Table_1_Association between inflammatory markers and non-alcoholic fatty liver disease in obese children.DOCX

BackgroundGiven the high prevalence of non-alcoholic fatty liver disease (NAFLD) in obese children, non-invasive markers of disease to date are still limited and worth exploring.
ObjectiveThis study aimed to evaluate the association between inflammatory markers and NAFLD in obese children.
MethodsWe performed a case-control study in Hunan Children's Hospital from September 2020 to September 2021. Study participants were children with obesity diagnosed with NAFLD by abdominal ultrasound examination. Mean platelet volume (MPV), platelet distribution width (PDW), neutrophil, lymphocyte, monocyte, and platelet counts were extracted from medical records and inflammatory cytokines were measured by enzyme-linked immunosorbent assay (ELISA). Multivariable logistic regression analysis was performed to evaluate the association between inflammatory markers and NAFLD. We also used receiver operating characteristic curve analysis to assess the discriminative ability of inflammatory cytokines for NAFLD.
ResultsTwo hundred and sixty-seven obese children were enrolled, including 176 NAFLD patients and 91 simple obesity controls. Multivariable logistic model indicated that increased interleukin (IL)-1β [odds ratio (OR) = 1.15, 95% confidence interval (CI): 1.04–1.27], IL-6 (OR = 1.28, 95% CI: 1.07–1.53), and IL-17 (OR = 1.04, 95% CI: 1.02–1.07) levels were significantly associated with NAFLD. In contrast, we observed non-significant associations for IL-8, IL-12, IL-21, IL-32, tumor necrosis factor-α (TNF-α), neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), lymphocyte to monocyte ratio (LMR), mean platelet volume (MPV), and platelet distribution width (PDW) with NAFLD. The area under the curves (AUCs) of IL-1β, IL-6, and IL-17 to discriminate obese children with or without NAFLD were 0.94, 0.94, and 0.97, respectively.
ConclusionsOur results indicated that IL-1β, IL-6, and IL-17 levels were significantly associated with NAFLD. These inflammatory cytokines may serve as non-invasive markers to determine the development of NAFLD and potentially identify additional avenues for therapeutic intervention.

背景 鉴于非酒精性脂肪性肝病（non-alcoholic fatty liver disease, NAFLD）在肥胖儿童中具有较高的患病率，目前可供使用的疾病无创标志物仍较为匮乏，值得进一步探索。
目的 本研究旨在探讨肥胖儿童体内炎症标志物与非酒精性脂肪性肝病（NAFLD）之间的关联。
方法 本研究于2020年9月至2021年9月在湖南省儿童医院开展病例对照研究。研究对象为经腹部超声检查确诊为非酒精性脂肪性肝病的肥胖儿童。从病历中提取平均血小板体积（mean platelet volume, MPV）、血小板分布宽度（platelet distribution width, PDW）、中性粒细胞、淋巴细胞、单核细胞及血小板计数等指标，并通过酶联免疫吸附试验（enzyme-linked immunosorbent assay, ELISA）检测炎症细胞因子水平。采用多变量logistic回归分析评估炎症标志物与非酒精性脂肪性肝病之间的关联；同时运用受试者工作特征曲线分析，评价炎症细胞因子对非酒精性脂肪性肝病的鉴别能力。
结果 本研究共纳入267名肥胖儿童，其中非酒精性脂肪性肝病患者176例，单纯性肥胖对照者91例。多变量logistic回归模型结果显示，白细胞介素-1β（interleukin-1β, IL-1β）[比值比（odds ratio, OR）=1.15，95%置信区间（confidence interval, CI）：1.04~1.27]、IL-6（OR=1.28，95%CI：1.07~1.53）及IL-17（OR=1.04，95%CI：1.02~1.07）水平升高与非酒精性脂肪性肝病显著相关。与之相反，IL-8、IL-12、IL-21、IL-32、肿瘤坏死因子-α（tumor necrosis factor-α, TNF-α）、中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值（PLR）、淋巴细胞与单核细胞比值（LMR）、平均血小板体积（MPV）及血小板分布宽度（PDW）与非酒精性脂肪性肝病均未呈现显著关联。IL-1β、IL-6及IL-17鉴别肥胖儿童是否合并非酒精性脂肪性肝病的曲线下面积（area under the curve, AUC）分别为0.94、0.94和0.97。
结论 本研究结果表明，IL-1β、IL-6及IL-17水平与非酒精性脂肪性肝病显著相关。上述炎症细胞因子可作为无创标志物，用于预判非酒精性脂肪性肝病的发生发展，同时有望为治疗干预提供新的方向。