Arata Mikage, Nakajima Junya, Nishimata Shigeo, Nagata Tomomi, Kawashima Hisashi
Mikage Arata, Junya Nakajima, Shigeo Nishimata, Tomomi Nagata, Hisashi Kawashima, Department of Pediatrics, Tokyo Medical University, Tokyo 160-0023, Japan.
World J Diabetes. 2014 Dec 15;5(6):917-23. doi: 10.4239/wjd.v5.i6.917.
Various pathological conditions can cause fatty liver in children. Nonalcoholic steatohepatitis (NASH) in children has been known since 1983. However, NASH diagnosed in childhood does not have a favorable outcome. The pathological characteristics of NASH are significantly different between children and adults. Nonalcoholic fatty liver disease (NAFLD)/NASH is accompanied by insulin resistance, which plays a pivotal role in its pathophysiology in both children and adults. In NASH, a "two-hit" model involving triglyceride accumulation (first hit) and liver damage (second hit) has been accepted. Insulin resistance was found to correlate with changes in fat levels; however, it did not correlate with fibrosis or NAFLD activity score in children. Therefore, insulin resistance may be important in the first hit. Because there is obvious familial clustering in NASH, genetic predisposition as well as environmental factors including diet might be the second hit of NAFLD/NASH.
多种病理状况可导致儿童脂肪肝。儿童非酒精性脂肪性肝炎（NASH）自1983年起就已为人所知。然而，儿童期诊断出的NASH预后不佳。儿童和成人NASH的病理特征有显著差异。非酒精性脂肪性肝病（NAFLD）/NASH伴有胰岛素抵抗，这在儿童和成人的病理生理学中都起着关键作用。在NASH中，一种涉及甘油三酯蓄积（第一次打击）和肝损伤（第二次打击）的“二次打击”模型已被认可。研究发现胰岛素抵抗与脂肪水平变化相关；然而，它与儿童的纤维化或NAFLD活动评分无关。因此，胰岛素抵抗可能在第一次打击中起重要作用。由于NASH存在明显的家族聚集性，遗传易感性以及包括饮食在内的环境因素可能是NAFLD/NASH的第二次打击。
