中国实用儿科杂志 ›› 2025, Vol. 40 ›› Issue (7): 601-607.DOI: 10.19538/j.ek2025070614

• 病例报告 • 上一篇    下一篇

婴儿期脂肪性肝病 3 例报告

  

  1. 华中科技大学同济医学院附属同济医院儿科,湖北  武汉  430030
  • 出版日期:2025-07-06 发布日期:2025-09-02
  • 通讯作者: 舒赛男,电子信箱:shusainan@163.com

Report on 3 cases of infantile fatty liver disease

  1. Department of Pediatrics,Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology,Wuhan  430030,China
  • Online:2025-07-06 Published:2025-09-02

摘要:

回顾性分析2018—2023年3例不同病因所致婴儿期脂肪性肝病的临床表现、血生化指标、肝组织病理特征、基因检测及随访结果。结合相关文献,探究婴儿期脂肪性肝病诊治策略,为婴儿期脂肪性肝病的早期准确诊断及改善预后提供参考。结果发现3例中男2例、女1例,起病年龄2~7月龄,例1和例3首发症状为胆汁淤积,例2为肝酶异常。主要临床表现及辅助检查特征:病例1为胆汁淤积,肝酶升高,甲胎蛋白水平升高,低血糖,凝血功能紊乱,高瓜氨酸血症,肝肿大和肝脂肪变性,SLC25A13基因纯合变异 c.852-855del。病例2为肝酶升高,高甘油三酯血症,总胆汁酸和血胆红素升高,并伴有肝肿大、肝脂肪变性和肝纤维化,GPD1基因杂合变异 c.220-2A>G 和 c.806G>A(p.R269Q)。病例3为胆汁淤积,肝酶升高,凝血功能异常,肝肿大和脂肪变性,并伴有神经病变表现,MPV17基因纯合变异 c.207G>C(p.W69C)。患儿给予饮食管理及护肝利胆治疗后,病例1和病例2恢复良好,病例3因肝衰竭死亡。由此认为,婴儿期脂肪性肝病病因复杂,临床诊治需充分综合其生化指标、凝血功能及体格检查,基因检测有助于明确病因。

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Abstract:

A retrospective analysis was conducted concerning the clinical manifestations,biochemical indicators,liver tissue pathology features,genetic testing,and follow-up results of infantile fatty liver disease caused by different etiologies in 3 cases collected from 2018 to 2023.Additionally,relevant literature was reviewed to explore diagnostic and therapeutic strategies for infantile fatty liver disease, in order to provide reference for early accurate diagnosis and improving prognosis of infantile fatty liver disease The results showed that among the three cases,two were male and one was female,with onset age ranging from 2 to 7 months.Case 1 and Case 3 initially presented with cholestasis,while Case 2 presented with abnormal transaminase levels.The primary clinical manifestations and auxiliary examination features included:Case 1 was with cholestasis,elevated transaminases,increased AFP levels,hypoglycemia,coagulation dysfunction,hyperornithinemia,hepatomegaly and hepatic steatosis,harboring a homozygous mutation c.852-855del in the SLC25A13 gene.Case 2 presented with elevated transaminases,hypertriglyceridemia,increased total bile acids and bilirubin,along with hepatomegaly,hepatic steatosis,and liver fibrosis,having a heterozygous mutation c.220-2A>G and c.806G>A(p.R269Q)in the GPD1 gene.Case 3 exhibited cholestasis,elevated transaminases,coagulation dysfunction,hepatomegaly,and steatosis,accompanied by neurological symptoms,with a homozygous mutation c.207G>C(p.W69C)in the MPV17 gene.After dietary management and hepatoprotective and choleretic treatment,Cases 1 and 2 recovered well,while Case 3 died of liver failure. The causes of infantile fatty liver disease are complex,and clinical diagnosis and treatment require a comprehensive assessment of biochemical indicators,coagulation function,and physical examination. Genetic testing helps to clarify the etiology.

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