Corte Claudia Della, Ferrari Federica, Villani Alberto, Nobili Valerio
Hepato-Metabolic Department, »Bambino Gesù« Children's Hospital, Rome, Italy.
Pediatric Department, Pediatric Gastroenterology and Liver Unit, Umberto I Hospital, Sapienza University of Rome, Italy.
J Med Biochem. 2015 Jan;34(1):13-17. doi: 10.2478/jomb-2014-0049. Epub 2014 Oct 8.
Paralleling the growing prevalence of obesity and metabolic syndrome, nonalcoholic fatty liver disease (NAFLD) is emerging as the most frequent hepatopathy in adults and children. The true prevalence of pediatric NAFLD is still unknown, because of the heterogeneity of diagnostic methods used for diagnosis in the available studies and the different characteristics of the populations evaluated. Pediatric NAFLD is typically of primary origin and it is strongly associated with several features of the metabolic syndrome. Age, gender and race/ethnicity are significant determinants of risk, and sex hormones, insulin sensitivity and adipocytokines are implicated in the pathogenesis of pediatric NAFLD. The natural history of NAFLD in children is still poorly understood, because of its complex nature and the scarcity of prospective studies, especially in pediatric populations. Both genetic and environmental factors seem to be implicated in the development and progression of the disease via multiple mechanisms that involve liver crosstalk with other organs and tissues, especially gut and adipose tissue. To evaluate and effectively treat pediatric NAFLD, the pathophysiology and natural history of the disease should be clarified and noninvasive methods for screening, diagnosis, and longitudinal assessment developed.
与肥胖和代谢综合征患病率不断上升相平行的是，非酒精性脂肪性肝病（NAFLD）正成为成人和儿童中最常见的肝病。由于现有研究中用于诊断的方法存在异质性以及所评估人群的不同特征，儿童NAFLD的真实患病率仍不清楚。儿童NAFLD通常为原发性，并且与代谢综合征的几个特征密切相关。年龄、性别和种族/族裔是风险的重要决定因素，性激素、胰岛素敏感性和脂肪细胞因子与儿童NAFLD的发病机制有关。由于其性质复杂且前瞻性研究稀缺，尤其是在儿科人群中，儿童NAFLD的自然病程仍知之甚少。遗传和环境因素似乎都通过多种机制参与了该疾病的发生和发展，这些机制涉及肝脏与其他器官和组织（尤其是肠道和脂肪组织）的相互作用。为了评估和有效治疗儿童NAFLD，应阐明该疾病的病理生理学和自然病程，并开发用于筛查、诊断和纵向评估的非侵入性方法。
