Giordano Ugo, Della Corte Claudia, Cafiero Giulia, Liccardo Daniela, Turchetta Attilio, Hoshemand Kazem Mohammad, Fintini Danilo, Bedogni Giorgio, Matteucci Maria Chiara, Nobili Valerio
Sport Medicine Unit, Bambino Gesù Children's Hospital-IRCCS, Rome, Italy,
Eur J Pediatr. 2014 Nov;173(11):1511-8. doi: 10.1007/s00431-014-2342-2. Epub 2014 Jun 17.
The aim of this study was to analyse the relationship between insulin-glucose metabolism, nocturnal blood pressure dipping and nonalcoholic fatty liver disease (NAFLD) in obese adolescents without diabetes. One hundred one consecutive children, with biopsy-proven NAFLD, were included in this study. Blood samples were drawn for the analyses of liver function tests, insulin-glucose metabolism and lipid profile appraisal. An ambulatory blood pressure measurement (ABPM) was performed. Seventy-six children (75.3 %) were systolic nondippers, and 23 of them were diastolic nondippers (30.3 %). No differences were found in the anthropometric parameters between the two groups. When compared to the systolic dippers, the systolic nondippers had higher medians of mean nocturnal blood pressure, glucose at 0, 60 and 120 min in the oral glucose tolerance test (OGTT), OGTT insulin at all time points and insulin-resistance values. No correlation of histopathological features with dipping/nondipping statuses was found.
We found an association between a nocturnal blood pressure fall and measures of insulin levels, independent of obesity, or daytime blood pressure levels, among the obese patients with NAFLD. Although no association between nondipping profiles and NAFLD was observed in our study, further studies with a longer term follow-up are needed, to better elucidate the complex link between these particular entities.
本研究旨在分析无糖尿病肥胖青少年中胰岛素 - 葡萄糖代谢、夜间血压下降与非酒精性脂肪性肝病（NAFLD）之间的关系。本研究纳入了101例经活检证实患有NAFLD的连续儿童。采集血样用于肝功能检查、胰岛素 - 葡萄糖代谢分析和血脂谱评估。进行了动态血压测量（ABPM）。76名儿童（75.3%）为收缩期非勺型血压者，其中23名是舒张期非勺型血压者（30.3%）。两组间人体测量参数无差异。与收缩期勺型血压者相比，收缩期非勺型血压者的夜间平均血压中位数、口服葡萄糖耐量试验（OGTT）中0、60和120分钟时的血糖、所有时间点的OGTT胰岛素及胰岛素抵抗值均较高。未发现组织病理学特征与勺型/非勺型状态之间存在相关性。
我们发现，在患有NAFLD的肥胖患者中，夜间血压下降与胰岛素水平测量值之间存在关联，且独立于肥胖或日间血压水平。尽管在我们的研究中未观察到非勺型血压模式与NAFLD之间存在关联，但需要进行更长期随访的进一步研究，以更好地阐明这些特定实体之间的复杂联系。
