Al-Harthy Fat'hiya, Kamath Neha, Hill Lee, Popov Jelena, Bossert Allison, Brill Herbert, Pai Nikhil
From the Department of Pediatrics, Division of Gastroenterology and Nutrition, McMaster University, Hamilton, Canada.
Faculty of Science, University of Western Ontario, London, Canada.
JPGN Rep. 2022 Mar 9;3(2):e181. doi: 10.1097/PG9.0000000000000181. eCollection 2022 May.
In 2017, the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition published clinical practice guidelines for the assessment and diagnosis of nonalcoholic fatty liver disease (NAFLD). We determined how frequently these investigations suggest an alternate etiology for chronic hepatitis in 8- to 17-year-old patients with body mass index >85%, elevated alanine aminotransferase and radiographic steatosis, and rates of adherence to 2017 guidelines.
We conducted a retrospective chart review of patients presenting to McMaster Children's Hospital from 2017-2020 for evaluation of suspected NAFLD. Bloodwork was reviewed.
Ninety-five patients met inclusion criteria. Abnormal bloodwork that required further testing was found in 28.4%; a different chronic liver disease was ultimately diagnosed in 11.6%. Only 9.5% received comprehensive, additional bloodwork for other causes of liver disease.
A high proportion of patients evaluated for suspected NAFLD had bloodwork possibly suggesting an alternate diagnosis. Comprehensive testing was infrequently performed. These results reinforce the importance of maintaining a differential diagnosis among children presumed to have NAFLD.
2017年，北美儿科胃肠病学、肝病学和营养学会发布了非酒精性脂肪性肝病（NAFLD）评估和诊断的临床实践指南。我们确定了这些检查在体重指数>85%、丙氨酸氨基转移酶升高和影像学脂肪变性的8至17岁慢性肝炎患者中提示其他病因的频率，以及遵循2017年指南的比例。
我们对2017年至2020年到麦克马斯特儿童医院就诊以评估疑似NAFLD的患者进行了回顾性病历审查。对血液检查结果进行了复查。
95名患者符合纳入标准。28.4%的患者血液检查异常需要进一步检查；最终11.6%的患者被诊断为其他慢性肝病。只有9.5%的患者接受了针对其他肝病病因的全面额外血液检查。
接受疑似NAFLD评估的患者中，很大一部分患者的血液检查结果可能提示其他诊断。全面检查很少进行。这些结果强化了在疑似患有NAFLD的儿童中进行鉴别诊断的重要性。
