Year 2019, Volume 14, Issue 4, Pages 258 - 262 2019-07-30

Obez çocuklarda alkolik olmayan yağlı karaciğer hastalığı ve eşlik eden diğer karaciğer hastalıkları
Non-alcoholic fatty liver disease in obese children and co-existing liver diseases

Ceyda Tuna Kırsaçlıoğlu [1] , Aslıhan Sanrı [2] , Gülin Hizal [3] , Esra Karakuş [4]

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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.





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.


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Primary Language en
Subjects General and Internal Medicine
Journal Section ORIGINAL ARTICLES
Authors

Orcid: 0000-0002-3551-7267
Author: Ceyda Tuna Kırsaçlıoğlu (Primary Author)
Institution: ANKARA ÇOCUK SAĞLIĞI VE HASTALIKLARI HEMATOLOJİ ONKOLOJİ EĞİTİM VE ARAŞTIRMA HASTANESİ
Country: Turkey


Orcid: 0000-0003-1898-0898
Author: Aslıhan Sanrı
Institution: ANKARA ÇOCUK SAĞLIĞI VE HASTALIKLARI HEMATOLOJİ ONKOLOJİ EĞİTİM VE ARAŞTIRMA HASTANESİ
Country: Turkey


Orcid: 0000-0003-0167-4990
Author: Gülin Hizal
Institution: ANKARA ÇOCUK SAĞLIĞI VE HASTALIKLARI HEMATOLOJİ ONKOLOJİ EĞİTİM VE ARAŞTIRMA HASTANESİ

Orcid: 0000-0002-6260-1122
Author: Esra Karakuş
Institution: ANKARA ÇOCUK SAĞLIĞI VE HASTALIKLARI HEMATOLOJİ ONKOLOJİ EĞİTİM VE ARAŞTIRMA HASTANESİ
Country: Turkey


Dates

Publication Date: July 30, 2019

Bibtex @research article { tchd544048, journal = {Türkiye Çocuk Hastalıkları Dergisi}, issn = {1307-4490}, eissn = {2148-3566}, address = {Sağlık Bilimleri Üniversitesi}, year = {2019}, volume = {14}, pages = {258 - 262}, doi = {10.12956/tchd.544048}, title = {Non-alcoholic fatty liver disease in obese children and co-existing liver diseases}, key = {cite}, author = {Tuna Kırsaçlıoğlu, Ceyda and Sanrı, Aslıhan and Hizal, Gülin and Karakuş, Esra} }
APA Tuna Kırsaçlıoğlu, C , Sanrı, A , Hizal, G , Karakuş, E . (2019). Non-alcoholic fatty liver disease in obese children and co-existing liver diseases. Türkiye Çocuk Hastalıkları Dergisi, 14 (4), 258-262. DOI: 10.12956/tchd.544048
MLA Tuna Kırsaçlıoğlu, C , Sanrı, A , Hizal, G , Karakuş, E . "Non-alcoholic fatty liver disease in obese children and co-existing liver diseases". Türkiye Çocuk Hastalıkları Dergisi 14 (2019): 258-262 <http://dergipark.org.tr/tchd/issue/47759/544048>
Chicago Tuna Kırsaçlıoğlu, C , Sanrı, A , Hizal, G , Karakuş, E . "Non-alcoholic fatty liver disease in obese children and co-existing liver diseases". Türkiye Çocuk Hastalıkları Dergisi 14 (2019): 258-262
RIS TY - JOUR T1 - Non-alcoholic fatty liver disease in obese children and co-existing liver diseases AU - Ceyda Tuna Kırsaçlıoğlu , Aslıhan Sanrı , Gülin Hizal , Esra Karakuş Y1 - 2019 PY - 2019 N1 - doi: 10.12956/tchd.544048 DO - 10.12956/tchd.544048 T2 - Türkiye Çocuk Hastalıkları Dergisi JF - Journal JO - JOR SP - 258 EP - 262 VL - 14 IS - 4 SN - 1307-4490-2148-3566 M3 - doi: 10.12956/tchd.544048 UR - https://doi.org/10.12956/tchd.544048 Y2 - 2019 ER -
EndNote %0 Turkish Journal of Pediatric Disease Non-alcoholic fatty liver disease in obese children and co-existing liver diseases %A Ceyda Tuna Kırsaçlıoğlu , Aslıhan Sanrı , Gülin Hizal , Esra Karakuş %T Non-alcoholic fatty liver disease in obese children and co-existing liver diseases %D 2019 %J Türkiye Çocuk Hastalıkları Dergisi %P 1307-4490-2148-3566 %V 14 %N 4 %R doi: 10.12956/tchd.544048 %U 10.12956/tchd.544048
ISNAD Tuna Kırsaçlıoğlu, Ceyda , Sanrı, Aslıhan , Hizal, Gülin , Karakuş, Esra . "Non-alcoholic fatty liver disease in obese children and co-existing liver diseases". Türkiye Çocuk Hastalıkları Dergisi 14 / 4 (July 2019): 258-262. https://doi.org/10.12956/tchd.544048
AMA Tuna Kırsaçlıoğlu C , Sanrı A , Hizal G , Karakuş E . Non-alcoholic fatty liver disease in obese children and co-existing liver diseases. Türkiye Çocuk Hast Derg. 2019; 14(4): 258-262.
Vancouver Tuna Kırsaçlıoğlu C , Sanrı A , Hizal G , Karakuş E . Non-alcoholic fatty liver disease in obese children and co-existing liver diseases. Türkiye Çocuk Hastalıkları Dergisi. 2019; 14(4): 262-258.