肝脏B超联合肝功能及Ⅲ型前胶原肽对肥胖儿童非酒精性脂肪肝病的诊断价值

Diagnostic value of combining hepatic ultrasound,liver function and procollagen type Ⅲ in nonalcoholic fatty liver disease in obese children

目的评价肝脏B超联合血清指标在儿童非酒精性脂肪肝病(NAFLD)中的诊断价值。方法将269例肥胖儿童按诊断标准分为单纯肥胖儿童组(SOC)和NAFLD组。NAFLD儿童根据有无肝功能受损分成NAFLD-1组(B超示脂肪肝,肝功能正常)和NAFLD-2组(B超示脂肪肝,同时伴肝功能异常);再根据B超影像学结果分成轻度脂肪肝组和中重度脂肪肝组。另设30例健康儿童为对照组。对各组患儿进行身高、体质量、腰围、臀围、肝功能(丙氨酸氨基转移酶ALT、天冬氨酸氨基转移酶AST)、血脂、透明质酸(HA)、Ⅳ型胶原(CⅣ)、层黏蛋白(LN)、Ⅲ型前胶原肽(PCⅢ)、肝脏B超、糖耐量试验及胰岛素释放试验等检查,并比较各组间体质指数(BMI)、腰臀比、血压、血脂、肝功能、血糖、胰岛素、肝纤维化指标、胰岛素抵抗指数。对单纯肥胖组和肥胖伴NAFLD组进行二分类Logistic回归分析,并用ROC曲线下面积评价各血清指标的诊断价值。结果 SOC组与NAFLD-1组间ALT、AST、TG、HA、PCⅢ、空腹胰岛素(FINS)、2 h胰岛素、WBISI差异有统计学意义;NAFLD-1组与NAFLD-2组比ALT、PCⅢ差异有统计学意义。Logistic回归分析,ALT水平的回归系数为0.11,P为0。通过ROC曲线决策分析,ALT、AST、PCⅢ的曲线下面积最大,分别为0.88、0.80、0.70。结论同时检查肝脏B超及血清指标ALT、AST、PCⅢ,不但可反映肝脏的炎症程度,也反映了肝纤维化的程度,是诊断肥胖儿童NAFLD严重分层最有价值的方法。

Objective To evaluate the diagnostic value of combining hepatic ultrasound and non-invasive biochemical markers in detecting nonalcoholic fatty liver disease（NAFLD）.Methods Two hundred and sixty-nine obese children were enrolled in the study and 30 healthy age-matched children were studied as control.Body mass index（BMI）,waist and hip circumference,blood pressure,blood glucose,insulin,lipid profile,transaminases（ALT,AST）,serum hepatic fibrosis marker hyaluronic acid（HA）,type Ⅳ collagen（CIV）,procollagen type Ⅲ（PcⅢ）,and laminin（LN）were measured.Oral glucose tolerance test,insulin releasing test and hepatic ultrasound were performed.The obese children were divided into three subgroups according to the serum transaminases level：group 1（simple obese children,SOC group）,group 2（ultrasound（US）fatty liver and normal transaminases,NAFLD-1 group）,and group 3（US fatty liver and abnormal transaminases,NAFLD-2 group）.The obese children were also divided into three subgroups according to ultrasound examination：group 1（US normal and normal liver transaminases,SOC group）,group 2（mild fatty liver）,and group 3（moderate and severe fatty liver）.BMI,the ratio of waist and hip circumference,lipid profile,and transaminases（ALT,AST）,fasting blood glucose,insulin,serum hepatic fibrosis markers,HOMA score,WBISI based on OGTT test were compared between obese children and controls.Binary Logistic regression analysis was made between SOC group and NAFLD group.The diagnostic value of the biochemical markers were assessed with the area under receiver-operating characteristics（ROC）curve.Results The levels of ALT,AST,TG,HA,PCⅢ,FINS,2hINS,and WBISI were significantly elevated in NAFLD-1 group compared with those in SOC group.ALT,PCⅢ were significantly higher in NAFLD-2 than those in NAFLD-1 group.ALT was significantly correlated with ultrasound result,and the regression coefficient was 0.11（P = 0）.The area under the ROC of ALT,AST,and PcⅢ was 0.88,0.80,and 0.70,respectively,with the highest value in NAFLD in obese children.Conclusions Combining hepatic ultrasound and biochemical markers of ALT,AST,PCⅢ was most useful in diagnosis of NAFLD in obese children,which showed not only the degree of hepatic inflammation but also the severity of hepatic fibrosis.