儿童肥胖非酒精性脂肪肝胰岛β细胞功能的研究

Study of Islet β Cell Function in Obese Children with Nonalcoholic Fatty Liver Disease

目的:研究肥胖伴非酒精性脂肪肝(NAFLD)儿童的胰岛β细胞功能。方法:选取362例肥胖儿童,分为伴NAFLD组170例及不伴NAFLD的单纯肥胖组192例,同时选取164例体质量正常的儿童作为对照组。检测所有儿童的空腹血糖(FPG)、空腹胰岛素(FINS)及糖化血红蛋白(HbA1c)水平。计算胰岛素敏感指数(QUICKI)、胰岛素抵抗指数(HOMA-IR)及胰岛β细胞功能指数(HOMA-β)。肥胖儿童行口服葡萄糖耐量及胰岛素释放试验。结果:对于FPG、FINS、HbA1c、HOMA-IR和HOMA-β,NAFLD组高于单纯肥胖组,单纯肥胖组高于对照组。对于QUICKI,NAFLD组低于单纯肥胖组和对照组,单纯肥胖组低于对照组,差异均有统计学意义(P<0.05或P<0.01)。NAFLD组的糖代谢异常总检出率高于单纯肥胖组,NAFLD组糖耐量受损(IGT)检出率高于单纯肥胖组,差异有统计学意义(P<0.05)。空腹及口服葡萄糖后不同时间的胰岛素水平,均是NAFLD组高于单纯肥胖组,差异有统计学意义(P<0.05或P<0.01)。结论:肥胖伴NAFLD儿童存在胰岛β细胞功能受损和糖脂代谢异常,胰岛β细胞功能受损可能是儿童NAFLD的发病机制之一。

Objective： To investigate the islet β-cell function in obese children with nonalcoholic fatty liver disease （NAFLD）. Methods： Three hundred and sixty-two obese children were divided into obesity with NAFLD group （n=192） and obesity without NAFLD group （n=170）. One hundred and sixty-four children with normal body mass index were uesed as control group. Levels of fasting plasma glucose （FPG）, fasting insulin （FINS） and glycosylated hemoglobin （HbA1c） were detected in three groups. Oral glucose tolerance test and insulin releasing test were performed in all obese children. The insulin sensitivity index （QUICKI）, insulin resistance （HOMA-IR） and β-cell function index （HOMA-β） were calculated. Results： Values of FPG, FINS, HbA1c, HOMA-IR and HOMA-β were significantly higher in obesity with NAFLD group than those of other two groups （P 〈 0.05）. The value of QUICKI was significantly lower in obesity with NAFLD group than that of other two groups （P 〈 0.05 or P 〈 0.01）. The relevance ratio of abnormal glucose metabolism was significantly higher in obesity with NAFLD group than that of obesity without NAFLD group （P 〈 0：05）. The relevance ratio of impaired glucose tolerance （IGT） was significantly higher in obesity with NAFLD group than that of obesity without NAFLD group （P 〈 0.05）. The level of insulin was significantly higher after oral glucose administration in the different time periods in obesity with NAFLD group than that of obesity without NAFLD group （P 〈 0.05 or P 〈 0.01）. Conclusion：The impaired islet β-cell function and glycolipid metabolic disorder existed in obese children with NAFLD. The impaired islet β-cell function could be one of the pathogenesis for nonalcoholic fatty liver disease.