儿童、青少年1型糖尿病患者中非酒精性脂肪性肝病患病率及其影响因素分析

Prevalence and Influencing Factors of Nonalcoholic Fatty Liver Disease in Children and Adolescents with Type 1 Diabetes

【目的】探讨MRI检查质子密度脂肪分数(MRI-PDFF)技术检测儿童、青少年1型糖尿病(T1DM)患者非酒精性脂肪性肝病(NAFLD)的患病率并分析影响因素。【方法】选择2012年1月至2021年1月西安唐城医院收治的164例儿童、青少年T1DM患者,根据是否合并NAFLD将其分为观察组(合并NAFLD,n=26)和对照组(未合并NAFLD,n=138)。采用单因素和多因素Logistic回归分析儿童、青少年T1DM患者发生NAFLD的相关影响因素,比较儿童、青少年T1DM合并NAFLD患者不同肝组织学特征MRI-PDFF。【结果】164例儿童、青少年T1DM患者中合并NAFLD共计26例,NAFLD患病率为15.8%(26/164)。两组患者体重指数(BMI)标准差分值(BMI-SDS)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、谷丙转氨酶(ALT)、黑棘皮病所占比例及MRI-PDFF比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析显示,BMI-SDS、MRI-PDFF是儿童、青少年T1DM患者合并NAFLD的独立预测因素(P<0.05)。F_(3)级肝脂肪变性儿童、青少年T1DM合并NAFLD患者MRI-PDFF显著高于F_(2)、F_(1)、F_(0)级(P<0.05);F_(3)、F_(4)期肝纤维化患者MRI-PDFF显著高于F_(2)、F_(1)、F_(0)期,且F_(4)期显著高于F_(3)期,差异有统计学意义(P<0.05)。【结论】BMI-SDS、MRI-PDFF是儿童、青少年T1DM患者合并NAFLD的独立预测因素,MRI-PDFF有助于量化评价NAFLD患者肝脂肪变程度、肝纤维化分期,具有重要临床意义。

【Objective】To investigate the prevalence of nonalcoholic fatty liver disease(NAFLD)in children and adolescents with type 1 diabetes(T1DM)by proton density fat fraction(MRI-PDFF)with MRI and analyze the influencing factors.【Methods】A total of 164 children and adolescents with T1DM admitted to Xi'an Tangcheng Hospital from January 2012 to January 2021 were selected and divided into observation group(NAFLD,n=26)and control group(NAFLD,n=138)according to whether NAFLD was combined or not.Univariate and multivariate logistic regression were used to analyze the related influencing factors of adolescent T1DM patients with NAFLD,and to compare the different liver histologic characteristics of children and adolescents with T1DM patients with NAFLD MRI-PDFF.【Results】Among 164 children and adolescents with T1DM,there were 26 patients with NAFLD.The prevalence of NAFLD was 15.8%(26/164).The proportion of BMI-SDS,HDL,TG,ALT,acanthosis nigricans and MRI-PDFF in the two groups were statistically significant(P<0.05).Multivariate logistic regression analysis showed that BMI SDS and MRI-PDFF were independent predictors of NAFLD in children and adolescents with T1DM(P<0.05).In children and adolescents of F_(3) hanepatic steatosis with T1DM combined with NAFLD,MRI-PDFF was significantly higher than that of F_(2),F_(1),F_(0)(P<0.05);MRI-PDFF in patients with liver fibrosis at F_(3) and F_(4) stages was significantly higher than that in patients with liver fibrosis at F_(2),F_(1) and F_(0) stages,and that in patients with liver fibrosis at F_(4) stage was significantly higher than that in patients with liver fibrosis at F_(3) stage(P<0.05).【Conclusion】BMI-SDS and MRI-PDFF are independent predictors of NAFLD in children and adolescents with T1DM.MRI-PDFF is helpful to quantitatively evaluate the degree of liver steatosis and the stage of liver fibrosis in NAFLD patients,and has important clinical significance.