儿童肥胖与非酒精性脂肪性肝病临床特征及危险因素分析。
Clinical characteristics and risk factors of nonalcoholic fatty liver disease in children with obesity.
机构信息
Department of Children Health Care, Children's Hospital of Nanjing Medical University, 72 Guangzhou Road, Nanjing, 210008, People's Republic of China.
Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, People's Republic of China.
出版信息
BMC Pediatr. 2021 Mar 12;21(1):122. doi: 10.1186/s12887-021-02595-2.
BACKGROUND
With the increasing number of children with obesity worldwide, nonalcoholic fatty liver disease (NAFLD) has become the most common liver disease among children. It is necessary to recognize the risk factors of NAFLD for prevention in childhood since NAFLD is asymptomatic in the early stage.
OBJECTIVES
The objective of this study was to investigate possible risk factors of NAFLD in children with obesity, providing evidence for monitoring and prevention strategies at an early stage for obese children with NAFLD.
METHODS
Data were collected from 428 children and adolescents aged 6-16 years recruited from the Children's Hospital at Nanjing Medical University from September 2015 to April 2018 and analyzed. Based on a combination of ultrasound results and alanine transaminase levels, subjects were divided into three groups: simple obesity (SOB), simple steatosis (SS), and nonalcoholic fatty hepatitis (NASH). Blood biochemical examination included glucose, insulin, uric acid, lipid profile and liver enzymes.
RESULTS
Among 428 children with obesity, 235 (54.9%) had SS and 45 (10.5%) had NASH. Body mass index, body mass index standard deviation score (BMI-SDS), waist circumference, body fat, liver enzymes, uric acid and HOMA-IR level were significantly higher in the NASH group than in the SS and SOB groups (p < 0.001). 53.3% of the SS group and 49.8% of the NASH group had metabolic syndrome, significantly more than in the SOB group (19.6%, p < 0.001). After adjustment for confounding factors, logistic regression models revealed that NASH was associated with BMI-SDS ≥ 3, gender, hyperuricemia and insulin resistance.
CONCLUSIONS
The prevalence of NASH in children with obesity is closely related to high BMI-SDS, gender, insulin resistance and hyperuricemia. These findings provide evidence that monitoring risk factors of childhood obesity can assist in developing prevention strategies for liver disease at an early stage.
背景
随着全球肥胖儿童数量的增加，非酒精性脂肪性肝病（NAFLD）已成为儿童中最常见的肝病。由于 NAFLD 在早期阶段无症状，因此有必要认识到儿童肥胖症的 NAFLD 危险因素，以便进行预防。
目的
本研究旨在探讨儿童肥胖症患者中 NAFLD 的可能危险因素，为肥胖儿童 NAFLD 的早期监测和预防策略提供依据。
方法
收集 2015 年 9 月至 2018 年 4 月在南京医科大学附属儿童医院就诊的 6-16 岁肥胖儿童和青少年 428 例，进行数据分析。根据超声结果和丙氨酸氨基转移酶水平将受试者分为单纯性肥胖（SOB）、单纯性脂肪变性（SS）和非酒精性脂肪性肝炎（NASH）三组。血液生化检查包括血糖、胰岛素、尿酸、血脂和肝功能。
结果
在 428 例肥胖儿童中，235 例（54.9%）为 SS，45 例（10.5%）为 NASH。NASH 组的体重指数（BMI）、BMI 标准差评分（BMI-SDS）、腰围、体脂、肝酶、尿酸和 HOMA-IR 水平明显高于 SS 组和 SOB 组（p<0.001）。SS 组和 NASH 组分别有 53.3%和 49.8%患有代谢综合征，明显高于 SOB 组（19.6%，p<0.001）。经混杂因素调整后，logistic 回归模型显示，NASH 与 BMI-SDS≥3、性别、高尿酸血症和胰岛素抵抗有关。
结论
肥胖儿童 NASH 的患病率与高 BMI-SDS、性别、胰岛素抵抗和高尿酸血症密切相关。这些发现为监测儿童肥胖的危险因素提供了证据，有助于制定早期预防肝病的策略。
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