肥胖儿童非酒精性脂肪肝病与心血管疾病的相关性

目的：探讨肥胖儿童非酒精性脂肪肝病（NAFLD）与心血管疾病(CVD)的关系。方法：231例肥胖儿童以及24例非肥胖儿童(对照组)进行临床、生化指标及颈动脉内膜-中层厚度（IMT）各项检查，根据诊断标准将231例肥胖儿童分为肥胖无肝脏损伤组（OCWLD）75例和NAFLD组156例。比较各组儿童临床、生化各项指标及IMT。结：果NAFLD组患儿IMT为0.066±0.021 cm,显著高于OCWLD组和对照组（分别为0.060±0.011 cm，0.037±0.007 cm，均P＜0.05）,OCWLD组亦显著高于对照组，P<0.05。NAFLD组患儿高血压、高脂血症患病率分别为39.7%和40.4%，明显高于OCWLD组（分别为22.7%，29.3%）和正常对照组（分别为4.2%，12.6%）（P<0.05）。经逐步线性回归分析显示IMT与BMI、NAFLD、ALT呈正相关（调整R2=0.316，P<0.01）。结论：肥胖儿童NAFLD的出现不仅是CVD发生的早期标志，而且是CVD发生的早期状态。NAFLD的早期诊断和治疗是预防心血管疾病发生发展的关键。［中国当代儿科杂志，2010，12（7）：547-550］

Relationship between nonalcoholic fatty liver disease and cardiovascular disease in children with obesity

Objective To study the relationship between nonalcoholic fatty liver disease(NAFLD) and the development of cardiovascular disease(CVD) in children with obesity.Methods Two hundred and thirty-one obese children and 24 non-obese children as control were enrolled.Body mass index(BMI),serum triglyceride,blood pressure,liver function,and carotid artery intima-media thickness(IMT) were examined.The obese children were classified into two subgroups according to the diagnosis criteria:group 1 without liver disorder(OCWLD group,n = 75) and group 2 with NAFLD(NAFLD group,n = 156).The incidences of hyperlipidemia and hypertension,carotid artery intima-media thickness(IMT) and biochemical indicators were compared in the three groups.Results The NAFLD group showed significantly greater carotid IMT(0.066 ± 0.021 cm) than the OCWLD(0.060 ± 0.011 cm) and control groups(0.037 ± 0.007 cm)(P < 0.05).The OCWLD group had also thicker IMT than the control group(P < 0.05).The incidences of hyperlipidemia and hypertension were 39.7% and 40.4%,respectively in the NAFLD group,which were significantly higher than those in the OCWLD(22.7% and 29.3% respectively) and control groups(4.2% and 12.6% respectively)(P < 0.05).The liner stepwise regression analysis showed that the IMT was positively correlated with BMI,NAFLD and ALT(adjusted R2 = 0.316,P < 0.01).Conclusions NAFLD may be not only an early marker but also an early state of CVD in obese children.Early diagnosis and treatment of NAFLD is crucial for the prevention of the occurrence and development of CVD.