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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。
Objective To investigate the relationship between non-alcoholic fatty liver disease (NAFLD) and insulin resistance (IR), lipids, body mass index (BMI) and waist-hip ratio (WHR) in children with simple obesity. Methods 90 cases of obese children aged 2.5 to 14.3 years old. Including NAFLD 24 cases (NAFLD group), no NAFLD 66 cases (no NAFLD group). Another 35 healthy children whose age and gender were matched were healthy control group. Body mass, height, waist circumference and hip circumference were measured in fasting morning, and BMI and WHR were calculated. Meanwhile, the levels of serum insulin (FINS), glucose (FBG), cholesterol (TC), triglyceride (TG) (HOMA-IR = FINS × FBG / 22.5) were calculated, HDL-C, LDL-C, ALT and AST were calculated and ultrasound examination of liver and gallbladder . Results NAFLD accounted for 26.67% of obese children; NAFLD children in the highest BMI, WHR, followed by no NAFLD group, the difference was statistically significant (Pa <0.001); 3 groups of children FINS and HOMA-IR values were statistically significant (P <0.001), NAFLD group was the highest, followed by NAFLD group, were significantly higher than the healthy control group, but FBG no significant difference; NAFLD group serum TG, LDL-C and TC levels were significantly higher than the NAFLD group and healthy controls (P <0.01). There was a positive correlation between HOMA-IR and BMI, WHR, blood TG and LDL-C (r = 0.402,0.256,0.239,0.180, P = 0.000,0.004,0.008,0.046) The area under the receiver operating characteristic (ROC) curve for NAFLD was 0.805 and 0.765, respectively (Pa = 0.000). Conclusion The incidence of NAFLD in obese children is closely related to the increase of IR, blood TG, LDL-C, TC and the increase of BMI and WHR. BMI and WHR have some diagnostic value in childhood obesity NAFLD. Control body mass, reduce waist circumference, reduce IR, prevent the occurrence and development of NAFLD.