Temple Jonathan L, Cordero Paul, Li Jiawei, Nguyen Vi, Oben Jude A
Faculty of Life Sciences and Medicine, King's College London, Strand, London WC2R 2LS, UK.
Institute for Liver and Digestive Health, University College London, Rowland Hill Street, London NW3 2PF, UK.
Int J Mol Sci. 2016 Jun 15;17(6):947. doi: 10.3390/ijms17060947.
Non-Alcoholic Fatty Liver Disease (NAFLD) is now the most prevalent form of chronic liver disease, affecting 10%-20% of the general paediatric population. Within the next 10 years it is expected to become the leading cause of liver pathology, liver failure and indication for liver transplantation in childhood and adolescence in the Western world. While our understanding of the pathophysiological mechanisms underlying this disease remains limited, it is thought to be the hepatic manifestation of more widespread metabolic dysfunction and is strongly associated with a number of metabolic risk factors, including insulin resistance, dyslipidaemia, cardiovascular disease and, most significantly, obesity. Despite this, "paediatric" NAFLD remains under-studied, under-recognised and, potentially, undermanaged. This article will explore and evaluate our current understanding of NAFLD in childhood and adolescence and how it differs from adult NAFLD, in terms of its epidemiology, pathophysiology, natural history, diagnosis and clinical management. Given the current absence of definitive radiological and histopathological diagnostic tests, maintenance of a high clinical suspicion by all members of the multidisciplinary team in primary and specialist care settings remains the most potent of diagnostic tools, enabling early diagnosis and appropriate therapeutic intervention.
非酒精性脂肪性肝病（NAFLD）现已成为最常见的慢性肝病形式，影响着10%-20%的普通儿科人群。预计在未来10年内，它将成为西方世界儿童和青少年肝脏病理、肝衰竭及肝移植指征的主要原因。尽管我们对该疾病潜在的病理生理机制的了解仍然有限，但它被认为是更广泛代谢功能障碍的肝脏表现，并且与多种代谢危险因素密切相关，包括胰岛素抵抗、血脂异常、心血管疾病，以及最显著的肥胖。尽管如此，“儿科”NAFLD仍然研究不足、认识不足，而且可能管理不到位。本文将探讨和评估我们目前对儿童和青少年NAFLD的理解，以及它在流行病学、病理生理学、自然史、诊断和临床管理方面与成人NAFLD的差异。鉴于目前缺乏明确的放射学和组织病理学诊断测试，初级和专科护理环境中的多学科团队所有成员保持高度的临床怀疑仍然是最有效的诊断工具，能够实现早期诊断和适当的治疗干预。
