超重/肥胖儿童非酒精性脂肪肝病患病率及其影响因素的横断面研究

A cross-sectional study on the prevalence rate and influencing factors of nonalcoholic fatty liver disease in overweight/obese children

目的 调查医院就诊的超重/肥胖儿童非酒精性脂肪肝病(non-alcoholic fatty liver disease,NAFLD)的患病率,并探讨NAFLD发生的影响因素,为超重/肥胖儿童NAFLD的预防提供依据。方法 招募2019年6月-2021年9月在湖南省儿童医院就诊的超重/肥胖儿童作为研究对象,调查NAFLD患病率,并采用logistic回归分析探讨NAFLD,包括单纯性脂肪肝(non-alcoholic fatty liver,NAFL)和非酒精性脂肪肝炎(non-alcoholic steatohepatitis,NASH)发生的影响因素。采用受试者操作特征曲线分析评价影响因素对NAFL及NASH的预测价值。结果 共纳入844例超重/肥胖儿童,年龄为6~17岁。NAFLD患病率为38.2%(322/844),其中NAFL和NASH患病率分别为28.8%(243/844)和9.4%(79/844)。多因素logistic回归分析显示,腰臀比(waist-to-hip ratio,WHR)增加及低高密度脂蛋白胆固醇血症与NAFL和NASH的发生有关(P<0.05)。受试者操作特征曲线分析显示:WHR和高密度脂蛋白胆固醇联合检测预测NAFL的曲线下面积为0.653 (95%CI:0.613~0.694);二者联合检测预测NASH的曲线下面积为0.771 (95%CI:0.723~0.819)。结论 医院就诊的超重/肥胖儿童NAFLD的患病率较高;WHR和高密度脂蛋白胆固醇与NAFLD的发生有关,二者联合检测对NAFLD的发生具有一定的预测价值。

Objective To investigate the prevalence rate of non-alcoholic fatty liver disease(NAFLD)in overweight/obese children who visit a hospital,and to explore the influencing factors of NAFLD,in order to provide a basis for the prevention of NAFLD in overweight/obese children.Methods Overweight/obese children who visited Hunan Children's Hospital from June 2019 to September 2021 were recruited.The prevalence rate of NAFLD was examined.Logistic regression analysis was used to explore the factors influencing the development of NAFLD[nonalcoholic fatty liver(NAFL)and non-alcoholic steatohepatitis(NASH)].Receiver operating characteristic curve analysis was used to evaluate the predictive value of the influencing factors for NAFL and NASH.Results A total of 844 overweight/obese children aged 6-17 years were enrolled.The prevalence rate of NAFLD in overweight/obese children was 38.2%(322/844),among which the prevalence rates of NAFL and NASH were 28.8%(243/844)and 9.4%(79/844),respectively.Multivariate logistic regression analysis showed that the increase of waist-to-hip ratio(WHR)and low highdensity lipoprotein cholesterol(HDL-C)were associated with the development of NAFL and NASH(P<0.05).The receiver operating characteristic curve analysis showed that the combined measurement of WHR and HDL-C had a predictive value for NAFL(area under the curve:0.653,95%CI:0.613-0.694),and for NASH(area under the curve:0.771,95%CI:0.723-0.819).Conclusions The prevalence rate of NAFLD in overweight/obese children who visit a hospital is high.WHR and HDL-C are associated with the development of NAFLD and the combined measurement of WHR and HDL-C has a certain value for predicating the development of NAFLD.