obtained within 6 months of liver biopsy were included. MetS was defined as the presence of three or more of the following features as determined by application of age-adjusted normative values: central obesity, dyslipidemia, impaired fasting glucose, and elevated blood pressure. Liver biopsies were evaluated by the Pathology Committee of the NASH CRN. Two hundred fifty four children were included in the analysis, of whom 65 (26 %) met specified criteria for MetS. Among children with MetS, there is a higher proportion of females who were on average older in age and pubertal. The risk of MetS was greatest among those with severe steatosis (odds ratio (OR) = 2.58 for grade 3 vs. grade 1 steatosis, P = 0.001). The presence of hepatocellular ballooning was also significantly associated with MetS (OR = 2.10, P = 0.03). Those with advanced fibrosis (stage 3/4) had an OR for MetS of 3.21 (P = 0.04) vs. those without fibrosis (stage 0). Borderline zone 1 or definite NASH patterns compared with “ not NASH ” were strongly associated with MetS (OR = 4.44, P = 0.005 and OR = 4.07, P = 0.002, respectively). The mean NAFLD Activity Score (NAS) was greater among children with MetS vs. those without (4.8 ± 1.4 vs. 4.3 ± 1.4, P = 0.01). Central obesity was significantly associated with steatosis, fibrosis, hepatocellular ballooning, and NAFLD pattern. Insulin resistance was significantly associated with steatosis, fibrosis, hepatocellular ballooning, NAS, and NAFLD pattern. MetS is common among children with NAFLD and is associated with severity of steatosis, hepatocellular ballooning, NAS, NAFLD pattern, and the presence of advanced fibrosis. Individual MetS features, particularly central obesity and insulin resistance, were also associated with severity of NAFLD. MetS features should be considered in children with NAFLD as individually and collectively they help identify children with more advanced disease.
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影响因子：
29.4
作者：
Fraser, Abigail;Longnecker, Matthew P.;Lawlor, Debbie A.
通讯作者：
Lawlor, Debbie A.
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37.8
作者：
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通讯作者：
Janssen, Ian
影响因子：
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作者：
Hickman, TB;Briefel, RR;Johnson, CL
通讯作者：
Johnson, CL
影响因子：
13.5
作者：
Charlton, N;Sreekumar, R;Nair, KS
通讯作者：
Nair, KS