Journal List > Korean J Gastroenterol > v.57(3) > 1006780

Jee, Kim, Song, and Paik: Association among Histopathology, Clinical Manifestation, and Ultrasonographic Grades in Pediatric Non-alcoholic Fatty Liver Disease

Abstract

Background/Aims

Nonalcoholic steatohepatitis (NASH) is the progressive form of non-alcoholic fatty liver disease (NAFLD), and its prevalence is increasing worldwide. Liver biopsy remains the best way to diagnose NASH and establish the presence of fibrosis, but has not been performed easily in children because of its invasiveness. We analyzed the ultrasonographic and histopathologic findings of pediatric NAFLD patients, and studied to find their association with clinical characteristics and laboratory findings.

Methods

The study involved 18 obese children ranging from 7 to 15 years of age, who were diagnosed with NASH by liver biopsy. We performed the abdomen ultrasonography before the liver biopsy. We reviewed their pathology slides and classified them by NASH CRN (Clinical Research Network) scoring system. We also reviewed the abdomen ultrasonographic findings of the patients and classified them into grade of 1, 2, and 3. We reviewed the medical records of the patients and investigated their clinical characteristics and laboratory findings.

Results

The ultrasonographic grades had significant association with NAFLD activity score, grade of steatosis amount, ballooning change, and portal inflammation. Serum triglyceride level was significantly higher in patients who showed high grade steatosis and high NAFLD activity score.

Conclusions

This study showed that serum triglycerides and ultrasonographic findings are highly correlated with pathologic findings in children with NAFLD.

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Table 1.
Grades of Hepatic Ultrasonographic Findings in Children with NAFLD14
Grade   Ultrasonographic findings
1 Mild Slight diffuse increase in the fine echoes of the diaphragm and intrahepatic vessel borders
2 Moderate Moderate diffuse increase in the fine echoes with slightly impaired visualization of the intrahepatic vessels and diaphragm
3 Severe Marked increase in fine echoes with poor or no visualization of the intrahepatic vessel borders, diaphragm, and posterior portion of the right lobe of liver

NAFLD, nonalcoholic fatty liver disease.

Table 2.
Correlatoin between Histologic Grades and Ultrasonographic Grades
  Histologic grades Ultrasonograghic grades p-value
Children of grade 1 and grade 2 fatty liver (%) Children of grade 3 fatty liver (%)
NAS a Non-NASH (≤4) 4 (57.1) 1 (9.1) 0.026 b
  NASH(≥5) 3 (42.9) 10 (90.9)  
Steatosis amount Grade 0 (<5%) 0 (0.0) 0 (0.0)  
  Grade 1 (5–32%) 4 (57.1) 2 (18.2) 0.046 b
  Grade 2 (33–66%) 2 (28.6) 3 (27.3)  
  Grade 3 (>66%) 1 (14.3) 6 (54.5)  
Lobular inflammation Grade 0 (no foci) 0 (0.0) 0 (0.0)  
  Grade 1 (<2 foci/200x) 3 (42.9) 3 (27.3) 0.28
  Grade 2 (2–4 foci/200x) 4 (57.1) 6 (54.5) 0.28
  Grade 3 (>4 foci/200x) 0 (0.0) 2 (18.2)  
Portal inflammation Grade 0 (none to minimal) 7 (100) 5 (45.5) 0.02 b
  Grade 1 (greater than minimal) 0 (0.0) 6 (54.5)  
Ballooning degeneration Grade 0 (none) 0 (0.0) 0 (0.0)  
  Grade 1 (few) 4 (57.1) 1 (9.1) 0.03 b
  Grade 2 (many) 3 (42.9) 10 (90.9)  
Fibrosis Grade 0 (none) 0 (0.0) 0 (0.0)  
  Grade 1 (zone 3 perisinusoidal) 1 (14.2) 2 (18.2)  
  Grade 2 (perisinusoidaltal) and portal/periport 3 (42.9) 1 (9.1) 0.493
  Grade 3 (bridging fibrosis) 3 (42.9) 8 (72.7)  
  Grade 4 (cirrhosis) 0 (0.0) 0 (0.0)  

a NAS (NAFLD activity score); sum of steatosis, lobular inflammation, and ballooning degeneration scores. NAS of 5 or more correlates well with a diagnosis of NASH.

b p<0.05.

Table 3.
Comparison of Biochemical Profiles according to the Degree of Steatosis
  Steatosis amount of hepatic cells on pathologic findings
1 2 3 p-value
Number of patients 6 5 7  
ALT (U/L) 191.17±220.00 144.80±93.28 188.00±108.57 0.857
AST (U/L) 90.67±91.92 74.60±36.88 199.85±52.32 0.490
ALP (U/L) TG (mg/dL) 274.17±80.99 117.67±51.71 225.60±110.22 119.00±30.20 282.00±63.27 219.47±52.68 0.498 0.002 a
Total cholesterol (mg/dL) 174.50±22.38 169.80±29.78 200.57±35.30 0.181
HDL (mg/dL) 39.67±8.89 41.40±6.87 40.86±14.28 0.964
LDL (mg/dL) 118.50±30.39 111.40±20.06 110.43±22.71 0.828
Total protein (g/dL) 7.78±0.31 7.78±0.40 7.61±0.30 0.600
Albumin (g/dL) 5.13±0.44 4.58±0.39 4.71±0.34 0.076
Total bilirubin (mg/dL) 0.50±0.20 0.52±0.21 0.31±0.14 0.127

All values are described as mean±SD.

a p<0.05.

Table 4.
Association between the Biochemical Profiles and the NAFLD Activity Scores
  Non-NASH a NASH b p-value
Number of patients 5 13  
ALT (U/L) 149.60±184.05 187.61±133.56 0.632
AST (U/L) 71.60±73.08 107.53±60.89 0.303
ALP (U/L) 278.20±102.24 258.15±77.67 0.658
TG (mg/dL) 96.20±28.85 181.30±63.30 0.012 c
Total cholesterol (mg/dL) 163.20±22.88 191.07±31.74 0.094
HDL (mg/dL) 41.80±8.58 40.15±11.23 0.772
LDL (mg/dL) 112.20±31.72 113.84±21.46 0.900
Total protein (g/dL) 7.64±0.32 7.74±0.33 0.554
Albumin (g/dL) 5.02±0.49 4.73±0.40 0.234
Total bilirubin (mg/dL) 0.48±0.19 0.41±0.20 0.555

All values are described as mean±SD.

a non-NASH: patients of the NAFLD activity scores of 0, 1, 2, 3, 4.

b NASH: patients of the NAFLD activity scores of 5, 6, 7, 8.

c p<0.05.

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