空腹C肽与肥胖儿童非酒精性脂肪性肝病的相关性

Relationship of fasting C-peptide with nonalcoholic fatty liver disease in children with obesity

目的探讨空腹C肽与肥胖儿童非酒精性脂肪性肝病(NAFLD)的相关性。方法选取经腹部超声确诊为NAFLD的肥胖患儿211例(NAFLD组),以119例单纯肥胖儿童作为对照组。检测所有患儿的总蛋白(TP)、白蛋白(Alb)、γ-谷氨酰基转移酶(GGT)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、总胆固醇(TC)、三酰甘油(TG)、肌酐(Cr)、空腹血糖(FBG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、白细胞(WBC)计数、血小板(PLT)计数、血红蛋白(Hb)、空腹C肽、糖化血红蛋白(HbA1c)、空腹胰岛素(FINS),计算胰岛素抵抗指数(HOMAIR)。采用倾向性评分匹配法,以性别、年龄、血压、体质量指数(BMI)为协变量,按1∶1比例构成82对配对,分析空腹C肽与NAFLD的关系。采用多元逐步Logistic回归分析评估NAFLD发生的危险因素。结果采用倾向性评分匹配后,NAFLD组ALT、AST、GGT、TP、空腹C肽、FINS、HOMA-IR显著高于对照组(P<0.05),其他各项指标2个组之间差异均无统计学意义(P>0.05)。多元逐步Logistic回归分析结果显示,ALT和空腹C肽是NAFLD发生的危险因素[比值比(OR)值分别为1.057、3.307,95%可信区间(CI)分别为1.036~1.078、1.439~7.602]。按空腹C肽的三分位数将所有患儿分为C肽≤1.06 pmol/mL组、C肽1.07~1.41 pmol/mL组、C肽≥1.42 pmol/mL组,调整混杂因素(年龄、性别、BMI、腰围、收缩压、ALT、Cr、TG、HDL-C、HOMA-IR和WBC计数)后,结果显示,C肽≥1.42 pmol/mL是NAFLD发生的危险因素(OR=4.635,95%CI为1.610~13.346)。结论空腹C肽在肥胖儿童NAFLD发生的早期诊断中一定的临床意义。

Objective To investigate the relationship of fasting C-peptide with nonalcoholic fatty liver disease(NAFLD)in children with obesity.Methods A total of 211 obese children diagnosed with NAFLD by abdominal ultrasound(NAFLD group)were enrolled,and 119 obese children were enrolled as control group.Among them,serum levels of total protein(TP),albumin(Alb),gamma glutamyltransferase(GGT),alanine aminotransferase(ALT),aspartate aminotransferase(AST),total cholesterol(TC),triglyceride(TG),creatinine(Cr),fasting blood glucose(FBG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),white blood cell(WBC)count,platelet(PLT)count,hemoglobin(Hb),fasting C-peptide,glycated hemoglobin A1c(HbA1c),fasting insulin(FINS)were determined,and homeostasis model assessment for insulin resistance(HOMA-IR)was calculated.Using propensity score matching,82 patients were matched in a ratio of 1∶1 with sex,age,blood pressure,body mass index(BMI)as control variables and the relation of fasting C-peptide and the risk of NAFLD were analyzed.Multivariate stepwise Logistic regression analysis was used to evaluate the risk factors of NAFLD.Results After propensity score matching,the levels of ALT,AST,GGT,TP,fasting C-peptide,FINS and HOMA-IR in NAFLD group were higher than those in control group(P<0.05),and there was no statistical significance in the other indicators between the 2 groups(P>0.05).Multivariate stepwise Logistic regression analysis showed that ALT and fasting C-peptide were risk factors for NAFLD[odds ratios(OR)were 1.057 and 3.307,95%confidence intervals(CI)1.036-1.078 and 1.439-7.602,respectively].According to the tertiles of fasting C-peptide,the children were classified into C-peptide≤1.06 pmol/mL group,C-peptide 1.07-1.41 pmol/mL group and C-peptide≥1.42 pmol/mL group.After the adjustment for confounding factors(age,sex,BMI,waist circumference,systolic blood pressure,ALT,Cr,TG,HDL-C,HOMA-IR and WBC count),C-peptide≥1.42 pmol/mL was a risk factor for NAFLD(OR=4.635,95%CI 1.610-13.346).Conclusions Fasting C-peptide plays a role in the early diagnosis of NAFLD in children with obesity.