Objectives

To evaluate the prevalence and clinical significance of autoantibodies in children with overweight and obesity with nonalcoholic fatty liver (NAFL) and nonalcoholic steatohepatitis (NASH) compared with those with autoimmune liver disease (ALD).

Study design

This was a retrospective, cross-sectional study of children with a biopsy-proven diagnosis of NAFL, NASH, autoimmune hepatitis (AIH), or primary sclerosing cholangitis (PSC) and a body mass index (BMI) >85th percentile treated between 2007 and 2016.

Results

A total of 181 patients were identified, including 31 (17%) with NAFL, 121 (67%) with NASH, 12 (6.6%) with ALD (AIH, PSC, or overlap), and 17 (9.4%) with combined ALD and NAFLD. Antinuclear antibody (ANA), anti-actin antibody, and anti–liver kidney microsomal (LKM) antibody were positive in 16.1%, 13.8%, and 0%, respectively, of the patients with NAFL and in 32.8%, 15.5%, and 0%, respectively, of those with NASH. Total immunoglobulin G (IgG) was elevated in 27.3% of the patients with NAFL and in 47.7% of those with NASH, but in 100% of those with ALD. The positive predictive value of LKM was 100% for ALD but only 29% for ANA and 46% for anti-actin antibody.

Conclusions

False-positive rates of autoantibodies were higher in pediatric patients with overweight and obesity with NAFLD compared with the general adult population. Positive LKM had the highest specificity and positive predictive value, and elevated IgG level had the highest sensitivity for ALD. The presence of autoantibodies does not signal more severe NAFLD in children. BMI >98th percentile seems to be an important breakpoint above which ALD is less likely.

中文翻译：

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非酒精性脂肪肝超重和肥胖儿童自身抗体的患病率和临床意义

目标

与患有自身免疫性肝病 (ALD) 的儿童相比，评估患有非酒精性脂肪肝 (NAFL) 和非酒精性脂肪性肝炎 (NASH) 的超重和肥胖儿童自身抗体的患病率和临床意义。

学习规划

这是一项回顾性横断面研究，对活检证实诊断为 NAFL、NASH、自身免疫性肝炎 (AIH) 或原发性硬化性胆管炎 (PSC) 且体重指数 (BMI) > 85% 百分位的儿童在 2007 年至 2007 年至2016 年。

结果

共确定了 181 名患者，其中 31 名（17%）患有 NAFL，121 名（67%）患有 NASH，12 名（6.6%）患有 ALD（AIH、PSC 或重叠），17 名（9.4%）患有联合 ALD和 NAFLD。NAFL 患者的抗核抗体 (ANA)、抗肌动蛋白抗体和抗肝肾微粒体 (LKM) 抗体分别为 16.1%、13.8% 和 0%，分别为 32.8%、15.5% 和 0%。分别为 NASH 患者的 0%。27.3% 的 NAFL 患者和 47.7% 的 NASH 患者的总免疫球蛋白 G (IgG) 升高，但 100% 的 ALD 患者升高。LKM 对 ALD 的阳性预测值为 100%，但对 ANA 和抗肌动蛋白抗体只有 29% 和 46%。

结论

与一般成人人群相比，患有 NAFLD 的超重和肥胖儿科患者自身抗体的假阳性率更高。LKM阳性对ALD的特异性和阳性预测值最高，IgG水平升高对ALD的敏感性最高。自身抗体的存在并不表示儿童更严重的 NAFLD。BMI > 98th 百分位似乎是一个重要的断点，超过该断点 ALD 的可能性较小。