腰围预测肥胖儿童非酒精性脂肪性肝病的价值

The value of waist circumference in predicting nonalcoholic fatty liver diseases in obese children.

目的探讨腰围预测肥胖儿童发生非酒精性脂肪性肝病（NAFLD）的价值。方法2003-06--2006-09对浙江大学医学院附属儿童医院儿科197例9—14岁肥胖儿童进行腰围、体质指数（BMI）测定，作肝脏B超检查、血清肝酶测定，并与正常对照组比较。同时对肥胖儿童进行腰围、BMI与脂肪肝严重程度、血清ALT水平的相关性分析，以及腰围、BMI诊断肥胖儿童发生NAFLD曲线下面积的ROC分析。结果肥胖组腰围[（91．99±11．03）cm]显著大于正常对照组[（66．27±4．76）cm]，BMI、肝酶水平也显著高于正常对照组。197例9—14岁肥胖患儿中诊断为NAFLD者147例，占74．62％；肥胖组NAFLD患儿腰围、BMI均大于非NAFLD患儿。肥胖患儿腰围、BMI与脂肪肝严重程度、血清ALT水平均呈正相关（r=0．478、0．356、0．302、0．205，均P〈0．01）；腰围和BMI诊断NAFLD的ROC曲线下面积分别为0．767、0．717（均P〈0．01）。结论9—14岁肥胖儿童NAFLD发生与腰围密切相关，腰围、BMI对肥胖儿童发生NAFLD有一定的预测价值。

Objective To evaluate the value of waist circumference （WC） in predicting nonalcoholic fatty liver diseases （NAFLD）. Methods WC,body mass index（ BMI）, liver B-ultrasonic inspection, and liver function were determined in 197 obese children aged from 9 to 14 years and 30 healthy subjects （ as control group）. Relative analysis about WC and BMI and hepatic adiposis severity and serum glutamic-pyruvic transaminase（GPT） level was carried out in the obese children. Receiver operating characteristic （ ROC ） curves was used in the evaluation of the correctness of WC and BMI in diagnosing NAFLD in obese children. Results The measured WC （ 91.99cm ± 11.03cm） in the obese children was significantly larger than that （66.27cm ±4.76cm） in the control group, as was BMI and the level of glutamic-oxalacetic transaminase（GOT） and GPT. A total of 147 patients （74. 62%, out of 197 obese children） were diagnosed as having NAFLD. In the obese children, those with NAFLD had greater WC and BMI than those without NAFLD. Both of WC and BMI were positively correlated with hepatic adiposis severity and serum GPT （ r=0. 478,0. 356,0. 302,0. 205, respectively, P 〈0. 01 ）. The areas under ROC curve of WC and BMI diagnosing NAFLD were 0. 767（ P 〈0. 01 ） and 0. 717（ P 〈 0. 01 ） ,respectively. Conclusion The occurrence of NAFLD in obese children aged from 9 to 14 years is highly related to WC. Both of WC and BMI are valuable predictors of NAFLD.