肥胖儿童黑棘皮伴非酒精性脂肪性肝病的临床探析

摘要 目的：探讨黑棘皮（AN）结合非酒精性脂肪性肝病（NAFLD）的检测对于早期发现肥胖儿童代谢紊乱的意义。方法：132例肥胖儿童根据AN及NAFLD的出现情况分为AN伴NAFLD（A组），AN组（B组）及NAFLD组（C组），无AN无NAFLD组（D组），比较4组间体质指数（BMI）、腰围（WC）、空腹血糖（FPG）、三酰甘油（TG）、高密度脂蛋白（HDL）、收缩压（SBP）、舒张压（DBP）、空腹胰岛素（FINS）、胰岛素抵抗指数（HOMA-IR）及4组间代谢综合征（MS）检出率。结果：⑴A组BMI、WC、FINS、HOMA-IR高于B、C、D组，HDL低于D组，DBP 高于C、D，FPG、TG高于B、D组（P＜0.05或P＜0.01）⑵B组DBP高于D组，C组FPG、TG高于D组，B、C组WC、FINS、HOMA-IR高于D组（均P＜0.01）⑶A、B、C、D组检出MS分别为19例（45.24﹪）、5例（16.13﹪）、5例（16.67﹪）、0例(0％)，差异具有统计学意义（?2=22.539，P＜0.001）。132例肥胖儿童中AN 73例，NAFLD 72例，检出率分别为55.3﹪和54.5﹪。结论：AN合并NAFLD儿童较其他肥胖儿童代谢紊乱情况严重，临床上应引起高度重视。

Clinical Study on Acanthosis Nigricans and Non-Alcoholic Fatty Liver Disease in Obese Children

Objective: To explore the significance of detecting acanthosis nigricans (AN) and non-alcoholic fatty liver disease (NAFLD) in early diagnosis of metabolic disorders in obese children. Methods: According to the presence of AN and/or NAFLD, 132 obese children were divided into four groups: children with AN and NAFLD(group A), children with AN but without NAFLD (group B), children with NAFLD but without AN (group C) and children without AN and NAFLD (group D). The values of body mass index (BMI), waist circumference (WC), fasting plasma glucose (FPG), triglyceride (TG), high density lipoprotein (HDL), systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting insulin (FINS) and homeostasis model of insulin resistance (HOMA-IR) were detected and compared between 4 groups. The prevalence of metabolic syndrome (MS) were also compared between the four groups. Results: ⑴ The values of BMI, WC, FINS and HOMA-IR were significantly higher in group A than those of group B, group C and group D. The level of HDL was significantly lower in group A than that of B, C and D groups. The level of DBP was higher in group A than that of group C and group D. The levels of FPG and TG were significantly higher in group A than those of B and D groups (P < 0.05 or P < 0.01). ⑵ The level of DBP was significantly higher in group B compared with that of group D. The values of FPG and TG were significantly higher in group C than those of group D. The values of WC, FINS and HOMA-IR were significantly higher in group B and group C than those of group D(P < 0.05 or P < 0.01). ⑶ The detection rates of prevalence of MS were 19 (45.24%), 5(16.13%), 5(16.67%) and 0 in group A, group B, group C and group D, respectively. The differences were significant between groups(χ2 = 22.539,P < 0.001). Conclusion: We should pay more attention to the obese children with AN and NAFLD because of more serious metabolic disorders in them.