Hildreth Amber, Shapiro Warren L, Lowenthal Brett M, Goyal Anurag, Schwimmer Jeffrey B
From the Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of California San Diego School of Medicine, La Jolla, California.
Department of Gastroenterology, Rady Children's Hospital, San Diego, California.
JPGN Rep. 2023 Feb 28;4(2):e292. doi: 10.1097/PG9.0000000000000292. eCollection 2023 May.
Screening children with obesity for nonalcoholic fatty liver disease leads to identification of elevated alanine aminotransferase (ALT) and is a common cause for referral to pediatric gastroenterology. Guidelines recommend that children with positive screening ALT be evaluated for causes of ALT elevation beyond nonalcoholic fatty liver disease. One clinical challenge is that autoantibodies can be present in patients with obesity and thus may or may not represent autoimmune hepatitis. This case series highlights the importance of a comprehensive evaluation to reach an accurate diagnosis.
对肥胖儿童进行非酒精性脂肪性肝病筛查可发现丙氨酸氨基转移酶（ALT）升高，这是转诊至儿科胃肠病学的常见原因。指南建议，对ALT筛查呈阳性的儿童，除了非酒精性脂肪性肝病外，还应评估ALT升高的其他原因。一个临床挑战是，肥胖患者体内可能存在自身抗体，因此这些抗体可能代表自身免疫性肝炎，也可能不代表。本病例系列强调了进行全面评估以做出准确诊断的重要性。
