提示肥胖症儿童/青少年存在非酒精性脂肪性肝炎的指标分析*

doi:10.3969/j.issn.1672-5069.2022.06.013

摘要/Abstract

摘要： 目的分析提示肥胖症儿童/青少年存在非酒精性脂肪肝炎(NASH)的指标,为临床诊断NASH提供简易解决方案。方法 2015年7月～2021年1月我院诊治的肥胖症儿童/青少年117例,采用ELISA法检测血清IL-2、IL-4、IL-6、IL-10、TNF-α和INF-γ水平,计算稳态模型胰岛素抵抗指数(HOMA-IR),使用FibroScan 502型肝脏弹性检测仪行肝脏硬度测定(LSM)和受控衰减参数(CAP),应用单因素和多因素Logistic回归分析提示NASH存在的指标。结果在117例儿童/青少年人群中,发现单纯性脂肪肝90例,NASH者27例;NASH患者血清空腹胰岛素、HOMA-IR、ALT、AST、LSM和CAP分别为(20.2±3.2)pmol/L、(5.2±0.4)、(70.8±12.8)U/L、(57.3±12.0)U/L、(9.2±2.7)kPa和(255.6±33.7)dB/m,显著高于单纯性脂肪肝组【分别为(17.8±3.0)pmol/L、(4.0±0.3)、(33.8±7.5)U/L、(25.2±8.0)U/L、(7.8±2.4)kPa和(290.8±28.1)dB/m,P<0.05】;NASH患者血清IL-6和IL-10水平分别为(4.0±0.8)pg/ml和(3.2±0.5)pg/ml,显著高于单纯性脂肪肝组【分别为(3.3±0.6)pg/ml和(2.4±0.4)pg/ml,P<0.05】,而两组血清IL-2、IL-4、TNF-α和INF-γ水平无显著性差异(P>0.05);多因素Logistic回归分析结果表明HOMA-IR、血清IL-10水平和肝脏CAP值是提示存在NASH的独立指标(P<0.05)。结论儿童/青少年肥胖症患者存在一定比例的NASH,可能对健康成长造成不利影响,一些血清指标和肝脏脂肪肝检测指标可能有助于临床医生作出早期判断,并给予正确的健康管理。

关键词: 非酒精性脂肪肝炎, 肥胖症, 白细胞介素-10, 受控衰减参数, 诊断, 儿童/青少年

Abstract: Objective The purpose of this study was to investigate the prevalence and clues for non-alcoholic steatohepatitis (NASH) in obese children/ adolescents. Methods 117 obese children and adolescents, including 78 males and 39 females with the average age of (10.0±2.4) year old, were enrolled in our hospital between July 2015 and January 2021. Serum interleukin-2 (IL-2), IL-4, IL-6, IL-10, tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ) levels were detected by ELISA, and thehomeostasis model of assessment for insulin resistance index (HOMA-IR) were obtained by fasting blood glucose (FBG) and fasting insulin (FINS) calculation. The liver stiffness measurement (LSM) and the controlled attenuation parameter (CAP) were detected by FibroScan 502. Results 27 cases of NASH and 90 simple fatty liver (SFL) were diagnosed in our 117 obese children/ adolescents; serum FINS, HOMA-IR, ALT, AST, LSM and CAP in patients with NASH were(20.2±3.2)pmol/L, (5.2±0.4), (70.8±12.8)U/L, (57.3±12.0)U/L, (9.2±2.7)kPa and (255.6±33.7)dB/m, all significantly higher than [(17.8±3.0)pmol/L, (4.0±0.3), (33.8±7.5)U/L, (25.2±8.0)U/L, (7.8±2.4)kPa and (290.8±28.1)dB/m, respectively,P<0.05] in children and adolescents with SFL; serum IL-6 and IL-10 levels in patients with NASH were (4.0±0.8)pg/ml and (3.2±0.5)pg/ml, both significantly higher than [(3.3±0.6)pg/ml and (2.4±0.4)pg/ml, respectively, P<0.05] in those with SFL, while there were no significant differences as respect to serum IL-2, IL-4, TNF-α and INF-γ levels between the twogroups (P>0.05); the multivariate Logistic regression analysis showed that the HOMA-IR, serum IL-10 and liver CAP were the independent clues for NASH existence (P<0.05). Conclusion The prevalence of NASH in Children and adolescents with obesityis a severe public health problem, and some clinical clues might hints the disease existence. The clinicians, including paediatricians, should give them appropriate advice and managements.

Key words: Nonalcoholic steatohepatitis, Obesity, IL-10, Controlled attenuation parameter, Diagnosis, Children/adolescents

王玉梅, 袁向东, 刘玉玲, 赵子瑜. 提示肥胖症儿童/青少年存在非酒精性脂肪性肝炎的指标分析^*[J]. 实用肝脏病杂志, 2022, 25(6): 808-811.

Wang Yumei, Yuan Xiangdong, Liu Yuling, et al.. Prevalence and clues for non-alcoholic steatohepatitis in obese children/adolescents[J]. Journal of Practical Hepatology, 2022, 25(6): 808-811.

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提示肥胖症儿童/青少年存在非酒精性脂肪性肝炎的指标分析^*

Prevalence and clues for non-alcoholic steatohepatitis in obese children/adolescents

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