肥胖儿童脂肪肝与胰岛素抵抗的关系

目的了解肥胖儿童非酒精性脂肪肝(NASH)的发病情况及与胰岛素抵抗的关系。方法对125例肥胖儿童行肝脏B超检查及血生化检查;对其中36例肥胖伴NASH儿童和41例无并发症的单纯肥胖儿童,以及22例对照儿童空腹行口服葡萄糖耐量和胰岛素释放试验,计算体重指数(BMI)、稳态模型胰岛素抵抗指数(HOMA蛳IR)、总体胰岛素敏感指数(WBISI)和葡萄糖、胰岛素曲线下面积之比(AUCINS/AUCBG)。结果NASH在肥胖儿童中的发生率为28.8%;NASH组BMI、HOMA蛳IR、AUCINS/AUCBG均明显高于单纯肥胖组和对照组熏WBISI明显低于单纯肥胖组和对照组;单纯肥胖组HOMA蛳IR、AUCINS/AUCBG均明显高于对照组。结论肥胖儿童中NASH发生率较高;NASH儿童存在严重的胰岛素抵抗,胰岛素抵抗可能是NASH重要发病机制之一。

Study of the relationship between the insulin resistance and nonalcoholic steatohepatitis in obese children

Objectives To investigate the prevalence of nonalcoholic steatohepatitis(NASH)in obese children and the relationship between the disease and insulin resistance.Methods One hundred and twenty five obese and 22 normal children were enrolled in the study from 1st June 2003 to 1st June in 2004.Ultrasonographic and biochemical parameters were assayed in these obese children.Oral glucose tolerance test and insulin releasing test were performed in 36 of the obese children accompanied with NASH(NASH group),41 simple obese children without any complication(simple obese group),and 25 normal children (control group).The body mass index(BMI),homeostasis model assessment-insulin resistance(HOMA-IR),whole body insulin sensitivity index (WBISI) and the ratio of area under curve of glucose to area under curve of insulin(AUCINS/AUCBG) were calculated.Results Thirty-six children (28.8 %) had NASH in 125 obese children.The body mass index?homeostasis model assessment-insulin resistance and the ratio of area under curve of glucose to area under curve of insulin in NASH group were obviously higher than those of simple obese children and normal children,while the whole body insulin sensitivity index in NASH group was lower than that of the other two groups.The homeostasis model assessment-insulin resistance and the ratio of area under curve of glucose to area under curve of insulin in simple obese group were higher than those of the normal control group.Conclusions There is a high prevalence of nonalcoholic steatohepatitis in obese children.The obese children accompanied with NASH existed severe insulin resistance which could be one of the pathogenesis for nonalcoholic steatohepatitis.