Thesis Type: Expertise In Medicine
Institution Of The Thesis: Marmara University, School of Medicine, Internal Medical Sciences, Turkey
Approval Date: 2017
Thesis Language: Turkish
Student: Cemile Burcu Kesici
Consultant: Engin TutarAbstract:
Background and Aim: Parallel with the increasing rates of obesity, Non-Alcoholic
Fatty Liver Disease (NAFLD) has become the most common cause of chronic liver
disease in children. Liver biopsy is the current gold standard for the diagnosis and
grading of NAFLD. Although non-invasive procedures such as ultrasonography
(USG), computerized tomography (CT), magnetic resonance imaging (MRI) are used
for NAFLD diagnosis, hepatic fibrosis and steatosis can not be evaluated
simultaneously by these methods. The aim of the study is to compare between
histopathologic findings of steatosis/fibrosis and various non-invasive imaging and
blood steatosis/fibrosis indicators of overweight and obese children.
Material and Methods: The children who presented to Pediatric Gastroenterology,
Hepatology and Nutrition policlinics of Marmara University Pendik Education and
Research Hospital aged 8-18 years, diagnosed as obese or overweighted and has AST
and/or ALT elevation and additionally ultrasonographic hepatosteatosis determined,
no underlying etiologic factor detected in further investigations and had liver biopsy
in past 3 year, were evaluated retrospectively. APRI and HOMA scores were
calculated in all patients who were included in the study. The presence and grade of
hepatosteatosis were recorded by USG within 1 month before biopsy procedure. In all
patients who were included in the study, measurements of fibrosis by fibroscan and
hepatosteatosis by ‘Controlled Attenuation Parameter (CAP)’ were applied by only
one expert user within 1-4 weeks after biopsy procedure.
Results: The mean age was 13±2.6 years and 33 (68.8%) of 48 patients were male.
The average weight of patients was 72.3±20.1 kg and average weight for height (WFH)
percentage was found as %151.9±23.8. Five of 48 patients were overweight and 43 of
them were obese according to body mass index (BMI) percentile, all patients were
obese according to WFH criterion. In 27.1% of patients grade 1, in 16.7% grade 2 and
in 56.3% grade 3 steatosis were found by biopsy. Although there was no fibrosis in
39.6% of patients, 35.4% had F1, 16.7% had F2, and 8.3% had F3 fibrosis. Although
steatosis severity was not significantly correlated with USG results, it was significantly
correlated with CAP (p:0.011). In patients with moderate and severe fibrosis, AST,
ALT and GGT values were significantly higher than those with mild and no fibrosis
(respectively p:0.007, p:0.004 and p:0.004). The average APRI score of patients with
fibrosis was determined significantly higher than in patients without fibrosis (p:
0.008). APRI score is also successful for discriminating mild fibrosis from severe
fibrosis (p:0.001). Fibroscan results was significantly associated with fibrosis presence
(p:0.003), but not with fibrosis severity. There was significant association between
magnetic resonance spectroscopy (MRS) results and steatosis severity.
Discussion: USG is lacking for determining steatosis severity when compared with
biopsy. CAP and MRS can be used to determine severity of steatosis, fibroscan can be
used to determine presence of fibrosis and APRI score can be used to determine both
presence and degree of fibrosis.
Key words: Child, Non-Alcoholic Fatty Liver Disease, APRI score, Fibroscan, CAP,
Magnetic resonance spectroscopy.