ÇOCUKLARDA ALKOLİK OLMAYAN YAĞLI KARACİĞER HASTALIĞI

Yıl 2014, Cilt: 4 Sayı: 1, 55 - 61, 06.08.2014

Meltem Uğraş Öznur Küçük , Suat Biçer Ayça Vitrinel

https://doi.org/10.16919/btd.90084

Cited By: 1

https://izlik.org/JA62BA54HG

Öz

Gelişen yaşam koşulları ile obezite ve komplikasyonları da artmaktadır. Alkolik Olmayan Yağlı Kara- ciğer Hastalığı (AOYKH)/ Alkolik Olmayan Steatohepatit (AOSH) gerçek prevalansı tahmin edilenin daha üzerindedir. Tanının tesadüfen konulduğu ancak çocukluk çağında nadiren de siroza neden olan bu hastalık, rutin muayene sırasında artmış ALT/AST oranı, ultrason (USG) de belirgin karaci- ğer ile tanınabilir. Karaciğer biyopsisi özellikli hastalarda tanı koymada altın standarttır. Klinik gidiş hakkında net veriler yoktur. Obezite, insülin direnci ve dislipidemi durumlarında histolojik bulgular daha ilerlemiştir ve prognoz daha kötü olabilir. İzole yağlanma en iyi prognoza sahip iken, fibrozisin eşlik ettiği hepatosit hasarı varlığında prognoz daha kötüleşmektedir. Karaciğer biyopsisi sırasında hastaların %7-16’sında siroz gelişmiştir. Tedavide kilo verme ve egzersiz en önemli rolü oynamakta- dır. İlaçlar konusunda çocuklarda kesinleşmiş veriler yoktur.

Anahtar Kelimeler

Çocuk , Non-alkolik yağlı karaciğer hastalığı , Siroz

Kaynakça

• Cortez-Pinto H, Camilo ME. Non-alcoholic fatty liver disease/non-alcoholic steatohepatitis (NAFLD/
• NASH): diagnosis and clinical course. Best Pract Res Clin Gastroenterol. 2004;18 (6):1089-104.
• Sathya P, Martin S, Alvarez F. Nonalcoholic fatty liver disease (NAFLD) in children. Curr Opin Pediatr 2002;14 (5):593-600.
• Leevy C. Fatty Liver. A study of 270 patients with biopsy proven fatty liver and review of the literature. Medicine.1962;41 (1):249-76.
• Ludwig J, Viggiano TR, McGill DB, Oh BJ. Non alcoholic steatohepatitis:Mayo clinic experiences with a hitherto unnamed disease. Mayo Clin Proc.1980;55 (7):434-8.
• Portincasa P, Grattagliano I, Palmieri Vo, Palasciano
• G. Nonalcoholic steatohepatitis: recent advances fron experimental models to clinical management. Clin Biochem. 2002;38 (3):203-17.
• Kimm SY, Barton BA, Obarzanek E, McMahon RP, Kronsberg SS, Waclawiw MA, et al. Obesity development during adolescence in a biracial cohort: the NHLBI Growth and Health Study. Pediatrics. 2002;110 (5):54.
• Livingstone B. Epidemiology of childhood obesity in Europe. Eur J Pediatr. 2000;159 (1):14-34.
• Kanbur NO, Derman O, Kinik E. Prevalence of obesityin adolescents and the impact of sexual maturation stage on body mass index in obese adolescents. Int J Adolesc Med Health. 2002;14 (1):61-5.
• Moran JR, Ghishan FK, Halter SA, Greene HL. Steatohepatitis in obese children: a cause of chronic liver dysfunction. Am J Gastroenterol. 1983;78 (6):374-7.
• Baldridge AD, Perez-Atayde AR, Graeme-Cook F, Higgins L, Lavine JE. Idiopathic steatohepatitis in childhood:
• a multicenter retrospective study. J Pediatr. 1995;127 (5):700-4.
• Nonomura A, Mizukami Y, Unoura M, Kobayashi K, Takeda Y, Takeda R. Clinicopathologic study of alcohol-like liver disease in nonalcoholics;non-alcoholic steatohepatitis and fibrosis. Gastroenterol Jpn.1992;27 (4):521-8.
• Propst A, Propst T, Judmaier G, Vogel W. Prognosis in nonalcoholic steatohepatitis. Gastroenterology. 1995;108 (5):1607.
• Clark JM, Brancati FL, Diehl AM. The prevalence and etiology of elevated aminotransferase levels in the United States. Am J Gastroenterol. 2003;98 (5):960-7.
• Reilly JJ, Dorosty AR. Epidemic of obesity in UK children. Lancet. 1999:354(9193);1874-5.
• Strauss RS, Barlow SE, Dietz WH: Prevalence of abnormal serum aminotransferase values in overweight and obese adolescents. J Pediatr. 2000;136 (6):727-33.
• Tominaga K, Kurata JH, Chen YK, Fujimoto E, Miyagawa S, Abe I, et al. Prevalence of fatty liver in Japanese children
• and relation to obesity: an epidemiological Ultrasonographic survey. Dig Dis Sci. 1995;40 (9):2002-9.
• Chan DF, Li AM, Chu WC, Chan MH, Wong EM, Liu EK, et al. Hepatic steatosis in obese Chinese children. Int J Obes Relat Metab Disord. 2004;28 (10):1257-63.
• Arslan N, BBüyükgebiz B, Öztürk Y, Çakmakçı H. Fatty liver in obese children: prevalence and correlation with anthropometricmeasurements and hyperlipidemia. Turk J Pediatr. 2005;47 (1): 23-7.
• Day CP, James OF. Steatohepatitis: a tale of two “hits?”. Gastroenterology.1998;114 (4):842-5.
• Diehl AM. Hepatic Complications of Obesity. Gastroenterol Clin N Am. 2005;34 (1):45-61.
• Brunt EM, Janney CG, Di Bisceglie AM, Neuschwander- Tetri BA, Bacon BR. Nonalcoholic steatohepatitis: a proposal for grading and staging the histological lesions. Am J Gastroenterol. 1999;94 (9):2467-74.
• Donnelly KL, Smith CI, Schwarzenberg SJ, Jessurun J, Boldt MD, Parks EJ. Sources of fatty acids stored in liver and secreted via lipoproteins in patients with nonalcoholic fatty liver disease. J Clin Invest. 2005;115 (5):1343-51.
• Musso G, Gambino R, De Michieli F, Cassader M, Rizzetto M, Durazzo M, et al. Dietary habits and their relations to insulinresistance and postprandial lipemia in nonalcoholic steatohepatitis. Hepatology. 2003;37 (4):909-16.
• Huang J, Iqbal J, Saha PK, Liu J, Chan L, Hussain MM, et al. Molecular characterization of the role of orphan receptor small heterodimer partner in development of fatty liver. Hepatology. 2007;46 (1):147-57.
• Letteron P, Sutton A, Mansouri A, Fromenty B, Pessayre
• D. Inhibition of microsomal triglyceride transfer protein: another mechanism for drug-induced steatosis in mice. Hepatology. 2003;38 (1):133-40.
• Gary-Bobo M, Elachouri G, Gallas JF, Janiak P, Marini P, Ravinet-Trillou C, et al. Rimonabant reduces obesity- associated hepatic steatosis and features of metabolic
• syndrome in obese Zucker fa/fa rats. Hepatology. 2007;46 (1):122-9.
• Abedin MZ, Narins SC, Park EH, Smith PR, Kirkwood
• KS. Lovastatin alters biliary lipid composition and dissolves gallstones:a long-term study in prairie dogs. Dig Dis Sci.
• ;47 (10):2192-210.
• Ip E, Farrell GC, Robertson G, Hall P, Kirsch R, Leclercq I. Central role of PPARalpha-dependent hepatic lipid turnover in dietary steatohepatitis in mice. Hepatology. 2003;38 (1):123-32.
• Kahn BB, Flier JS. Obesity and insulin resistance. J Clin Invest. 2000;106 (4):473-81.
• Krawczyk M, Bonfrate L, Portincasa P. Nonalcoholic fatty liver disease. Best Pract Res Clin Gastroenterol. 2010;24 (5):695-708.
• Diagnosis of Nonalcoholic Fatty Liver Disease in Children and Adolescents: Position Paper of the ESPGHAN Hepatology Committee. J Pediatr Gastroenterol Nutr. 2012;54 (5):700-13.
• Olcay N, Hülya G, Andrzej F , Bundak R, Gökçay G, Darendeliler F ve ark. Türk çocuklarında vücut ağırlığı, boy uzunluğu, baş çevresi ve vücut kitle indeksi referans
• değerleri. Çocuk Sağlığı ve Hastalıkları Dergisi. 2008;51(1):1- 14.
• -
• Taylor RW, Jones IE, Williams SM, Goulding A. Evaluation of waist circumference, waist-to-hip ratio, and the conicity index as screening tools for high trunk fat mass, as measured by dual-energy X-ray absorptiometry, in children aged 3–19 y. Am J Clin Nutr. 2000;72 (2):490-5.
• Moreno LA, Pineda I, Rodrı´guez G, et al. Waist circumference for the screening of the metabolic syndrome in children. Acta Paediatr. 2002;91 (12):1307-12.
• Lin YC, Chang PF, Yeh SJ, Liu K, Chen HC. Risk factors for liver steatosis in obese children and adolescents. Pediatr Neonatol. 2010;51 (3):149-54.
• Manco M, Bedogni G, Marcellini M, Devito R, Ciampalini P, Sartorelli MR, et al. Waist circumference correlates with liver fibrosis in children with non-alcoholic steatohepatitis. Gut. 2008; 57(9):1283-7.
• Shannon A, Alkhouri N, Carter-Kent C, Monti L, Devito R, Lopez R, et al. Ultrasonographic quantitative estimation of hepatic steatosis in children With NAFLD. J Pediatr Gastroenterol Nutr. 2011;53(2):190-5.
• Prasad SR, Wang H, Rosas H, Menias CO, Narra VR, Middleton WD, et al. Fat-containing lesions of the
• liver: radiologic-pathologic correlation. Radiographics. 2005;25(2):321-31.
• Noworolski SM, Lam MM, Merriman RB, Ferrell L, Qayyum A. Liver Steatosis: Concordance of MR Imaging and MR Spectroscopic Data with Histologic Grade. Radiology. 2012;264(1):88-96.
• Roberts EA. Pediatric nonalcoholic fatty liver disease (NAFLD):a ‘‘growing’’ problem? J Hepatol. 2007;46(6):1133- 42.
• Sobaniec-Lotowska ME, Lebensztejn DM. Ultrastructure of hepatocyte mitochondria in nonalcoholic steatohepatitis in pediatric patients: usefulness of electron microscopy in the diagnosis of the disease. Am J Gastroenterol. 2003;98 (7):1664-5.
• Socha P, Horvath A, Vajro P, Dziechciarz P, Dhawan A, Szajewska H. Pharmacological interventions for nonalcoholic fatty liver disease in adults and in children: a systematic review. J Pediatr Gastroenterol Nutr. 2009;48(5):587-96.
• Peng L, Wang J, Li F. Weight reduction for non- alcoholic fatty liver disease. Cochrane Database Syst Rev. 2011;15(6):CD003619. Doi: 10.1002/14651858.
• Lavine JE, Schwimmer JB, Van Natta ML, Molleston JP, Murray KF, Rosenthal P, et al. Effect of vitamin E or metformin for treatment of non-alcoholic fatty liver
• disease in children and adolescents: the TONIC randomized controlled trial. JAMA 2011;305(16):1659-68.