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非酒精性脂肪性肝病:儿科医生面临的挑战。

Nonalcoholic fatty liver disease: a challenge for pediatricians.

机构信息

Division of Pediatric Nutrition and Prevention, Department of Pediatrics, Medical University of Vienna, Vienna, Austria.

出版信息

Int J Obes (Lond). 2010 Oct;34(10):1451-67. doi: 10.1038/ijo.2010.185. Epub 2010 Sep 14.

Abstract

BACKGROUND

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of pediatric liver disease. Its prevalence is related to the growing epidemic in childhood obesity during the past decades. At present, NAFLD and nonalcoholic steatohepatitis (NASH) are increasingly recognized worldwide. In spite of alarming trend in the epidemiology in pediatric field and growing risk of end stage liver disease, there is no significant advance in its diagnosis and treatment.

AIM

To provide a detailed review for diagnosis and management of NAFLD and NASH.

METHODS

By using Pubmed to find review articles and relevant research.

RESULTS

The prevalence ranges from at least 3% in children overall to about 50% in obese children. The noninvasive biomarkers can be used to identify NAFLD/NASH patients. Diagnostic criteria based on biochemical and immunological indicators in the high-risk group of children could prevent about half of cases from receiving an invasive test. The pharmacological and surgical interventions have shown a growing role in pediatric NAFLD. Novel treatment modalities, such as probiotics, have hardly been studied.

CONCLUSION

Early diagnosis by using noninvasive screening methods in high-risk groups is the most effective strategy against the NAFLD. The biology of early growth and development, including hepatic metabolism, may hold the key to pediatric NAFLD. Prevention of overweight children and childhood obesity is undoubtedly the best strategy for treating NAFLD.

摘要

背景

非酒精性脂肪性肝病(NAFLD)是儿童最常见的肝脏疾病。其发病率与过去几十年儿童肥胖症的流行密切相关。目前,NAFLD 和非酒精性脂肪性肝炎(NASH)在世界范围内越来越受到关注。尽管儿科领域的流行病学趋势令人担忧,终末期肝病的风险不断增加,但在其诊断和治疗方面并没有显著进展。

目的

为 NAFLD 和 NASH 的诊断和治疗提供详细的综述。

方法

通过使用 Pubmed 查找综述文章和相关研究。

结果

总体而言,儿童中患病率至少为 3%,肥胖儿童中约为 50%。非侵入性生物标志物可用于识别 NAFLD/NASH 患者。基于高危儿童生化和免疫学指标的诊断标准可以防止约一半的患者接受侵入性检查。药物和手术干预在儿科 NAFLD 中的作用越来越大。新型治疗方法,如益生菌,几乎没有被研究过。

结论

在高危人群中使用非侵入性筛查方法进行早期诊断是防治 NAFLD 的最有效策略。早期生长发育的生物学,包括肝脏代谢,可能是儿童 NAFLD 的关键。预防超重儿童和儿童肥胖无疑是治疗 NAFLD 的最佳策略。

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