| Background:Non-alcoholic Fatty Liver Disease(NAFLD) is a kind of clinical and pathological syndrome which was not caused by the damage of alchohol and other known factors.It's character is diffuse bullous adipose degeneration in which encompasses a spectrum of hepatic histological lesions ranging from hepatic steatosis, steatohepatitis,hepatic fibrosis to cirrhosis. Liver biopsy is seen as the "gold standard". However, it has been concluded that there was significant sampling variability in routine liver biopsies in patients with NAFLD. The sampling variability has the potential to alter significantly the diagnosis and staging of NAFLD. In addition, there are several drawbacks in using liver biopsy because this procedure is invasive, and prone to complications, and others more severe, with a recorded risk of death of 0.01%, which can't be performed in the children. So it's necessary to find the markers which is noninvasive and represents the stage of NAFLD. So we combined Hepatic B-ultrasound imagine and the biochemical markers to estimate the degree of NAFLD in obese children.Objectives:To evaluate the diagnostic value of combining Hepatic B-ultrasound imagine and non-invasive biochemical markers such as transaminases (ALT, AST) type III procollagen N peptide (PCâ…¢) in nonalcoholic fatty liver disease(NAFLD), and screen applicable non-invasive diagnostic markers for compensated NAFLD in obese children.Methods:In this study,269 obese children and 30 healthy control group matched in age and sex were enrolled. We measured body mass index (BMI), waist and hip circumference, blood pressure, blood glucose,insulin,lipid profile, transaminases (ALT, AST), serum hepatic fibrosis markers hyaluronic acid(HA), type IV collagen(CIV),type III procollagen N peptide (PCâ…¢)and laminin(LN)and hepatic B-ultrasound imagine in all participants. Oral glucose tolerance test and insulin releasing test were performed. Three subgroups were selected according to the diagnostic criteria. Group 1:SOC(simple obese children), Group 2:NAFLD-1 (US fatty liver and normal transaminases) and Group 3:NAFLD-2 (US fatty liver and elevated transaminases).We also classified 269 obese children into three subgroups according to B-ultrasound imagine examination. Group 1:SOC (normal US liver and normal transaminases), Group 2:mild fatty liver and Group 3:moderate and severe fatty liver. We compared body mass index (BMI), the ratio of waist and hip circumference, lipid profile and transaminases (ALT, AST), fasting blood glucose, insulin, serum hepatic fibrosis markers,HOMA score, WBISI based on OGTT test in all participants and 30 healthy control. The binary Logistic regression analysis was applied between Group SOC and Group NAFLD. We evaluated and compared all the biochemical markers with the area under receiver-operating characteristics (ROC)curve.Results:(1) Compared with group SOC, the biochemical markers ALT,AST,TG,HA. PCâ…¢,FINS,2hINS,WBISI were significantly increased in NAFLD-1 group, Compared with group NAFLD-1, the biochemical markers ALT,PCâ…¢were significantly increased in NAFLD-2. (2)The level of ALT was significantly correlated with B-ultrasound imagine examination, and it's regression coefficient was o.11(p=0). (3) The area under the receiver-operating characteristics (ROC)curve of ALT,AST, PCâ…¢was 0.88,0.80,0.70,which showed the most value in diagnosis of NAFLD in obese children.Conclusion:The combining Hepatic B-ultrasound imagine and the biochemical markers ALT, AST, PCâ…¢were most useful in diagnosis of NAFLD in obese children, which showed not only the degree of hepatic inflammation but also the degree of hepatic fibrosis. |
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