Ceyda TUNA KIRSACLIOGLU, Gulin HIZAL, Aslıhan SANRI, Esra KARAKUŞ

Obez çocuklarda alkolik olmayan yağlı karaciğer hastalığı ve eşlik eden diğer karaciğer hastalıkları

Giriş: Çocuklarda obezitede artışa parallel olarak alkolik olmayan yağlı karaciğer hastalığı (AOYKH) da giderek artmaktadır. Ancak obez olmayan çocuklarda, farklı karaciğer hastalıklarında da karaciğer yağlanması görülebilir. Bu çalışmada aşırı kilolu ve obez çocuklarda, AOYKH’ye eşlik edebilecek diğer karaciğer hastalıklarının belirlenmesi amaçlandı.Gereç ve yöntemler: Polikliniğimizde aşırı kilo ya da obezite ile izlenen, 5-18 yaş aralığındaki hastaların dosyaları geriye dönük tarandı. Ultrasonografide karaciğerde yağlanma ve normalin üst sınırından en az 1.5 kat kadar alanin transaminaz (ALT) yüksekliği olan 70 hasta çalışmaya alındı. Hastaların demografik verileri, enfeksiyöz, metabolik ve otoimmun nedenler için yapılan laboratuvar testleri, abdominal ultrasonografi ve karaciğer biyopsi bulguları kaydedildi. Bulgular: Tanıda olguların %94,2’ünde (66 olgu) hafif transaminaz yüksekliği vardı. Tanıda viral hepatit tarama, anti-doku transglutaminaz immunglobulin (Ig) A, anti-liver-kidney-mikrozomal-1 ve anti-düz kas antikor negatifdi. Eritrosit sedimentasyon hızı (ESH), C-reaktif protein (CRP), total Ig G, seruloplazmin düzeyleri normaldi. Bir olguda alfa-1 antitripsin düzeyi düşüktü ve PiMZ fenotipi saptandı. Üç (%4,3) olguda antinükleer antikor (ANA) pozitifliği saptandı. Olguların %44,7’sine ursodeoksikolik asit verildi. İzlemde 31 (%44,2) olguda ortalama 6,1± 4,6 (2-19) ayda ALT normalleşme görüldü ancak ursodeoksikolik asit tedavisi ile ilişkisi saptanmadı. Tanıda ANA pozitif olan bir olguya izlemde ALT ve ANA titre düzeyi artması, eşlik eden IgG, ESH ve CRP yükselmesi nedeni ile karaciğer biyopsisi yapılarak otoimmun hepatit (OİH) tanısı konuldu, prednizolon ve azatiopürin tedavisi ile ALT düzeyinde ve ANA titresinde gerileme, ESR ve IgG’de normalleşme saptandı. Tartışma: Obezite ile ilişkili alkolik olmayan yağlı karaciğer hastalığında diğer kronik hepatit nedenleri taranmalı, ANA pozitifliğinde OİH gelişebileceği akılda tutulmalıdır.

Anahtar Kelimeler:

Çocukluk çağı, obezite, yağlı karaciğer hastalığı, otoimmun hepatit

Non-alcoholic fatty liver disease in obese children and co-existing liver diseases

Objective: The prevalence of non-alcoholic fatty liver disease (NAFLD) in children increased parallel to the increment of childhood obesity. Also, NAFLD may be the presenting feature of different liver diseases in non-obese children. We aimed to determine whether there were co-existing liver diseases in overweight and obese children with NAFLD. Material and Methods: Pediatric gastroenterology outpatient clinic records of obese and overweight patients, aged between 5-18 years, were retrospectively reviewed. Seventy patients who had liver steatosis on ultrasonography, and alanine aminotransferase (ALT) levels were higher than 1.5 times the upper limit of normal were recruited to the study. The demographic findings, laboratory tests for infectious, metabolic, and autoimmune causes, abdominal ultrasonography and liver biopsy findings of patients were recorded. Results: At presentation, 94.2% of the patients (n: 66) had mild transaminase elevation. All patients were negative for viral hepatitis, anti-tissue transglutaminase immunoglobulin (Ig) A, anti-liver-kidney-microsome type 1 and anti-smooth muscle antibody. They had normal erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), ceruloplasmin, and total IgG levels. Only one patient with low alpha-1 antitrypsin levels had heterozygotes of the PiMZ phenotype. Three (4.3%) patients had antinuclear antibody (ANA) positivity. 44.7% of patients were given ursodeoxycholic acid treatment. On follow-up, normalization of ALT was achieved in 31 (44.2%) patients at mean 6.1±4.6 (2-19) months, but no relation was found between normalization and ursodeoxycholic acid treatment. A patient with ANA positivity had increased ALT, ESR, CRP, IgG levels and ANA titers on follow-up, and she was diagnosed with autoimmune hepatitis with the support of liver biopsy. Under prednisolone and azathioprine treatment, ESR and IgG levels were normalized, ALT and ANA titers decreased. Conclusion: Other causes of chronic hepatitis should be screened in obesity-related non-alcoholic fatty liver disease and the development of autoimmune hepatitis should be kept in mind in the presence of ANA.

Keywords:

Child, non-alcoholic fatty liver disease, autoimmunity, obesity,

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