维生素D治疗肥胖合并非酒精性脂肪肝儿童的临床研究

Clinical study on treatment of obese children with nonalcoholic fatty liver disease by vitamin D

目的分析肥胖合并非酒精性脂肪肝(NAFLD)儿童血清25羟维生素D[25(OH)D]水平以及补充维生素D(VD)对NAFLD的疗效,为VD用于儿童NAFLD治疗提供临床依据。方法1)2020年1月—2021年8月,纳入102名6~14周岁的肥胖儿童,依据肝脏超声分为肥胖合并NAFLD组和肥胖无NAFLD组;并纳入健康体检儿童作为对照组。比较3组儿童血清25(OH)D、血脂、转氨酶及胰岛素抵抗指数(HOMA-IR)等指标的差异。2)将58名肥胖合并NAFLD患儿随机分为:VD干预组和VD非干预组。两组儿童均予以饮食运动指导,VD干预组在此基础上补充骨化三醇800U/d,共16周。检测并比较两组儿童干预前后各项指标的变化。结果1)肥胖合并NAFLD组血清25(OH)D水平[(20.94±6.88)ng/ml]显著低于肥胖无NAFLD组[(24.31±7.69)ng/ml,P<0.05]及健康对照组[(29.19±5.44)ng/ml,P<0.01]。且血清25(OH)D水平与BMI及HOMA-IR呈负相关(r=-0.37、-0.71,P<0.01)。2)肥胖合并NAFLD组的VD缺乏及不足率(84.48%)高于肥胖无NAFLD组(68.18%)及健康对照组(35.00%),差异具有统计学意义(χ2=25.85,P<0.01)。3)干预前,VD干预组和VD非干预组各项指标无显著差异,而干预16周后VD干预组血清25(OH)D水平显著高于VD非干预组(t=2.22,P<0.05),血脂、转氨酶、BMI、HOMA-IR水平均显著低于VD非干预组(P<0.05),脂肪肝病变也有显著改善。结论肥胖合并NAFLD儿童普遍存在VD不足。补充VD能有效提高其血清25(OH)D水平,改善肝功能、高血脂、胰岛素抵抗及脂肪肝病变。

Objective To analyze the level of serum 25hydroxyvitamin D[25(OH)D]in obese children with nonalcoholic fatty liver disease(NAFLD)and the effect of vitamin D(VD)supplements on NAFLD,and to provide a clinical basis for VD in the treatment of children with NAFLD.Methods 1)From January 2020to August 2021,102obese children aged 6to 14years were enrolled in this study and were divided into two groups according to liver ultrasound results:obesity with NAFLD group(n=58)and obesity without NAFLD group(n=44).Meanwhile,40healthy children were included as controls.The differences of serum 25(OH)D,lipid,transaminase and homoeostasis model assessment of insulin resistance(HOMA-IR)among the three groups were compared.2)Fifty eight obese children with NAFLD were randomly divided into VD intervention group and VD non-intervention group.Children of both groups were given diet and exercise guidance,and the VD intervention group was supplemented with calcitriol 800U/d for 16weeks additionally.The changes of parameters were compared.Results 1)Serum 25(OH)D level of children in obesity with NAFLD group[(20.94±6.88)ng/ml]was significantly lower than that in obesity without NAFLD group[(24.31±7.69)ng/ml,P<0.05]and healthy control group[(29.19±5.44)ng/ml,P<0.01].Serum 25(OH)D level was negatively correlated with body mass index(BMI)and HOMA-IR(r=-0.37,-0.71,P<0.01).2)The detection rate of VD deficiency and insufficiency in obese children with NAFLD(84.48%)was higher than that in obese children without NAFLD(68.18%)and healthy control group(35.00%),and the difference was significant(χ2=25.85,P<0.01).3)Before intervention,there was no significant difference in parameters between VD intervention group and VD non-intervention group.After 16-week intervention,compared with the VD non-intervention group,serum 25(OH)D level was significantly higher(t=2.22,P<0.05)while the levels of serum lipid,transaminase,BMI and HOMA-IR were significantly lower in VD intervention group(P<0.05).The hepatic pathology also improved after intervention.Conclusions VD deficiency is common in obese children with NAFLD.VD supplementation can effectively improve serum 25(OH)D level,attenuate liver function,hyperlipidemia,insulin resistance and fatty liver.