Liver Research Unit, Bambino Gesù Children's Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Piazza Sant'Onofrio 4, 00165 Rome, Italy.
Nat Rev Gastroenterol Hepatol. 2012 Jan 17;9(3):152-61. doi: 10.1038/nrgastro.2011.273.
Nonalcoholic fatty liver disease (NAFLD) is a multifactorial condition, ranging from simple steatosis to nonalcoholic steatohepatitis (NASH) with or without fibrosis. NAFLD affects both adults and children who present with particular risk factors, including obesity, sedentary lifestyle and/or a predisposing genetic background. The escalation of the prevalence of NAFLD in children worldwide is a worrying phenomenon because this disease is closely associated with the development of both cirrhosis and cardiometabolic syndrome in adulthood. The etiopathogenesis of primary NAFLD in children is unknown; however, considerable knowledge about the mechanisms of liver damage that occur during disease progression has been gathered over the past 30 years. Understanding the pathogenetic mechanisms, together with the histological pattern, provide the basis to characterize potential early predictors of the disease, suitable noninvasive diagnostic tools and design novel specific treatments and possible management strategies. Despite a few clinical trials on the use of antioxidants combined with lifestyle intervention for NAFLD that showed encouraging results, to date, no treatment guidelines exist for children with NAFLD. In this Review, we provide an overview of current concepts in epidemiology, histological features, etiopathogenesis, diagnosis and treatment of NAFLD in children and adolescents.
非酒精性脂肪性肝病（NAFLD）是一种多因素疾病，从单纯性脂肪变性到伴有或不伴有纤维化的非酒精性脂肪性肝炎（NASH）不等。NAFLD 影响成年人和儿童，他们具有特定的风险因素，包括肥胖、久坐的生活方式和/或易患遗传背景。全球儿童中 NAFLD 的患病率不断上升是一个令人担忧的现象，因为这种疾病与成年期肝硬化和代谢综合征的发展密切相关。儿童原发性 NAFLD 的病因发病机制尚不清楚；然而，在过去 30 年中，人们对疾病进展过程中发生的肝损伤机制有了相当多的了解。了解发病机制以及组织学模式为确定疾病的潜在早期预测指标、合适的非侵入性诊断工具以及设计新的特异性治疗方法和可能的管理策略提供了基础。尽管有几项关于抗氧化剂联合生活方式干预治疗 NAFLD 的临床试验结果令人鼓舞，但迄今为止，尚无针对儿童 NAFLD 的治疗指南。在这篇综述中，我们概述了儿童和青少年 NAFLD 的流行病学、组织学特征、病因发病机制、诊断和治疗的最新概念。
