单纯性肥胖患儿非酒精性脂肪肝病与胰岛素抵抗

目的探讨单纯性肥胖(肥胖)儿童发生非酒精性脂肪肝病(NAFLD)的情况及与胰岛素抵抗(IR)、血脂、体质量指数(BMI)、腰臀比(WHR)的关系。方法选择肥胖儿童90例,年龄2.5～14.3岁。其中NAFLD 24例(NAFLD组),无NAFLD 66例(无NAFLD组)。另选35例年龄、性别与其相匹配的健康儿童为健康对照组。清晨空腹测量其体质量、身高、腰围和臀围,计算BMI和WHR,同时静脉采血检测其血清胰岛素(FINS)、糖(FBG)、胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和ALT、AST等,计算稳态模型胰岛素抵抗指数(HOMA-IR=FINS×FBG/22.5),并做肝胆等部位超声检查。结果 NAFLD占肥胖儿童的26.67%;NAFLD组儿童BMI、WHR最高,其次为无NAFLD组,差异均有统计学意义(Pa<0.001);3组儿童FINS和HOMA-IR值差异均有统计学意义(Pa<0.001),NAFLD组最高,其次为无NAFLD组,均明显高于健康对照组,但FBG无明显差异;NAFLD组血清TG、LDL-C和TC水平明显高于无NAFLD组和健康对照组(Pa<0.01);HOMA-IR值与BMI、WHR、血TG、LDL-C呈正相关(r=0.402、0.256、0.239、0.180,P=0.000、0.004、0.008、0.046);BMI、WHR诊断NAFLD的受试者工作特征(ROC)曲线下面积分别为0.805和0.765(Pa=0.000)。结论肥胖儿童NAFLD的发生与IR,血TG、LDL-C、TC升高及BMI、WHR增高关系密切,BMI、WHR对儿童肥胖NAFLD具有一定的诊断价值。控制体质量,减少腰围,可减轻IR,阻止NAFLD的发生、发展。

Non- Alcoholic Fatty Liver Disease and Insulin Resistance in Simple Obese Children

Objective To observe the prevalence of non-alcoholic fatty liver disease(NAFLD) in simple obese children,and to explore the relationship between NAFLD and insulin resistance(IR),blood lipid level,body mass index(BMI) and waist circumference to hip cir-cumference ratio(WHR). Methods Ninety simple obese children aged between 2.5 and 14.3 years,including 24 cases with NAFLD(NAFLD group) and 66 cases without NAFLD(no NAFLD group) were chosen,and 35 healthy children of similar age and sex(healthy control group)were enrolled in the study.Early in the morning,fasting body weights,heights,waist circumferences and hip circumferences were measured for calculation of BMI and WHR,and venous blood samples were collected for tests of serum insulin(FINS),glucose(FBG),total cholesterol(TC),triglycerides(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),alanine aminotransferase(ALT) and aspartate aminotransferase(AST),which contributed to the calculation of homeostasis model assessment-insulin resistance(HOMA-IR=FINS×FBG/22.5). Results Twenty-four cases(26.67%) had NAFLD in 90 cases of obese children;BMI and WHR were the highest in NAFLD group,followed by no NAFLD group,and there were significant differences among 3 groups(Pa<0.001);FINS and HOMA-IR were the highest in NAFLD group,followed by no NAFLD group,there were significant differences among 3 groups(Pa<0.001),but FBG was no difference among 3 groups;The serum levels of TG,LDL-C and TC in NAFLD group were obviously higher than those in no NAFLD group and healthy control group(Pa<0.01);HOMA-IR was positively related to BMI,WHR,serum TG and LDL-C(r=0.402,0.256,0.239,0.180;P=0.000,0.004,0.008,0.046);The areas under receiver operating characteristic(ROC) curve of BMI and WHR diagnosing NAFLD were 0.805 and 0.765(Pa=0.000),respectively. Conclusions NAFLD in obese children is closely related to IR,the higher levels of serum TG,TC,LDLC and BMI,WHR.BMI and WHR are valuable predictors of NAFLD.Controlling body weight and decreasing waist circumference can reduce IR and prevent NAFLD from the occurrence and development.