Mărginean Cristina Oana, Meliț Lorena Elena, Săsăran Maria Oana
Department of Pediatrics I, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No 38, 540136 Târgu Mureș, Romania.
Department of Pediatrics III, George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Gheorghe Marinescu Street No 38, 540136 Târgu Mureș, Romania.
Biomedicines. 2021 Dec 9;9(12):1866. doi: 10.3390/biomedicines9121866.
Non-alcoholic fatty liver disease has become the most common chronic liver disease in children due to the alarmingly increasing incidence of pediatric obesity. It is well-documented that MAFLD prevalence is directly related to an incremental increase in BMI. The multiple hits theory was designed for providing insights regarding the pathogenesis of steatohepatitis and fibrosis in MAFLD. Recent evidence suggested that the microbiome is a crucial contributor in the pathogenesis of MAFLD. Aside from obesity, the most common risk factors for pediatric MAFLD include male gender, low-birth weight, family history of obesity, MAFLD, insulin resistance, type 2 diabetes mellitus, obstructive sleep apnea, and polycystic ovarium syndrome. Usually, pediatric patients with MAFLD have nonspecific symptoms consisting of fatigue, malaise, or diffuse abdominal pain. A wide spectrum of biomarkers was proposed for the diagnosis of MAFLD and NASH, as well as for quantifying the degree of fibrosis, but liver biopsy remains the key diagnostic and staging tool. Nevertheless, elastography-based methods present promising results in this age group as potential non-invasive replacers for liver biopsy. Despite the lack of current guidelines regarding MAFLD treatment in children, lifestyle intervention was proven to be crucial in the management of these patients.
由于儿童肥胖发病率惊人地上升，非酒精性脂肪性肝病已成为儿童中最常见的慢性肝病。有充分的文献记载，MAFLD患病率与BMI的逐渐增加直接相关。多重打击理论旨在为MAFLD中脂肪性肝炎和纤维化的发病机制提供见解。最近的证据表明，微生物群是MAFLD发病机制中的一个关键因素。除肥胖外，儿童MAFLD最常见的危险因素包括男性、低出生体重、肥胖家族史、MAFLD、胰岛素抵抗、2型糖尿病、阻塞性睡眠呼吸暂停和多囊卵巢综合征。通常，患有MAFLD的儿科患者有非特异性症状，包括疲劳、不适或弥漫性腹痛。人们提出了各种各样的生物标志物用于MAFLD和NASH的诊断，以及量化纤维化程度，但肝活检仍然是关键的诊断和分期工具。然而，基于弹性成像的方法在这个年龄组中显示出有希望的结果，作为肝活检的潜在非侵入性替代方法。尽管目前缺乏关于儿童MAFLD治疗的指南，但生活方式干预已被证明对这些患者的管理至关重要。
