The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years.
The natural history of non-alcoholic fatty liver disease in children: a follow-up study for up to 20 years.
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DOI：
10.1136/gut.2008.171280
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发表时间：
2009-11
期刊：
影响因子：
24.5
通讯作者：
Angulo P
中科院分区：
文献类型：
--
作者：
Feldstein AE;Charatcharoenwitthaya P;Treeprasertsuk S;Benson JT;Enders FB;Angulo P
儿童非酒精性脂肪性肝病（NAFLD）的长期预后仍不确定。我们旨在确定NAFLD儿童的长期结局和生存率。回顾性纵向医院队列研究。66名NAFLD儿童（平均年龄13.9±3.9岁）接受了长达20年的随访，总随访时间为409.6人年。在NAFLD诊断时，19名（29%）儿童存在代谢综合征，55名（83%）儿童至少存在一种代谢综合征特征，包括肥胖、高血压、血脂异常和/或高血糖。4名基线空腹血糖正常的儿童在NAFLD诊断后4-11年发展为II型糖尿病。在平均41.4±28.8个月的时间内，从5名患者中共获得13份肝活检，显示4名儿童的纤维化阶段进展。在随访期间，两名儿童死亡，两名因失代偿性肝硬化接受肝移植。与相同年龄和性别的美国一般人群的预期生存率相比，NAFLD队列中观察到的无肝移植生存率显著较短（对数秩检验，p<0.00001），标准化死亡率为13.6（95% CI 3.8，34.8）。2例移植患者的同种异体移植物中NAFLD复发，1例进展为肝硬化，需要再次移植。患有NAFLD的儿童可能会发展为终末期肝病，从而需要进行肝移植。与一般人群相比，在三级护理中心就诊的儿童NAFLD可能与生存期显著缩短相关。
The long-term prognosis of nonalcoholic fatty liver disease (NAFLD) in children remains uncertain. We aimed at determining the long-term outcomes and survival of children with NAFLD. Retrospective longitudinal hospital-based cohort study. Sixty-six children with NAFLD (mean age 13.9±3.9 years) were followed-up for up to 20 years with a total of 409.6 person-years of follow-up. The metabolic syndrome was present in 19 (29%) children at the time of NAFLD diagnosis with 55 (83%) presenting with at least one feature of the metabolic syndrome including obesity, hypertension, dyslipidemia and/or hyperglycemia. Four children with baseline normal fasting glucose developed type II diabetes 4-11 years after NAFLD diagnosis. A total of 13 liver biopsies were obtained from five patients over a mean of 41.4±28.8 months showing progression of fibrosis stage in four children. During follow-up, two children died and two underwent liver transplantation for decompensated cirrhosis. The observed survival free of liver transplantation was significantly shorter in the NAFLD cohort as compared to the expected survival in the general United States population of the same age and sex (log-rank test, p<0.00001), with a standarized mortality ratio of 13.6 (95% CI 3.8, 34.8). NAFLD recurred in the allograft in the two cases transplanted, with one case progressing to cirrhosis and requiring re-transplantation. Children with NAFLD may develop end-stage liver disease with the consequent need for liver transplantation. NAFLD in children seen in a tertiary care center may be associated with a significantly shorter survival as compared to the general population.
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影响因子：
29.4
作者：
Day, CP
通讯作者：
Day, CP
影响因子：
5.1
作者：
BALDRIDGE, AD;PEREZATAYDE, AR;LAVINE, JE
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LAVINE, JE
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13.5
作者：
Kleiner, DE;Brunt, EM;Sanyal, AJ
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Sanyal, AJ
影响因子：
9.8
作者：
Adams, LA;Lindor, KD;Angulo, P
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影响因子：
8.2
作者：
Lee, DH;Ha, MH;Jacobs, DR
通讯作者：
Jacobs, DR