肥胖儿童脂肪肝与其糖脂代谢的初步探讨

目的探讨上海市部分肥胖儿童肥胖程度与脂肪肝发生率的关系以及这些儿童血清部分糖脂代谢指标改变。方法随机筛取1999年至2000年门诊体检儿童100名,同期内分泌门诊就诊单纯性肥胖儿童43名,年龄6~13岁,性别不限,无明显器质性疾病。收集病史资料,测量身高体重,B超检查肝脏,测定血清瘦素、C肽、空腹血糖、血脂(甘油三酯,胆固醇,高密度脂蛋白胆固醇,低密度脂蛋白胆固醇)。按体质指数(BMI)值和有无脂肪肝情况将这些儿童分组。比较各组血清瘦素、C肽、空腹血糖、血脂值有无差异。结果内分泌门诊就诊的肥胖儿童中脂肪肝发生率为13/43,最早发生脂肪肝年龄为7岁。脂肪肝组儿童BMI值明显高于非脂肪肝组儿童(P<0.05)。脂肪肝与非脂肪肝组肥胖儿童血脂、空腹血糖、C肽、瘦素无明显差异(P>0.05)。中重度肥胖儿童血清瘦素、C肽、空腹血糖、血脂(甘油三酯)明显升高(P<0.05)。结论中重度肥胖儿童已发生糖脂代谢紊乱,其中近1/3并发脂肪肝。BMI值可能有助于判断儿童脂肪肝的发生。

Fatty Liver and Glucose, Fat Metabolism in Obese Children

Objectives To study the incidence of fatty liver in the obese children and levels of their blood glucose,serum lipids,C peptide and leptin.Methods Serum parameters of leptin,C peptide,fast blood glucose,lipids(triglycerides,cholesterol,lipoprotein cholesterol),height and weight were measured in100healthy children,aged six to thirteen,with a wide range of body weight (body mass index,14to30kg/m 2 ).Other43obese children,consulted in the endocrine clinic,were screened for fatty liver by ultrasound.All the children were classified into three groups by the ratio of body mass index(BMI)values over ideal BMI (iBMI).Results The thirteen of the forty-three were diagnosed with fatty livers by ultrasound.The youngest with fat deposit in liver was seven years old.Obese children with fatty liver had higher body mass index value than that without fatty liver(P<0.05).The serum concentration of leptin,C peptide,blood lipids(triglycerides)in the moderate and the severe obese children were higher than those in the normal weight children(P<0.05),while HDL-c level was on the contrary.Conclusions The moderate and the severe obese children had lipid and glucose metabolic disorder,nearly one third of whom were complicated with fatty liver.BMI value might predict fat deposit in liver in children.