代谢综合征患儿肝前脂肪厚度和腰围变化

Anterior liver fat thickness and waist circumference changes in children with metabolic syndrome

目的研究代谢综合征(MS)儿童肝前脂肪厚度和腰围的变化及其临床意义。方法2017年2月~2019年2月在我院健康体检儿童445例,发现非酒精性脂肪性肝病(NAFLD)54例,MS 18例,对患儿和从373例健康儿童中配比选择54例,分别行超声检查,检测肝前脂肪厚度、腹内脂肪厚度、腰围和颈动脉内中膜层厚度(IMT),并行血清检测。结果MS患儿肝前脂肪厚度、腹内脂肪厚度和腰围分别为(1.6±0.2)cm、(4.4±1.5)cm和(83.4±4.8)cm,显著大于健康儿童【分别为(1.3±0.4)cm、(3.4±1.5)cm和(76.8±5.3)cm,P<0.05】或NAFLD儿童【分别为(1.4±0.3)cm、(3.5±1.6)cm和(80.3±5.0)cm,P<0.05】;MS患儿胰岛素抵抗指数、高敏C反应蛋白、收缩压和低密度脂蛋白胆固醇水平分别为(5.9±1.6)、(1.8±0.2)mg/L、(136.5±14.0)mmHg和(2.6±0.8)mmol/L,显著大于健康儿童【分别为(3.5±1.7)、(1.4±0.2)mg/L、(110.8±12.7)mmHg和(1.7±0.5)mmol/L,P<0.05】或NAFLD儿童【分别为(4.2±1.5)、(1.5±0.3)mg/L、(128.9±13.8)mmHg和(2.4±0.7)mmol/L,P<0.05】,而MS患儿血清高密度脂蛋白胆固醇水平为(1.3±0.5)mmol/L,显著低于健康儿童【(1.8±0.7)mmol/L,P<0.05】或NAFLD儿童【1.4±0.5)mmol/L,P<0.05】;Logistic多因素回归分析结果显示肝前脂肪厚度(95%CI=1.098-4.198,OR=2.147,P=0.026)、腰围(95%CI=1.395-4.523,OR=2.512,P=0.002)和腹内脂肪厚度(95%CI=1.332-5.958,OR=2.817,P=0.007)是MS发生的独立危险因素。结论使用超声检测肝前脂肪厚度简单易行,有助于诊断MS儿童,临床应用价值较高。

Objective The aim of this study was to investigate the change of anterior liver fat thickness(ALFT)and waist circumference(WC)in children with metabolic syndrome(MS).Methods The clinical data of 445 children undergoing physical examination in our hospital between February 2017 and February 2019 were analyzed retrospectively.Out of them,54 children had non-alcoholic fatty liver disease(NAFLD)and 18 had MS.Another 54 children out of 373 healthy children were selected by age-and gender-matching for control.The ALFT,intra-abdominal fat thickness(IAFT),WC and the intima-media thickness(IMT)of carotid artery were measured by sonography,and serum parameter were also assayed.Results The ALFT,IAFT,WC in children with MS were(1.6±0.2)cm,(4.4±1.5)cm and(83.4±4.8)cm,significantly higher than【(1.3±0.4)cm,(3.4±1.5)cm and(76.8±5.3)cm,respectively,P<0.05】in healthy or【(1.4±0.3)cm,(3.5±1.6)cm and(80.3±5.0)cm,P<0.05】in children with NAFLD;the homeostasis model assessment of insulin resistance,serum high-sensitivity C-reactive protein level,systolic blood pressure and serum low density lipoprotein cholesterol level in children with MS were(5.9±1.6),(1.8±0.2)mg/L,(136.5±14.0)mmHg and(2.6±0.8)mmol/L,significantly greater than【(3.5±1.7),(1.4±0.2)mg/L,(110.8±12.7)mmHg and(1.7±0.5)mmol/L,respectively,P<0.05】in healthy children or【(4.2±1.5),(1.5±0.3)mg/L,(128.9±13.8)mmHg and(2.4±0.7)mmol/L,respectively,P<0.05】in children with NAFLD,while serum high density lipoprotein cholesterol level was(1.3±0.5)mmol/L,much lower than【(1.8±0.7)mmol/L,P<0.05】in healthy children or【1.4±0.5)mmol/L,P<0.05】in children with NAFLD;the multivariate Logistic analysis showed that ALFT(95%CI=1.098-4.198,OR=2.147,P=0.026),WC(95%CI=1.395-4.523,OR=2.512,P=0.002)and IAFT(95%CI=1.332-5.958,OR=2.817,P=0.007)were the independent risk factors for occurrence of MS in children.Conclusion The detection of ALFT by sonography is simple and easy to do,which might help to determine the presence of MS in children with NAFLD.