OBJECTIVETo determine the clinical value of hepatic fibrosis parameters and serum ferritin (SF) in obese children with nonalcoholic fatty liver disease.

METHODSOne hundred and one obese children aged 6-15 years and 30 healthy children aged 9-14 years were enrolled in the study. Body mass index (BMI), waist circumference (WC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), hepatic fibrosis parameters including hyaluronic acid (HA), laminin (LN), serum type III procollagen (PCIII) and type IV collagen (CIV), serum ferritin and hepatic B-ultrasonography were assessed. All subjects were divided into 4 subgroups: simple obese children (SOC), simple nonalcoholic fatty liver (SNAFL), nonalcoholic steatohepatitis (NASH) and control group. ALT, AST, hepatic fibrosis parameters and serum ferritin were compared in these four groups.

RESULTCompared with control group, the serum levels of HA and PCIII increased significantly in SOC group (P <0.05); Serum levels of HA, PCIII, SF, ALT and AST also elevated markedly in SNAFL group and NASH group compared with those in control group. PCIII, SF, ALT, AST increased stepwise as the disease developed from SOC to SNAFL and NASH (P <0.05). SF was correlated with PCIII, ALT and AST (r=0.33,0.63,0.69,P <0.05) and PCIII was well related to ALT and AST (r=0.55,0.56,P <0.05). There were only 6 cases with SF >301 microg/L among all obese children, they were all NASH. The average levels of HA, CIV, PCIII, ALT, AST of these 6 cases were significantly higher than those of other NASH children.

CONCLUSIONAmong all hepatic fibrosis parameters, serum PCIII level is an early and sensitive indicator of NAFLD and is correlated with the disease progress. SF may be also involved in early injury of fatty liver and the process of NAFLD.