Torun Emel, Özgen Ilker Tolga, Gökçe Selim, Aydın Sinem, Cesur Yaşar
Bezmialem Vakıf University Medical Faculty, Department of Pediatrics, İstanbul, Turkey. E-ma-il:
J Clin Res Pediatr Endocrinol. 2014;6(1):34-9. doi: 10.4274/Jcrpe.1155.
We aimed to determine the association of thyroid functions with the components of metabolic syndrome (MS) and non-alcoholic fatty liver disease (NAFLD) in pediatric obese patients.
The study included 109 obese children (aged 9-15 years) and a control group of 44 healthy age and gender-matched children of normal weight. NAFLD was diagnosed by conventional ultrasound examination. We assessed the anthropometric data and serum biochemical parameters including lipid profile, alanine aminotransferase (ALT), fasting glucose and insulin levels and thyroid stimulating hormone (TSH), free thyroxine (fT4) and free triiodothyronine (fT3) levels. The homeostasis model assessment of insulin resistance (HOMA-IR) was calculated as a measure of IR.
The mean age and gender distributions in the groups were similar (p=0.23). The mean body mass index (BMI) z-scores of obese children with grade 2-3 NAFLD were significantly higher than those of the obese children without hepatic steatosis (p<0.001). Mean ALT, triglyceride (TG) and LDL cholesterol increased and HDL-cholesterol significantly decreased as the hepatic steatosis increased (p<0.05). HOMA-IR levels in obese subjects with grade 2-3 NAFLD were significantly higher than those in both obese children without NAFLD and grade 1 NADFL (p=0.05 and 0.001, respectively). In the obese subjects, TSH levels were increased significantly as the degree of steatosis increased (p=0.04) but fT3 and fT4 levels were not different. In correlation analysis, TSH was significantly correlated with ALT, BMI SDS and the degree of steatosis.
Obese children demonstrate an increase in TSH levels as the degree of steatosis increased.
我们旨在确定小儿肥胖患者甲状腺功能与代谢综合征（MS）各组分及非酒精性脂肪性肝病（NAFLD）之间的关联。
该研究纳入了109名肥胖儿童（9 - 15岁）以及一个由44名年龄、性别匹配的正常体重健康儿童组成的对照组。通过常规超声检查诊断NAFLD。我们评估了人体测量数据和血清生化参数，包括血脂谱、丙氨酸转氨酶（ALT）、空腹血糖和胰岛素水平以及促甲状腺激素（TSH）、游离甲状腺素（fT4）和游离三碘甲状腺原氨酸（fT3）水平。计算胰岛素抵抗的稳态模型评估（HOMA - IR）作为胰岛素抵抗的指标。
两组的平均年龄和性别分布相似（p = 0.23）。2 - 3级NAFLD肥胖儿童的平均体重指数（BMI）z评分显著高于无肝脂肪变性的肥胖儿童（p < 0.001）。随着肝脂肪变性程度增加，平均ALT、甘油三酯（TG）和低密度脂蛋白胆固醇升高，高密度脂蛋白胆固醇显著降低（p < 0.05）。2 - 3级NAFLD肥胖受试者的HOMA - IR水平显著高于无NAFLD的肥胖儿童和1级NAFLD肥胖儿童（分别为p = 0.05和0.001）。在肥胖受试者中，随着脂肪变性程度增加，TSH水平显著升高（p = 0.04），但fT3和fT4水平无差异。在相关性分析中，TSH与ALT、BMI SDS及脂肪变性程度显著相关。
肥胖儿童中，随着脂肪变性程度增加，TSH水平升高。
