肥胖儿童非酒精性脂肪肝病及代谢综合征发病情况分析

Prevalence of nonalcoholic fatty liver disease and metabolic syndrome in obese children

目的研究肥胖儿童中非酒精性脂肪肝病（NAFLD）与代谢综合征（MS）的发生情况，并探索两者之间的关系。方法对308例在本院内分泌科住院的9～14岁肥胖儿童进行腰围、体块指数、血脂、肝功能、肝脏B超、糖耐量试验及胰岛素释放试验等各项检查，根据诊断标准分别计算发生NAFLD[包括单纯性非酒精性脂肪肝（SNAFL）、非酒精性脂肪肝炎（NASH）]和MS的患病率，并将308例肥胖患儿分为无肝脏损害的肥胖儿童组（OCWLD组），SNAFL组和NASH组，比较各组胰岛素、胰岛素抵抗（IR）指标及MS的发病率和MS组成成分的发病率。结果（1）308例中发生NAFLD的达到203例（65．9％），其中发生SNAFL者140例（45．5％），发生NASH者63例（20．5％）。（2）308例中发生MS76例（24．7％），这76例中合并有NAFLD的64例（84．2％）。NAFLD组中MS64例（31．5％），高于OCWLD组的12例（11．4％），差异有统计学意义，但SNAFL组中MS41例（29．3％），与NASH组的23例（36．5％）比较差异无统计学意义。（3）就单个MS的组成成分来说，OCWLD组与SNALF组比较仪在高血压的发病率上差异有统计学意义，而OCWLD组与NASH组比较在高血压、高血脂、高血糖的发病率上差异均有统计学意义；SNALF组与NASH组比较在高血脂的发病率上差异有统计学意义。随OCWLD向SNAFL和NASH发展，空腹胰岛素水平逐渐上升，IR也越加明显。但NAFLD患儿与MS患儿比较各IR指标差异无统计学意义。结论肥胖儿童中NAFLD和MS的发生率均已相当高，MS患儿合并NAFLD的比例很高，IR是NAFLD和MS共同的发病基础，且随着NAFLD患儿病情的进展，MS成分指标越来越严重，IR也越来越严重。

Objective The incidences of nonalcoholic fatty liver disease （NAFLD） and metabolic syndrome （MS） are very high in obese children, and insulin resistance may be the key point linking them together. Debates still remain as to whether NAFLD could be a component of MS. Some researchers reported that NAFLD was a composition of MS, while the others stated that NAFLD was an independent predicting factor of MS. Here we analyzed the prevalence of NAFLD and MS in 308 obese children who came to our endocrinology department from June 2003 to September 2006, and we also evaluated the relationship between NAFLD and MS in this group of obese children. Method Totally 308 obese children aged from 9 to 14 years with mean age of （ 10. 7 ± 2.6） years were enrolled. Two hundred and thirty one were males, and 77 were females. Body mass index （BMI）, waist circumference （WC）, biochemical indicators, liver B-mode ultrasound examination, oral glucose tolerance test （OGTT） and insulin releasing test were performed for all of the cases. The incidences of NAFLD including simple nonalcoholic fatty liver （SNAFL） and nonalcoholic steatohepatitis （NASH） as well as MS were calculated. Three subgroups were selected according to the diagnostic criteria： Group 1 ： OCWLD （obese children without liver disorder）, Group 2： SNAFL and Group 3 ： NASH. The prevalence of MS, components of MS, free insulin, whole body insulin sensitivity index （WBISI）, homeostasis model of insulin resistance （HOMAIR） were compared among these three subgroups. Result （1） Among all the obese children, the prevalence of NAFLD, SNAFL, NASH and MS was 65.9% （203）, 45.5% （140）, 20.5% （63） and 24.7% （76） respectively. Among all the MS children, the prevalence of NAFLD was 84. 2% （64/76）. The prevalence of MS was 29. 3% （41/140） in SNAFL group and 36. 5% （23/63） in NASH group, which was significantly higher than that of OCWLD group 11.4% （12/105） （P 〈 0. 05）, but no significant difference was found between SNAFL group and NASH group （P 〉 0. 05）. Moreover, there were significantly higher incidences in NASH group concerning every component of MS （hypertension, hyperlipidemia, hyperglycemia） compared with that of OCWLD group. The incidence of hypertension in SNAFL was significantly higher than that of OCWLD group. And the incidence of hyperlipidemia was markedly increased in NASH group compared with SNAFL group. NAFLD group had higher free insulin and more severe IR compared with that of OCWLD group. When OCWLD developed to SNAFL and NASH, free insulin and IR deteriorated calculated by HOMA-IR and WBISI. However there was no significant difference between NAFLD and MS children concerning free insulin and IR. Conclusion The prevalence of NAFLD and MS hits high in obese children. The prevalence of NAFLD was very high among children with MS and NAFLD and MS shared the common mechanism of IR. The higher prevalence of MS and higher frequencies of MS components were tightly associated with the development of NAFLD and severity of IR.