不同糖代谢状态肥胖儿童脂肪肝的发病和治疗情况分析

The incidence and treatmeat of fatty liver in obese children with different status of glucose metabolism

目的比较不同糖代谢状态肥胖儿童血脂、肝功能及脂肪肝和非酒精性脂肪性肝炎的发生率,探讨单纯生活方式和加用二甲双胍对其治疗效果的差异。方法选择肥胖儿童132例,根据口服葡萄糖耐量试验结果分为3组。组1:糖代谢正常的肥胖儿童;组2:高胰岛素血症者,又分为单纯生活方式干预者(组2A)和加用二甲双胍者(组2B);组3:糖代谢异常者。结果各组基线时脂肪肝的发病率组1为41.9%,组2为65.9%,组3为86.3%;脂肪性肝炎发病率分别为35.5%、53.7%、68.6%,3组比较有显著性差异(P<0.05)。脂肪肝、脂肪性肝炎好转率组1分别为38.5%、54.5%,组2A分别为31.3%、30.7%,组2B分别为82.4%、64.2%,组3分别为68%、60%。结论本组肥胖患儿脂肪肝和脂肪性肝炎发病率随代谢状况进展而逐渐升高,二甲双胍联合生活方式治疗高胰岛素血症脂肪肝和脂肪性肝炎的效果较合并糖代谢异常者更好,提示早期联合药物治疗效果好。

Objective To compare the level of blood lipid, liver function and the incidence of non-alcoholic fatty liver and fatty hepatitis in obese children with different glycometabolism status, and to evaluate the therapeutic efficacy of metformin. Methods 132 obese children were chosen from Beijing Children＇s Hospital, and were divided into three groups according to oral glucose tolerance test （OGTT） results.Group one：normal glucose metabolism. Group two： hyperinsulinaemia with lifestyle intervention（2A）or treated with metformin（2B）. Group three：abnormal glucose metabolism. Results The incidence of fatty liver in three groups was 41.9% ,65.9% and 86.3% respectively. The incidence of non-alcoholic fatty hepatitis was 35.5%, 53.7% and 68.6% respectively（P 〈 0.05）. The improvement rate of fatty liver and fatty hepatitis was 38.5% and 54.5% in group one, 31.3% and 30.7% in group 2A, 82.4% and 64.2% in group 2B, 68% and 60% in group three. Conclusions The incidence of fatty liver and fatty hepatitis steps up in the three groups. Metformin treatment is more effective than lifestyle intervention for patients with non-alcoholic fatty liver disease.