Pancreatic fat and β-cell function in overweight/obese children with nonalcoholic fatty liver disease

AIM: To analyze the associations of pancreatic fat with other fat depots and β-cell function in pediatric nonalcoholic fatty liver disease(NAFLD).METHODS: We examined 158 overweight/obese children and adolescents, 80 with NAFLD [hepatic fat fraction(HFF) ≥ 5%] and 78 without fatty liver. Visceral adipose tissue(VAT), pancreatic fat fraction(PFF) and HFF were determined by magnetic resonance imaging. Estimates of insulin sensitivity were calculated using the homeostasis model assessment of insulin resistance(HOMA-IR), defined by fasting insulin and fasting glucose and whole-body insulin sensitivity index(WBISI), based on mean values of insulin and glucose obtained from oral glucose tolerance test and the corresponding fasting values. Patients were considered to have prediabetes if they had either:(1) impaired fasting glucose, defined as a fasting glucose level ≥ 100 mg/d L to < 126 mg/d L;(2) impaired glucose tolerance, defined as a 2 h glucose concentration between ≥ 140 mg/d L and < 200 mg/d L; or(3) hemoglobin A1 c value of ≥ 5.7% to < 6.5%.RESULTS: PFF was significantly higher in NAFLD patients compared with subjects without liver involvement. PFF was significantly associated with HFF and VAT, as well as fasting insulin, C peptide, HOMA-IR, and WBISI. The association between PFF and HFF was no longer significant after adjusting for age, gender, Tanner stage, body mass index(BMI)-SD score, and VAT. In multiple regression analysis withWBISI or HOMA-IR as the dependent variables, against the covariates age, gender, Tanner stage, BMI-SD score, VAT, PFF, and HFF, the only variable significantly associated with WBISI(standardized coefficient B,-0.398; P = 0.001) as well as HOMA-IR(0.353; P = 0.003) was HFF. Children with prediabetes had higher PFF and HFF than those without. PFF and HFF were significantly associated with prediabetes after adjustment for clinical variables. When all fat depots where included in the same model, only HFF remained significantly associated with prediabetes(OR = 3.38; 95%CI: 1.10-10.4; P = 0.034).CONCLUSION: In overweight/obese children with NAFLD, pancreatic fat is increased compared with those without liver involvement. However, only liver fat is independently related to prediabetes.

Central body fat distribution indices in Thai preschool children

Background: Central obesity is associated with adverse health outcomes. This study aimed to determine the characteristics of central body fat distribution in Thai preschool children and to examine factors that could influence on body fat distribution of children. Methods: The total 811, 5 - 6 years old children were randomly sampled from 9 primary schools in Saraburi province. Body weight and height were measured in each child. Waist circumference (WC) was measured at the umbilicus level and hip circum-ference (HC) at the level yielding maximum circumference over buttock. Subcutaneous skinfold was measured on biceps, triceps, subscapular, suprailiac and abdominal regions. Total body fat (TBF) was measured with bioelectrical impedance analyzer. Results: Mean values of WC, waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) of boys were not different from those of girls. Even though trunk skinfolds of both genders were similar, girls tended to have slightly greater biceps, triceps and subscapular skinfolds than boys. Strongly positive correlation was found between WC, WHtR, trunk skinfold and child’s BMI (p = 0.01) as well as between WC, WHtR, trunk skinfold and child’s TBF (p = 0.01). Multiple regression analysis demonstrated, in both genders, that BMI, age and TBF were strongly associated with WC (Adjusted R2 0.92 - 0.93) and WHtR (Adjusted R2 0.90 - 0.92) and that BMI and TBF were strongly associated with trunk skinfold (Adjusted R2 0.88 - 0.89). The association between WHR and TBF for boys and between WHR and BMI for girls were found to be weak in this study. Conclusion: No gender difference in body fat distribution indices was found in Thai preschool children. Change in central body fat distribution of children could be strongly influenced by their changes in age, BMI and TBF.

超重/肥胖非酒精性脂肪性肝病儿童磁共振质子密度脂肪分数检测意义研究

目的探讨应用磁共振质子密度脂肪分数(MRI-PDFF)诊断超重和肥胖儿童非酒精性脂肪性肝炎(NASH)的效能。方法2022年12月~2023年12月江油市903医院诊治的超重/肥胖的非酒精性脂肪性肝病(NAFLD)儿童102例,其中超重儿童74例和肥胖儿童28例,使用3.0 T MRI扫描仪行肝脏检查,获取MRI-PDFF,使用FibroScan诊断仪检查获得肝脏硬度检测(LSM)和受控衰减参数(CAP),行肝穿刺诊断NASH,绘制受试者工作特征曲线(ROC),计算曲线下面积(AUC),评估诊断效能。结果在102例超重/肥胖的NAFLD儿童中,经组织学检查诊断单纯性非酒精性脂肪肝(SNFL)75例和NASH 27例;NASH组BMI、血清ALT、AST、TG、MRI-PDFF、LSM和CAP分别为(32.2±3.4)kg/m^(2)、(92.7±31.3)U/L、(96.8±34.1)U/L、(3.1±1.2)mmol/L、(12.5±4.7)%、(11.7±1.4)kPa和(370.4±146.9)dB/m,与SNFL组【分别为(26.7±2.2)kg/m^(2)、(38.2±4.4)U/L、(33.0±3.4)U/L、(2.3±0.7)mmol/L、(7.7±2.0)%、(6.2±1.0)kPa和(262.3±61.2)dB/m】比,差异具有统计学意义(P<0.05),NASH组超重和肥胖占比分别37.0%和63.0%,与SNFL组的85.3%和14.7%比,差异具有统计学意义(P<0.05);经ROC曲线分析显示,以MRI-PDFF为11.9%为截断点,其诊断NASH的AUC为0.87(95%CI为0.80~0.93),敏感性为81.5%,特异性为85.3%,而分别以LSM为10.8 kPa和CAP为310.5dB/m为截断点,其诊断的AUC为0.81(95%CI为0.78~0.89),敏感性为85.2%,特异性为58.7%,后者的特异性较差。结论应用MRI-PDFF诊断儿童NASH的效能较优,但考虑到临床的便捷性,使用弹性成像检测诊断也可获得初步结果,以便必要时进一步检查。

身体成分与儿童血压关系的系统评价/Meta分析

背景身体成分是体内各种成分的含量,其与儿童血压的关联存在争议。目的探讨身体成分与儿童血压的关联性。设计系统综述/Meta分析。方法计算机检索中国生物医学数据库、维普中文科技期刊数据库、中国知网期刊数据库、万方数据在线知识服务平台4个中文数据库和PubMed、Web of Science和EBSCO 4个外文数据库,检索起止时间均为各数据库建库至2023年8月8日。纳入身体成分与儿童血压关系的队列研究。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,对结果进行定量和定性归纳总结。主要结局指标身体成分与儿童高血压的相关性。结果共纳入9项身体成分与儿童舒张压和收缩压的纵向队列研究,其中7个队列报告了脂肪质量相关指标与儿童舒张压和收缩压的相关性,儿童期脂肪质量百分比与儿童舒张压和收缩压呈正相关,其他脂肪质量指标研究结论仍不一致。2个队列报告了非脂肪质量指标与儿童血压的相关性,研究结论不统一。3个队列报告了脂肪质量与儿童期血压偏高和高血压的发生呈正相关,但新生儿脂肪质量与6岁时高血压的风险可能为负相关。结论儿童期脂肪质量百分比与儿童舒张压和收缩压呈正相关,身体成分对儿童血压有一定影响。

儿童脊髓性肌萎缩症大腿肌肉MRI影像特点及与临床相关性分析

目的分析脊髓性肌萎缩症(spinal muscular atrophy,SMA)患儿大腿肌肉常规MRI影像表现特点及其临床应用价值。材料与方法以2022年1月至2022年8月在华中科技大学同济医学院附属武汉儿童医院经基因确诊并进行MRI检查的37例(Ⅰ型5例,Ⅱ型21例,Ⅲ型11例)SMA患儿为研究对象,回顾性分析不同临床分型SMA患儿大腿肌肉MRI影像表现及临床资料。采用改良版Mercuri分级对右侧大腿肌肉脂肪浸润程度进行半定量评估,采用Spearman相关性分析,将脂肪浸润总分与汉默史密斯功能运动-扩展量表(Hammersmith Functional Motor Scale Expanded,HFMSE)评分、病程及存活运动神经元2(survival motor neuron 2,SMN2)基因拷贝数进行相关性分析。结果SMA患儿表现为双侧大腿肌肉形态学改变,肌肉内部和(或)周围有点状、条状和(或)片状脂肪信号影,致肌肉呈“网状”和(或)“岛屿状”;Ⅰ型SMA以肌肉萎缩为主,Ⅱ型SMA伴有肌肉肥大,Ⅲ型SMA以脂肪浸润为主;Mercuri脂肪浸润评分显示股四头肌(肌直肌、股外侧肌、股中间肌及肌内侧肌)、缝匠肌、大收肌、股薄肌受累程度较重,其中缝匠肌的Mercuri评分最高,而长收肌、股二头肌长头、半腱肌和半膜肌受累程度较轻,其中长收肌的Mercuri评分最低,并且明显低于其他肌肉;Ⅲ型SMA患儿肌肉脂肪浸润程度与HFMSE运动功能评分呈负相关(r=-0.917,P<0.001),所有SMA患儿肌肉脂肪浸润程度均与病程呈正相关(r=0.772,P<0.001)。结论SMA患儿常规MRI表现为肌肉萎缩和脂肪浸润为主,且脂肪浸润是进行性的,不同临床表型SMA患儿肌肉受累模式及严重程度不同。此外,SMA累及肌肉是有选择性的,存在相对肌肉保留模式。MRI能可视化评估SMA患儿肌肉受累情况,并与临床指标具有良好的相关性,是一个有潜力的生物标志物。

不同人体测量指标评价学龄前儿童肥胖的比较

目的旨在建立武汉市学龄前儿童体脂率百分位数参考值及参考曲线,并分析不同人体测量指标与体成分的相关性,评价其在筛查学龄前儿童肥胖中的可靠性。方法采用横断面研究设计,通过整群随机抽样的方法于2021~2023年选取武汉市江汉区及汉阳区2710名3~5岁学龄前儿童进行调查,应用康娃WS-RT-2U体检仪及皮尺测量其身高、体重、腰围(WC)和臀围,同时计算身体质量指数(BMI)、腰围身高比(WHtR)和腰围臀围比(WHR);采用InBody 230体成分仪通过生物电阻抗法测量其体脂率(PBF)、脂肪质量及去脂肪质量。利用广义可加模型(GAMLSS)对儿童体脂率数据进行拟合,构建武汉市学龄前儿童体脂率的百分位数参考值;通过计算脂肪质量指数(FMI)及去脂肪体质量指数(FFMI),对BMI构成进行分解;以建立的PBF P95为肥胖标准参考值,使用受试者工作特征(ROC)曲线来评估BMI、WC、WHtR及WHR在肥胖筛查中的效果。结果在学龄前期,男女童体脂率随年龄增长逐渐下降,且男童下降幅度大于女童。同性别年龄不同体重状态儿童BMI的差异主要由FMI贡献(56%~82%),且BMI越大FMI贡献比例越高。ROC曲线分析显示,BMI的曲线下面积(AUC)接近1.0(男童=0.942;女童=0.937),显著大于WC、WHtR及WHR的AUC值(P<0.05)。结论本研究构建了武汉市学龄前儿童体脂率百分位参考值及生长曲线,并发现BMI是学龄前儿童肥胖筛查最佳评价指标,可为本地区学龄前儿童的生长发育评价和肥胖的识别提供参考依据。

血清Vaspin、cathelicidin的表达对糖尿病患儿早期肾功能改变的预测价值

目的探讨血清腹腔脂肪型丝氨酸蛋白酶抑制剂(Vaspin)、抗菌肽cathelicidin(LL-37)的表达对糖尿病患儿早期肾功能改变的预测价值。方法选取2020年7月—2023年7月遵义市第一人民医院收治的80例糖尿病住院患儿作为研究对象,依照患儿尿蛋白水平进行分组,分为正常组(尿蛋白<30 g/g Cr,n=31),微量组(尿蛋白为30~300 g/g Cr,n=24),大量组(尿蛋白>300 g/g Cr,n=25)。对比三组患儿血清Vaspin、cathelicidin表达水平,对比三组患儿尿酸(UA)、尿素氮(BUN)、血肌酐(Scr)、胱抑素C(CysC)常规肾功能损伤指标,分析血清Vaspin、cathelicidin与UA、BUN、Scr、CysC水平的相关性,并建立受试者特征(ROC)工作曲线分析Vaspin、cathelicidin诊断糖尿病患儿早期肾功能改变的临界值与诊断效能。结果三组患儿Vaspin、cathelicidin表达水平对比,大量组Vaspin水平明显高于微量组和正常组,cathelicidin水平明显低于微量组和正常组(P<0.05);三组患儿UA、BUN、Scr、CysC表达水平对比,大量组UA、BUN、Scr、CysC水平明显高于微量组和正常组(P<0.05),但微量组与正常组对比,差异无统计学意义(P>0.05);Spearman相关分析结果显示:UA、BUN、Scr、CysC与Vaspin呈正相关,UA、BUN、Scr、CysC与cathelicidin呈负相关(P<0.05);Vaspin临界值取7.97 ng/mL时,诊断指数达到最大值1.695,对糖尿病患儿早期肾功能改变的灵敏度为85.37%,特异性为82.73%。cathelicidin临界值取22.14μg/L时,诊断指数达到最大值1.654,对糖尿病患儿早期肾功能改变的灵敏度为84.84%,特异性为80.73%。当Vaspin临界值取7.97 ng/mL,cathelicidin临界值取22.14μg/L时,诊断指数达到最大值1.731,联合诊断糖尿病患儿早期肾功能改变的灵敏度为93.15%,特异性为88.34%,高于单一诊断。结论Vaspin联合cathelicidin检测可提升糖尿病患儿早期肾功能改变的诊断效能,Vaspin>7.97 ng/mL,cathelicidin<22.14μg/L时要警惕早期肾功能改变的发生,并及时采取相关措施进行干预。但由于Vaspin、cathelicidin水平可能与糖尿病所引起的心脏、血管、胃肠等多器官损伤相关,因此Vaspin、cathelicidin是否可作为糖尿病患儿早期肾功能改变的独立预测指标还有待深入研究分析。

腹腔镜辅助脂肪锚定法在小儿低位隐睾中的应用研究

目的探讨腹腔镜辅助脂肪锚定法治疗小儿低位隐睾的临床价值。方法选取2021年1月至2023年4月该院低位隐睾患儿89例,根据手术方案分为观察组(47例)和对照组(42例)。对照组采用经腹股沟切口睾丸固定术,观察组采用腹腔镜辅助脂肪锚定法。比较2组手术时间、出血量、术后6 h改良面部表情评分法(FLACC)评分、出院时间,以及随访情况。结果观察组手术时间、出血量、术后6 h FLACC评分、出院时间均优于对照组,差异有统计学意义(P<0.05)。见随访结果显示,对照组出现睾丸回缩1例,无睾丸萎缩。观察组阴囊饱满,外观满意,未出现睾丸萎缩或睾丸回缩。结论采用腹腔镜辅助脂肪锚定法治疗小儿低位隐睾,具有出血少、疼痛轻、恢复快,并发症少等优点。

频率偏移在儿童胸椎快速自旋回波T1WI SPIR抑脂序列图像质量优化中的价值

目的 优化T1WI频率预饱和结合反转恢复(spectral pre-saturation with inversion recovery, SPIR)抑脂序列的频率偏移值,提升胸椎T1WI SPIR抑脂序列的图像质量。材料与方法 回顾性分析36例患儿胸椎具有9个不同频率偏移值(40、60、80、100、120、127、140、160、180 Hz)的T1WI SPIR抑脂序列图像,并进行主客观图像质量评价。利用4分法对椎体脂肪抑脂均一性、背部脂肪抑脂均一性及总体图像质量进行主观评分;计算椎体、脑脊液、椎间盘及脊髓的信噪比(signal-to-noise ratio, SNR)及它们间的对比噪声比(contrast-to-noise ratio, CNR)。采用Kruskal-Wallis非参数检验评价主观图像质量评分,采用单因素方差分析评价SNR和CNR,并采用LSD法作组间两两比较。结果 (1)9个T1WI SPIR序列的椎体脂肪抑脂均一性(F=168.49,P<0.001)、背部脂肪抑脂均一性(F=96.10,P<0.001)及总体图像质量评分(F=27.11,P<0.001)差异均具有统计学意义。频率偏移为40、60、80、100 Hz的4个序列具有最佳的椎体抑脂均一性,4个序列的组间差异无统计学意义;频率偏移为100、120、127、140、160 Hz的5个序列具有最佳的背部抑脂均一性,5个序列间的组间差异无统计学意义;频率偏移为80、100 Hz的2个序列具有最佳的总体图像质量,2个序列的组间差异无统计学意义。(2)6个T1WI SPIR序列的椎体SNR(F=2.83,P<0.05)及椎体与脑脊液间的CNR(F=2.67,P<0.05)的差异具有统计学意义,频率偏移为40、60、80 Hz的3个序列的椎体SNR及椎体与脑脊液的CNR差异无统计学意义,频率偏移为40 Hz序列的椎体SNR优于频率偏移为100、120、127 Hz的序列,其余被研究组织的SNR及组织间的CNR差异在6个序列间无统计学意义。结论 频率偏移在80、100 Hz时,可优化提升胸椎T1WI SPIR序列的总体图像质量。

The Effect of Antiretroviral Therapy (ART) on Body Composition and Clinical Markers of Lipodystrophy in HIV-Infected Children Assessed in Follow-Up Study

Objectives: Antiretroviral therapy (ART) has been associated with lipodystrophy in children. We evaluated changes in various anthropometric measurements for the assessment of lipodystrophy and assessed whether there was an association with use of protease inhibitors (PI), non-PI containing ART and/or stavudine (d4T). Methods: Eighty-five HIV-infected children attending the HIV clinic at Great Ormond Street Hospital (GOSH) were included. The average follow-up was 8.4 months (range 3 - 12 months). Body fat redistribution was assessed by anthropometric measurements including skinfold thickness and circumferences of upper and lower limbs. Measurements were converted to age- and sex-adjusted z-scores through development stages including puberty. Results: Sixty children had taken ART;37 received PI-containing;38 received d4T;25 had never been treated. In the studied population, clinically important changes with decreases in biceps (BSF), subscapular skinfolds and total body fat (4SFT) over period of 12 months were observed. Some increase was noticed in triceps skinfolds (TSF). Limbs circumferences remained at the same level. Further we looked at 4 months basis changes in anthropometric measurements stratified by baseline ART. Generally z-scores of anthropometric measurements were lower in therapy naive children when compared to ART groups. PI-based ART regimens resulted in significant increases in BSF with a trend towards increases in TSF, suprailiac and 4SFT. Mid-arm and thigh circumferences were higher in PI compared to naive group. Similarly, significant changes in BSF z-scores were associated with d4T use. Increases were seen in TSF and mid-arm circumference and decreases were observed in subscapular skinfolds and calf circumference z-scores. Conclusions: Body fat redistribution in HIV-infected children with sub-clinical lipodystrophy could be detected by anthropometric measurements, particularly when PI or d4T is included in ART. Over time, changes with increase in arm and trunk fat, and no change or decrease in leg fat were more pronounced among ART-receiving children.

Dietary intakes of Karen hill triber children aged 1-6 years in northern Thailand

Malnutrition results from insufficient intakes of food including micronutrients such as vitamin A,iron,iodine, zinc,and folic acid.This paper reported the results from a study of dietary intakes of Karen hill tribe children aged 1-6 years in the north of Thailand.All children aged 1-6 years(n=158;83 boys,75 girls)from the three Karen villages(Mae Hae Tai,Mae Yot,Mae Raek) of Mae Chaem district in the north of Thailand were studied.All children were examined by a qualified medical doctor and were assessed for their nutrient intakes using 24 hours dietary recall.All families had income lower than the Thailand poverty line(US $1000/ year).For children aged 1-3 years,the nutrients generally consumed were much less than the Thai RDA. Compared with the Thai RDA,all children consumed much less energy(28%-40.5%RDA)than protein (55.8%-96.1%RDA).Interestingly,all boys and only girls from Mae Raek village consumed vitamin A more than the Thai RDA but girls from Mae Hae Tai village and Mae Yot village consumed vitamin A less than the Thai RDA.For children aged 4-6 years,boys from Mae Raek village consumed protein(128.4%RDA) and vitamin C(143.1%RDA)above the Thai RDA.Girls from Mae Yot village also consumed vitamin C (132.9%RDA)above the Thai RDA.Both boys and girls from Mae Raek village and also girls from Mae Yot village consumed vitamin A more than the Thai RDA.Other nutrients were consumed much less than the Thai RDA by all children.All children consumed protein more than 10%of the total energy consumption per day. Most of the energy consumed by children came from carbohydrate.Nearly all children consumed carbohydrate more than 50%of the total energy consumption per day except boys aged 1-3 years from Mae Raek village (consumed 45%).All children from Mae Hae Tai village and boys aged 4-6 years from Mae Yot village(consumed 27%)consumed fat less than 30%of the total energy consumption per day.It appeared that the priority recommendations for improving nutrition in Karen villages in Mae Chaem would be increase energy consumption such as fat and oil.More general work is needed on how children’s diets might be improved in a culturally acceptable manner,so as to bring consumption patterns closer to recommended allowance levels.

Characteristics and Factors Associated with Obesity and Thinness among Children with Developmental Disorders

Obesity in childhood or adolescence has been recognized to be a risk factor for the onset of lifestyle-related diseases, not only in healthy children, but also in children with developmental disorders. Therefore, this study was conducted to examine the characteristics of obesity and thinness as assessed by the body fat percentage among children with developmental disorders during certain growth periods. It was also designed to investigate those factors associated with obesity and thinness based on a lifestyle and behavioral questionnaire. The subjects included 260 children from 5 to 18 years old with developmental disorders. The results of the study showed that a decrease in thinness and increase in obesity with ageing exhibited more noticeable trends among those children with mental retardation. The factors associated with obesity in children with developmental disorders were characterized by the dietary content, eating behaviors, and food preferences particular to such children, as well as low physical activity and a family history of obesity. The results of this study suggested the importance of continuous guidance along with family participation in order to improve obesity among children with developmental disorders, while focusing on the characteristics of certain growth periods.

磁共振多回波Dixon技术在肥胖儿童肝脏脂肪含量定量评估中的敏感性、特异性分析

目的 研究肥胖儿童肝脏脂肪含量定量评估中应用磁共振多回波Dixon技术的诊断敏感性、特异性。方法 研究对象为2020年1月-2022年6月我院收治的108例肥胖儿童,并分为甲组(单纯肥胖)、乙组(合并脂肪肝但肝功能正常)、丙组(合并脂肪肝且肝功能异常),另以同期在我院进行体检的40名健康儿童为对照组,所有儿童均进行体格检查、实验室检查及超声、磁共振多回波Dixon序列检查。结果 健康儿童体重指数(BMI)低于肥胖儿童(P<0.05);对照组与甲组、乙组、丙组PDFF值比较差异有统计学意义(P<0.05),甲组PDFF值高于对照组,乙组PDFF值高于甲组,丙组PDFF值高于乙组,乙组PDFF值高于对照组,丙组PDFF值高于对照组,丙组PDFF值高于甲组(P<0.05);PDFF值与腰围、BMI、谷丙转氨酶(ALT)、谷草转氨酶(AST)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)、甘油三脂(TG)为正相关关系(P<0.01),与AST/ALT、高密度脂蛋白(HDL)为负相关关系(P<0.01);PDFF值鉴别诊断对照组与甲组的敏感度、特异度分别为0.693、0.666,鉴别诊断甲组与乙组的敏感度、特异度分别为0.770、0.791,鉴别诊断乙组与丙组的敏感度、特异度分别为0.828、0.809。结论 磁共振多回波Dixon技术能够有效显示肥胖儿童肝脏脂肪浸润,其PDFF值诊断患儿肝脏脂肪浸润程度具有较高的敏感性与特异性。

超重/肥胖儿童非酒精性脂肪性肝病的磁共振成像质子密度脂肪分数分布特点

目的:探讨超重/肥胖儿童非酒精性脂肪性肝病(non-alcoholic fatty liver disease,NAFLD)的磁共振成像质子密度脂肪分数(magnetic resonance imaging-proton density fat fraction,MRI-PDFF)分布特点,为未来NAFLD患儿肝脏脂肪含量评估标准方案的制订提供参考依据。方法:入组2022年8月—2023年3月在上海交通大学医学院附属新华医院行上腹部3.0 T MRI m-Dixon-quant序列扫描的超重/肥胖儿童受试者69例。收集入组受试者基本信息及实验室检查结果。根据全肝加权平均MRI-PDFF(weighted mean of MRI-PDFF,MRI-PDFFwm)将受试者分为正常肝脏(Grade 0级)、轻度脂肪肝(Grade 1级)、中度脂肪肝(Grade 2级)及重度脂肪肝(Grade 3级)。分析肝段间MRI-PDFF的变异度及其与脂肪肝分级的关系。探讨肝脏各段MRI-PDFF(MRI-PDFFⅠ-Ⅷ)及其与MRI-PDFFwm在脂肪肝诊断及分级中的一致性;比较PDFFⅠ-Ⅷ与丙氨酸转氨酶、天冬氨酸转氨酶及γ-谷氨酰转移酶的相关性。结果:69例入组受试者中确诊NAFLD患者58例(84.06%)。NAFLD患者MRI-PDFFwm为(20.23±10.16)%,相较于其他肝段,MRI-PDFFVⅡ最高(22.23±9.85)%。MRI-PDFFV与MRI-PDFFwm组内相关系数(intra-class correlation coefficient,ICC)最高(ICC=0.988,P<0.001)。正常肝脏(2.59%)及轻度脂肪肝(7.15%)肝段间MRI-PDFF范围低于中、重度脂肪肝患者(9.71%~11.14%),组间差异有统计学意义(P<0.001)。在诊断有无脂肪肝(Kappa值为1,P<0.001)及脂肪肝分级(Kappa值为0.880,P<0.001)方面,MRI-PDFFV与MRI-PDFFwm一致性最高。MRI-PDFFI-Ⅷ与丙氨酸转氨酶均呈中度相关(r=0.415~0.470,P<0.001),其中MRI-PDFFⅣb相关性最大(r=0.470,P<0.001);MRI-PDFFI-Ⅷ与天冬氨酸转氨酶(r=0.252~0.337,P<0.005)及γ-谷氨酰转移酶(r=0.232~0.333,P<0.005)均呈低度相关。结论:超重/肥胖儿童中NAFLD发病率较高,且肝内脂肪分布较不均匀。肝脂肪变性程度越高,肝内脂肪分布越不均质。相较于其他肝段,MRI-PDFFV更能代表肝脏整体脂肪变性程度,可作为肝脏活检或其他无创性定量评估的首选部位。肝脏脂肪含量可在一定程度上反映肝功能的受损程度。

持续大剂量胰岛素泵注射对小儿糖尿病的临床效果及对不良反应的影响

目的 分析持续大剂量胰岛素泵注射对小儿糖尿病的临床效果及对不良反应的影响。方法 选取2021年6月至2022年6月山东省邹平市人民医院收治的小儿糖尿病患者62例,按照随机数字表法分为对照组、研究组,各31例。给予对照组患儿常规计量胰岛素泵治疗,给予研究组患儿大剂量胰岛素泵注射治疗,分析两组患儿临床指标、血脂指标[低密度脂蛋白胆固醇(LDL-C)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)]、血糖指标[糖化血红蛋白(GHb)、餐后2 h血糖(2 h PBG)、空腹血糖(FPG)],分析两组患儿治疗有效率及不良反应发生情况。结果 与对照组相比,研究组血糖下降速度、血糖达标时间均较低,具有统计学差异(P>0.05);治疗后两组患儿LDL-C、TG水平有所下降,HDL-C水平有所上升,且与对照组相比,研究组患儿LDL-C、TG水平较低,HDL-C水平较高(P<0.05);治疗后两组患儿GHb、2 h PBG、FPG水平有所下降,且与对照组相比,研究组GHb、2 h PBG、FPG水平较低(P<0.05);与对照组相比,研究组治疗总有效率较高,两组相比具有统计学意义(P<0.05);相较于对照组,研究组小儿治疗后不良反应发生情况略高,但两组相比无统计学差异(P>0.05)。结论 给予糖尿病患儿大剂量胰岛素泵治疗,患儿血糖指标以及血脂指标得到较好的改善,有着较好的治疗效果,并且治疗中不良反应发生情况较低。

基于16S rDNA高通量测序技术分析不同身体质量指数儿童的肠道菌群结构差异

目的 分析基于16S rDNA高通量测序技术分析不同身体质量指数儿童的肠道菌群结构差异。方法 选取2020年8月至2022年8月82例到许昌市中心医院进行健康体检的儿童作为研究对象,采用身体质量指数(BMI)分为正常组及肥胖组,采用16S rDNA高通量测序技术结合生物信息分析不同身体质量指数儿童肠道菌群丰富性和多样性指标及菌群的结构组成。结果 肥胖组的Ace指数和Chaol指数明显低于正常组,差异具有统计学意义(t=2.053、2.168,P<0.05);肥胖组的Shannon和Simpson指数较正常组低,但两组的差异无统计学意义(t=1.298、1.662,P>0.05)。儿童肠道微生物群落在门水平上排名的分别为:厚壁菌门>拟杆菌门>放线菌门>变形菌门。肥胖组的变形菌门明显高于正常组,差异具有统计学意义(t=7.019,P<0.05);但两组的拟杆菌门、拟杆菌属、乳杆菌属、大肠志贺菌属、放线菌门、双歧杆菌属水平比较,差异无统计学意义(t=1.897、1.977、1.662、1.818、0.468、0.227,P>0.05)。结论 不同身体质量指数儿童的肠道菌群的丰度不同,肥胖儿童的肠道菌群的丰度明显较低,且肠道菌群结构组成有差异,变形菌门可能是BMI升高的标志菌群,可能在儿童BMI升高中发挥着重要作用。

北京城区超重及肥胖学龄儿童体脂百分比的测定——生物电阻抗法

目的了解北京城区超重及肥胖小学生的体脂水平，为制定临床肥胖诊断标准提供依据。方法在北京某城区选取的有代表性的2所小学中，按随机整群抽样方法，抽取7-11岁学龄儿童681人，男生338名（占49．6％），平均年龄（9．4±1．4）岁；女生343名（占50．4％），平均年龄（9．3±1．4）岁。采用生物电阻抗体脂测定仪（TBF-026），测定儿童体脂含量。依据中国肥胖工作组公布的7～18岁儿童青少年性别、年龄别BMI切点判定超重和肥胖。采用非参数检验的u检验比较两组间平均值的差别。结果正常体重、超重及肥胖儿童的体脂百分比中位数及四分位数范围在男生分别为：15．8％（13．0％～18．2％），21．8％（19．4％～26．1％）及29．6％（25．1％．34．3％），女生为15．5％（12．2％一19．3％），25．2％（21．1％～27．5％）及30．5％（28．2％。34．8％）。不同体型儿童的体脂含量差异有显著性（P〈0．01）。结论北京城区超重及肥胖学龄儿童的体脂百分比水平≥20％，与世界其他种族学龄儿童接近。

人体脂肪测量方法及其在儿童肥胖评估中的应用价值

在人体成分的测量中,有关脂肪组织这一成分的测量由于儿童肥胖及其相关代谢性并发症的日益流行而显得极为重要。目前,人体脂肪测量方法主要有体格测量法、密度法、生物电阻抗法、同位素稀释法、影像学技术等,这些测量手段各有优劣,适应于各种不同的条件和要求。该文复习了常见的几种人体脂肪测量方法及其在儿童肥胖评估中的应用价值。

肥胖儿童运动疗法的效果观察

为探讨健身运动对肥胖儿童身体健康的影响,为肥胖儿童健身运动处方的制定与实施提供理论与实践依据。随机选择20名肥胖儿童进行为期12周的综合运动训练,测试运动前后的身体形态及机能的多项指标,并与随机选择的20名肥胖儿童(未接受运动处方)的相应指标进行比较,结果表明接受训练的肥胖儿童的各项身体指标变化与未接受训练的肥胖儿童的各指标变化的比较,具有显著或非常显著的差异,运动效果显著。运动能有效地降低体脂,增加瘦体重,改善儿童心肺功能和身体素质。