Papachristodoulou Angeliki, Kavvadas Dimitrios, Karamitsos Athanasios, Papamitsou Theodora, Chatzidimitriou Maria, Sioga Antonia
Laboratory of Histology and Embryology, School of Medicine, Faculty of Health, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece.
2nd Department of Ophthalmology, School of Medicine, Faculty of Health, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece.
Pediatr Rep. 2021 Jun 8;13(2):312-321. doi: 10.3390/pediatric13020039.
The increased prevalence of non-alcoholic fatty liver disease (NAFLD) requires special attention in pediatric patients, as it manifests in them in a more severe and progressive way compared to adults. The implementation of the appropriate therapeutic interventions is determinant of the attempts to treat it. For that purpose, early diagnosis and staging of the disease is essential. The purpose of this review was to find and reveal the most appropriate diagnostic strategies and tools for diagnosis and staging of pediatric NAFLD/NASH based on their accuracy, safety and effectiveness. The methodology followed was that of the literature review. Particular emphasis was put on the recent bibliography. A comparative study of published articles about the diagnosis and management of pediatric NAFLD/NASH was also performed. In terms of diagnosis, the findings converged on the use of classical ultrasound. Ultrasound presented average sensitivity and specificity for diagnosing the disease in children, while in the adult population, sensitivity and specificity were significantly higher. Proton density fat fraction magnetic resonance imaging has been increasingly used for the diagnosis of steatosis in pediatric patients. Elastography is an effective tool for staging liver fibrosis and discriminating NASH from NAFLD in children. Even though liver biopsy is the gold standard, especially for NASH, it should be avoided for pediatric patients. Biochemical tests are less specific and less sensitive for the diagnosis of NAFLD, and some of them are of high cost. It seems that diagnostic imaging should be a first-line tool for the staging and monitoring pediatric NAFLD/NASH in order for appropriate interventions to be implanted in a timely way.
非酒精性脂肪性肝病（NAFLD）患病率的上升在儿科患者中需要特别关注，因为与成人相比，它在儿科患者中表现得更为严重且呈进行性发展。实施适当的治疗干预措施是治疗该病的关键。为此，疾病的早期诊断和分期至关重要。本综述的目的是基于准确性、安全性和有效性，寻找并揭示用于儿科NAFLD/NASH诊断和分期的最合适的诊断策略和工具。所采用的方法是文献综述。特别强调了近期的文献。还对已发表的关于儿科NAFLD/NASH诊断和管理的文章进行了比较研究。在诊断方面，研究结果集中在使用经典超声。超声在诊断儿童疾病时呈现出平均敏感性和特异性，而在成人中，敏感性和特异性显著更高。质子密度脂肪分数磁共振成像越来越多地用于儿科患者脂肪变性的诊断。弹性成像对于儿童肝纤维化分期以及区分NASH和NAFLD是一种有效的工具。尽管肝活检是金标准，尤其是对于NASH，但儿科患者应避免进行。生化检测对NAFLD的诊断特异性较低且敏感性较差，并且其中一些成本较高。为了及时实施适当的干预措施，诊断成像似乎应成为儿科NAFLD/NASH分期和监测的一线工具。
