IDIOPATHIC STEATOHEPATITIS IN CHILDHOOD - A MULTICENTER RETROSPECTIVE STUDY
IDIOPATHIC STEATOHEPATITIS IN CHILDHOOD - A MULTICENTER RETROSPECTIVE STUDY
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DOI：
10.1016/s0022-3476(95)70156-7
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发表时间：
1995-11-01
影响因子：
5.1
通讯作者：
LAVINE, JE
中科院分区：
文献类型：
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作者：
BALDRIDGE, AD;PEREZATAYDE, AR;LAVINE, JE
目的：探讨儿童特发性脂肪性肝炎的临床、实验室和组织病理学特征。研究设计：回顾性分析1991年至1994年在波士顿儿童医院、麻省总医院和马萨诸塞大学医学中心进行的所有肝活检。当活检显示脂肪变性时，进行图表复查。结果：82例患者活检证实肝脂肪变性。14例脂肪肝患者无遗传、感染、自身免疫、内分泌、毒理学或医源性原因的证据。所有14例患者均为肥胖，平均为理想体重的159%（范围121%至222%），9例患者最初有一过性腹痛，2例肝肿大，1例通过偶然的实验室评估确定。这12例患者因转氨酶水平持续升高而行活组织检查。另外两名没有脂肪变性危险因素的患者在霍奇金淋巴瘤的剖腹手术分期中被确定。10名男孩和4名女孩的平均年龄为13.5岁（范围为10至18岁）。转氨酶的升高是适度的，天冬氨酸转氨酶和丙氨酸转氨酶的平均值分别为77 +/- 38 IU和129 +/- 73 IU。所有患者影像学检查均显示弥漫性脂肪改变。活检标本的组织学检查显示不同程度的脂肪变性伴炎症和纤维化。结论：特发性脂肪性肝炎主要或只发生在青春期周围的肥胖儿童中。这是该年龄组肝脏活检的常见原因。脂肪变性、纤维化和炎症的程度与症状或体征无关，可能存在明显的肝损伤和桥式纤维化。
Objective: To describe the clinical, laboratory, and histopathologic features of Idiopathic steatohepatitis in children.Study design: Retrospective review of all liver biopsies performed at Boston Children's Hospital, Massachusetts General Hospital, and the University of Massachusetts Medical Center from 1991 to 1994. Chart review was performed when biopsies demonstrated steatosis.Results: Eighty-two patients had biopsy-proven hepatic steatosis. Fourteen patients had fatty liver without evidence of inherited, infectious, autoimmune, endocrinologic, toxicologic, or iatrogenic causes. All 14 patients were obese, averaging 159% of ideal body weight(range, 121% to 222%), Nine patients initially had transient abdominal pain, two had hepatomegaly, and one was identified by incidental laboratory evaluation. These 12 patients had biopsies because of persistent elevations of aminotransferase levels. Two other patients without risk factors for steatosis were identified at staging laparotomy for Hodgkin lymphoma. The 10 boys and 4 girls had an average age of 13.5 years (range, 10 to 18 years). Aminotransferase elevations were modest, with aspartate aminotransferase and alanine aminotransferase values averaging 77 +/- 38 IU and 129 +/- 73 IU, respectively. All had imaging studies demonstrating diffuse fatty change. Histologic examination of biopsy specimens revealed varying degrees of steatosis with inflammation and fibrosis.Conclusion: Idiopathic steatohepatitis occurs predominantly or exclusively in obese peripubertal children. This entity represents a frequent reason far liver biopsy in this age group. The degree of steatosis, fibrosis, and inflammation does not correlate with symptoms or signs, and significant liver injury with bridging fibrosis may be present.