靶向治疗对肥胖合并代谢功能障碍相关脂肪性肝病（MASLD）儿童阻塞性睡眠呼吸暂停的结局

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中文摘要

背景： 阻塞性睡眠呼吸暂停（OSA）与代谢功能障碍相关脂肪性肝病（MASLD）在肥胖儿童中常共存，但关于OSA治疗后肝脏结局的数据有限。本研究评估了靶向OSA治疗与睡眠呼吸障碍及肝脏结局纵向变化之间的关联。方法：这项回顾性观察性队列纳入2018年至2025年间接受临床诊疗的4-18岁肥胖儿童，均经多导睡眠监测确诊OSA并经超声确诊MASLD。儿童接受靶向OSA治疗（腺样体扁桃体切除术和/或持续气道正压通气[CPAP]）或非靶向治疗。在基线和6-12个月时评估多导睡眠监测参数、肝酶和超声肝脂肪变性。主要结局为丙氨酸氨基转移酶（ALT）降低≥30%。结果：在127名儿童中，67名接受靶向治疗，60名未接受。靶向治疗与OSA严重程度、夜间氧合、ALT、AST和超声脂肪变性的改善相关，而未接受靶向治疗者则出现较不利的轨迹。ALT降低在不同治疗方式间存在显著差异，CPAP观察到的降低幅度最大。在多变量分析中，CPAP与ALT降低≥30%（OR 14.54，95% CI 3.87-54.69；p < 0.01）和超声改善（OR 3.33，95% CI 1.16-9.59；p = 0.03）均相关。BMI z评分降低≥0.25与任一肝脏结局均无独立关联。结论：靶向OSA治疗与更有利的睡眠和肝脏结局相关，其中CPAP的关联最强。需要前瞻性研究来确定这些关联是否代表因果治疗效应。

英文摘要

Background: Obstructive sleep apnea (OSA) and metabolic dysfunction-associated steatotic liver disease (MASLD) frequently coexist in children with obesity, but data on hepatic outcomes following OSA treatment are limited. This study evaluated associations between targeted OSA treatment and longitudinal changes in sleep-disordered breathing and hepatic outcomes. Methods: This retrospective observational cohort included children aged 4-18 years with obesity, polysomnography-confirmed OSA, and ultrasonography-confirmed MASLD who received clinical care between 2018 and 2025. Children received targeted OSA treatment (adenotonsillectomy and/or continuous positive airway pressure [CPAP]) or non-targeted treatment. Polysomnographic parameters, liver enzymes, and ultrasonographic hepatic steatosis were assessed at baseline and 6-12 months. The primary outcome was a ≥30% reduction in alanine aminotransferase (ALT). Results: Among 127 children, 67 received targeted treatment and 60 did not. Targeted treatment was associated with improvements in OSA severity, nocturnal oxygenation, ALT, AST, and ultrasonographic steatosis, whereas less favorable trajectories occurred without targeted treatment. ALT reduction differed significantly among treatment modalities, with the greatest reduction observed with CPAP. In multivariable analyses, CPAP was associated with both ≥30% ALT reduction (OR 14.54, 95% CI 3.87-54.69; p < 0.01) and ultrasonographic improvement (OR 3.33, 95% CI 1.16-9.59; p = 0.03). A BMI z-score reduction of ≥0.25 was not independently associated with either hepatic outcome. Conclusions: Targeted OSA treatment was associated with more favorable sleep and hepatic outcomes, with the strongest associations observed for CPAP. Prospective studies are needed to determine whether these associations represent causal treatment effects.