Doherty J F, Adam E J, Griffin G E, Golden M H
Tropical Metabolism Research Unit, University of the West Indies, Kingston, Jamaica.
Arch Dis Child. 1992 Nov;67(11):1348-52. doi: 10.1136/adc.67.11.1348.
Ultrasonographic, blinded assessment was made of the extent of hepatic steatosis in 55 children with severe malnutrition: undernutrition (n = 6), marasmus (n = 18), marasmickwashiorkor (n = 17), and kwashiorkor (n = 14). The children were examined on admission, in early recovery (considered as baseline), and again at discharge. Eleven healthy control children and eight of the previously malnourished children were studied as comparison groups. Both oedematous and non-oedematous malnourished children had significantly more steatosis than the comparison groups at each time. Children with oedematous malnutrition had significantly greater steatosis than non-oedematous children at admission. Half of the non-oedematous malnourished children had appreciable hepatic steatosis at both admission and at baseline. Hepatic fat was only slowly mobilised. The rate constant was 1.4 +/- 0.3%/day. One quarter of the children did not change steatosis grades during the period they were in hospital. There was no overall correlation between the extent of steatosis and liver size. Hepatic steatosis in childhood malnutrition is not confined to oedematous children: it is frequently present in marasmic and undernourished children. Its extent is not necessarily related to the degree of hepatomegaly and accumulated lipid is only slowly mobilised.
对55名重度营养不良儿童的肝脂肪变性程度进行了超声盲法评估，这些儿童包括：营养不良（n = 6）、消瘦（n = 18）、消瘦型夸希奥科病（n = 17）和夸希奥科病（n = 14）。在入院时、早期恢复阶段（视为基线）以及出院时对这些儿童进行了检查。选取11名健康对照儿童和8名曾患营养不良的儿童作为比较组。在每次检查时，水肿型和非水肿型营养不良儿童的脂肪变性均显著多于比较组。水肿型营养不良儿童在入院时的脂肪变性显著多于非水肿型儿童。一半的非水肿型营养不良儿童在入院时和基线时均有明显的肝脂肪变性。肝脏脂肪仅缓慢动员。速率常数为1.4±0.3%/天。四分之一的儿童在住院期间脂肪变性等级未发生变化。脂肪变性程度与肝脏大小之间无总体相关性。儿童期营养不良中的肝脂肪变性并不局限于水肿型儿童：在消瘦型和营养不良型儿童中也很常见。其程度不一定与肝肿大程度相关，且蓄积的脂质仅缓慢动员。
