超重肥胖儿童泌乳素水平及其与非酒精性脂肪肝发病风险的关系

Relationship between prolactin levels and risk of nonalcoholic fatty liver disease in overweight and obese children

目的 探讨超重肥胖儿童中血清泌乳素(PRL)水平及其与非酒精性脂肪性肝病(NAFLD)发病风险的关系。方法 回顾性分析2017年6月至2020年12月在本院就诊的超重肥胖儿童150例,根据影像学检查结果分为NAFLD组和非NAFLD组。比较两组儿童临床资料的差异,采用二元Logistic回归分析超重肥胖儿童发生NAFLD的独立影响因素。按照儿童平均PRL水平三分位数分组,比较不同血清PRL组间NAFLD发生率的差异,利用Cox回归模型分析超重肥胖儿童血清PRL水平与超重肥胖儿童发生NAFLD风险的关系。根据多因素分析结果构建风险预测模型并评价模型效能。结果 150例超重肥胖儿童中检测出54例NAFLD,检出率为36.00%(54/150)。NAFLD组的体质量指数(BMI)、腰围、甘油三酯(TG)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、γ-谷酰转肽酶(GGT)、胰岛素抵抗指数(HOMA-IR)均值显著高于非NAFLD组,而PRL均值明显低于非NAFLD组(P<0.05)。Logistic分析结果显示高BMI、较大腰围、高TG、高ALT、高HOMA-IR是超重肥胖儿童发生NAFLD的独立危险因素,高PRL则为保护因素(P<0.05)。不同PRL水平组NAFLD发生率比较结果显示,随着PRL水平的升高,NAFLD发生率显著降低。PRL≤6.5μg/L组儿童发生NAFLD风险显著高于PRL≥10μg/L组(HR=2.892,95%CI 2.622~3.760,P=0.005)。所构建的风险预测模型效能良好,可以较为准确地预测超重肥胖儿童发生NAFLD风险。结论 高PRL水平是超重肥胖儿童发生NAFLD的保护因素,可降低NAFLD发生风险,临床应对低PRL水平儿童提高警惕。

Objective To investigate the relationship between serum prolactin(prolactin, PRL) level and the risk of non-alcoholic fatty liver disease(nonalcoholic fatty liver disease, NAFLD) in overweight and obese children. Methods A retrospective analysis was performed on 150 overweight and obese children admitted to our hospital from June 2017 to December 2020, who were divided into NAFLD group and non-NAFLD group according to imaging findings. The clinical data of the two groups were compared. Binary Logistic regression was used to analyze the independent influencing factors of NAFLD in overweight and obese children. Children were classed to three groups according to the average PRL level of children, and the differences in the incidence of NAFLD between PRL groups with different serum levels were compared. Cox regression model was used to analyze the relationship between PRL level and NAFLD risk in overweight and obese children. According to the results of multi-factor analysis, the risk prediction model is constructed and the effectiveness of the model is evaluated.Results 54 cases of NAFLD were detected in 150 overweight and obese children, with a detection rate of 36.00%(54/150).Body mass index(BMI), waist circumference, triglycerides(TG), alanine transaminase(ALT), aspartate transaminase(AST),gamma-glutyltranspeptidase(GGT) and homeostasis model assessment of insulin resistance(HOMA-IR) in NAFLD group were significantly higher than those in non-NAFLD group, while PRL was significantly lower than those in non-NAFLD group(P<0.05). Logistic analysis showed that high BMI, large waist circumference, high TG, high ALT and high HOMA-IR were independent risk factors for NAFLD in overweight and obese children, while high PRL was a protective factor(P<0.05). The comparison of NAFLD incidence in different PRL level groups showed that the incidence of NAFLD decreased significantly with the increase of PRL level. The risk of NAFLD in PRL≤6.5 μg/L group was significantly higher than that in PRL≥10 μg/L group(HR=2.892, 95%CI 2.622-3.760, P=0.005). The established risk prediction model has good performance and can accurately predict the risk of NAFLD in overweight and obese children. Conclusion High PRL level is a protective factor for NAFLD in overweight and obese children, which can reduce the risk of NAFLD. Clinical vigilance should be raised for children with low PRL level.