肥胖伴非酒精性脂肪肝病患儿血管内皮功能的变化研究

Change of Vascular Endothelial Function in Obese Children with Non-alcoholic Fatty Liver Disease

目的探讨肥胖患儿非酒精性脂肪肝病(NAFLD)与血管内皮功能障碍的关系。方法 90例肥胖患儿以及34例非肥胖儿童(对照组)进行临床、生化指标及肱动脉血流介导的内皮依赖性舒张功能(FMD)各项检查,根据诊断标准将90例肥胖患儿分为NAFLD组51例和单纯肥胖组39例。比较各组儿童临床、生化各项指标及FMD。结果 NAFLD病组患儿FMD为(7.9±2.1)%,低于单纯肥胖组(10.6±1.7)%和对照组(12.1±2.1)%,三组间差异有统计学意义(F=8.32,P<0.05);NAFLD组患儿内皮素-1、超敏C反应蛋白(hs-CRP)、胰岛素抵抗指数(HOMA-IR)、可溶性细胞间黏附分子-1水平均高于单纯肥胖组和对照组,三组间差异有统计学意义(P<0.05)。经逐步线性回归分析显示,FMD水平和hs-CRP、HOMA-IR、NAFLD呈负相关(r值分别为-0.487、-0.424、-0.407,P<0.05)。结论肥胖患儿NAFLD的出现不仅是血管内皮功能障碍发生的早期标志,也是血管内皮功能障碍发生的早期状态。

Objective To study the relationship between non - alcoholic fatty liver disease （NAFLD） and the vascular endothelial dysfunction in children with obesity. Methods A total of 90 obese children and 34 non - obese children as control were enrolled. Their clinical indicators, biochemical indicators, and flow - mediated dilatation （FMD） of braehial artery were examined. The obese children were classified into two subgroups according to the diagnosis criteria： obesity group without liver disorder （n = 39 ） and NAFLD group （n = 51 ）. The clinical indicators, biochemical indicators, and FMD of braehial artery were compared among the three groups. Results The FMD prevalence in NAFLD group was （7.9 ± 2. 1 ） % , lower than （ 10. 6 ± 1.7 ） % in obesity group and （ 12.1 ± 2. 1 ） % in control group, with a significant difference among the 3 groups （ F = 8.32, P 〈0. 05 ）. The levels of endothelin - 1 （ ET - 1 ）, high sensitivity C - reactive protein （ hs - CRP）, HOMA insulin resistance index （HOMA- IR） and soluble intercellular adhesion molecule （slCAM -1 ） in NAFLD were all higher than those in obesity and control groups, with a significant difference among the 3 groups （ P 〈 0. 05 ）. The liner stepwise regression analysis showed that the FMD was negatively correlated with hs - CRP, HOMA - IR and NAFLD （r = - 0. 487, - 0. 424, - 0. 407, P 〈 0. 05 ）. Conclusion NAFLD may be not only an early marker but also an early state of vascular endothelial dysfunction in obese children.