Zhang Hong-Xi, Fu Jun-Fen, Huang Ke, Lai Can, Liang Li, Jiang Ke-Wen
Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2012 Aug;14(8):598-603.
To quantitatively evaluate clinical significance of intrahepatic fat (IHF) content in children and adolescents with non-alcoholic fatty liver disease (NAFLD).
Ninety-three obese children were enrolled in this study. Physical parameters, liver function, serum lipids, glycemic and insulin related parameters were measured. Liver B-mode ultrasound (US) examination was performed. IHF content was quantified by 1H magnetic resonance spectroscopy (1H MRS). Three subgroups were classified according to the conditional diagnostic criteria for obese children: simple obesity (n=31), NAFLD-1 (US fatty liver and normal alanine aminotransterase, n=33) and NAFLD-2 (US fatty liver and elevated alanine aminotransterase, n=29). Twenty healthy age- and sex-matched children served as a control group. IHF content among the four groups was compared. The relationship of IHF content with other common clinical laboratory parameters and independent factors influencing increased IHF content were investigated.
IHF content measured by 1H MRS was 0.80% (0.4%-1.0%), 2.9% (1.7%-4.30%), 14.0% (7.2%-17.5%) and 18.8% (14.0%-29.1%) respectively in the control, simple obese, NAFLD-1 and NAFLD-2 groups. There were significant differences in IHF content between the groups. Univariate correlation analysis demonstrated that IHF content was positively correlated with waist circumference, hip circumference, waisttohip ratio, body mass index, systolic blood pressure, diastolic blood pressure, alanine aminotransferase, aspartate aminoreansferase, γ-glutamic acid transtetase, triglyceride, low-density lipoprotein, OGTT 2-hour plasma glucose, fasting insulin, 2-hour insulin and insulin resisfence, and negatively correlated with high-density lipoprotein. Multivariate linear regression analysis demonstrated three independent risk factors for increased IHF content: increased waist circumference, increased 2-hour plasma glucose and decreased high-density lipoprotein levels.
IHF content determined by 1H MRS can reflect early hepatic fatty infiltration and is closely related to the occurrence and progress of NAFLD in obese children and adolescents. There is a significant correlation between most of common clinical laboratory parameters and IHF content, and waist circumference, high-density lipoprotein and OGTT 2-hour plasma glucose are independent factors impacting IHF content.
定量评估非酒精性脂肪性肝病（NAFLD）患儿及青少年肝内脂肪（IHF）含量的临床意义。
本研究纳入93例肥胖儿童。测量其身体参数、肝功能、血脂、血糖及胰岛素相关参数。进行肝脏B超检查。采用氢质子磁共振波谱（1H MRS）定量测定IHF含量。根据肥胖儿童的条件诊断标准分为三个亚组：单纯性肥胖（n = 31）、NAFLD-1（B超提示脂肪肝且丙氨酸氨基转移酶正常，n = 33）和NAFLD-2（B超提示脂肪肝且丙氨酸氨基转移酶升高，n = 29）。选取20例年龄和性别匹配的健康儿童作为对照组。比较四组的IHF含量。研究IHF含量与其他常见临床实验室参数的关系以及影响IHF含量增加的独立因素。
对照组、单纯性肥胖组、NAFLD-1组和NAFLD-2组经1H MRS测定的IHF含量分别为0.80%（0.4% - 1.0%）、2.9%（1.7% - 4.30%）、14.0%（7.2% - 17.5%）和18.8%（14.0% - 29.1%）。各组间IHF含量差异有统计学意义。单因素相关分析显示，IHF含量与腰围、臀围、腰臀比、体重指数、收缩压、舒张压、丙氨酸氨基转移酶、天冬氨酸氨基转移酶、γ-谷氨酰转肽酶、甘油三酯、低密度脂蛋白、口服葡萄糖耐量试验2小时血糖、空腹胰岛素、2小时胰岛素及胰岛素抵抗呈正相关，与高密度脂蛋白呈负相关。多因素线性回归分析显示，IHF含量增加的三个独立危险因素为：腰围增加、2小时血糖升高及高密度脂蛋白水平降低。
1H MRS测定的IHF含量可反映早期肝脏脂肪浸润，且与肥胖儿童及青少年NAFLD的发生发展密切相关。多数常见临床实验室参数与IHF含量有显著相关性，腰围、高密度脂蛋白及口服葡萄糖耐量试验2小时血糖是影响IHF含量的独立因素。
