CAJ | 학술논문

目的探讨血清铁蛋白(SF)与肥胖儿童非酒精性脂肪性肝病的关系.方法以6～14岁肥胖儿童为研究对象,入选儿童均了解肥胖持续时间,进行体格检查(身高、体质量、腰围、臀围)、生物电阻抗法(体脂含量)、血清学指标(肝氨基转移酶、血脂代谢、空腹血糖、胰岛素、SF)以及肝脏超声检查.按稳态评估模型(HOMA)计算胰岛素抵抗(IR)指数.根据肝脏超声及肝氨基转移酶将所有研究对象分为单纯性肥胖(SOC)组、肥胖儿童伴非酒精性单纯性脂肪肝(NAFL)组和肥胖儿童伴非酒精性脂肪性肝炎(NASH)组.结果共纳入肥胖儿童86例,年龄(10.4±1.9)岁,其中SOC组26例、肥胖儿童伴NAFL组28例、肥胖儿童伴NASH组32例.肥胖儿童伴NASH组腰围-标准差分值(Z分值)、腰臀比、HOMA-IR指数、SF均明显高于肥胖儿童伴NAFL组[2.3±0.3比2.1±0.3,P=0.020;1.0 ±0.0比0.9±0.1,P=0.014;4.0±1.7比2.9±1.8,P=0.006;(104.1士49.6)μg/L比(68.4±22.7)μg/L,P=0.004]和SOC组[2.3±0.3比1.9±0.3, P=0.000;1.0±0.0比0.9±0.1, P=0.012;4.0±1.7比2.5±1.6, P=0.001;(104.1±49.6) μg/L比(59.2±28.9) μg/L,P=0.001],体质量指数-Z分值差异无统计学意义(2.8±0.5比2.7±0.6,P=0.524;2.8±0.5比2.7±0.6,P=0.662);肥胖儿童伴NAFL组和SOC组各项指标比较差异均无统计学意义[2.1±0.3比1.9±0.3,P=0.260;0.9±0.1比0.9±0.1,P=0.952;2.9±1.8比2.5±1.6,P=0.283;(68.4±22.7) μg/L比(59.2±28.9) μg/L,P=0.161].控制年龄、体质量指数、腰围、腰臀比、三酰甘油、HOMA-IR指数影响,SF仍与肥胖儿童非酒精性脂肪肝病变程度呈正相关(r =0.335,P=0.002).结论血清铁蛋白可能是肥胖儿童NASH发生的独立危险因素.
목적 탐토혈청철단백(SF)여비반인동비주정성지방성간병적관계.방법 이6～14세비반인동위연구대상,입선인동균료해비반지속시간,진행체격검사(신고、체질량、요위、둔위)、생물전조항법(체지함량)、혈청학지표(간안기전이매、혈지대사、공복혈당、이도소、SF)이급간장초성검사.안은태평고모형(HOMA)계산이도소저항(IR)지수.근거간장초성급간안기전이매장소유연구대상분위단순성비반(SOC)조、비반인동반비주정성단순성지방간(NAFL)조화비반인동반비주정성지방성간염(NASH)조.결과 공납입비반인동86례,년령(10.4±1.9)세,기중SOC조26례、비반인동반NAFL조28례、비반인동반NASH조32례.비반인동반NASH조요위-표준차분치(Z분치)、요둔비、HOMA-IR지수、SF균명현고우비반인동반NAFL조[2.3±0.3비2.1±0.3,P=0.020;1.0 ±0.0비0.9±0.1,P=0.014;4.0±1.7비2.9±1.8,P=0.006;(104.1사49.6)μg/L비(68.4±22.7)μg/L,P=0.004]화SOC조[2.3±0.3비1.9±0.3, P=0.000;1.0±0.0비0.9±0.1, P=0.012;4.0±1.7비2.5±1.6, P=0.001;(104.1±49.6) μg/L비(59.2±28.9) μg/L,P=0.001],체질량지수-Z분치차이무통계학의의(2.8±0.5비2.7±0.6,P=0.524;2.8±0.5비2.7±0.6,P=0.662);비반인동반NAFL조화SOC조각항지표비교차이균무통계학의의[2.1±0.3비1.9±0.3,P=0.260;0.9±0.1비0.9±0.1,P=0.952;2.9±1.8비2.5±1.6,P=0.283;(68.4±22.7) μg/L비(59.2±28.9) μg/L,P=0.161].공제년령、체질량지수、요위、요둔비、삼선감유、HOMA-IR지수영향,SF잉여비반인동비주정성지방간병변정도정정상관(r =0.335,P=0.002).결론 혈청철단백가능시비반인동NASH발생적독립위험인소.
Objective To investigate the relationship between serum ferritin and nonalcoholic fatty liver diseases in obese children.Methods Obese children aged 6 to 14 years old were enrolled.Duration of obesity, anthropometric parameters (height, body weight, waist circumference, hip circumference), bioelectrical impedance analysis (body fat), serological parameters (liver transaminases, lipid metabolism, fasting blood glucose, fasting insulin, serum ferritin) and liver ultrasonography were recorded.Insulin resistance (IR) index was calculated by homeostasis model assessment (HOMA).All subjects were divided into 3 groups according to liver ultrasound and liver transaminases : simple obese children (SOC) group, obese children with nonalcoholic simple fatty liver (NAFL) group and obese children with nonalcoholic steatohepatitis (NASH) group.Results 86 obese children entered the study, with a mean age of (10.4 ± 1.9) years, including 26 in the SOC group, 28 in the NAFL group and 32 in the NASH group.Waist circumference standard deviation score (SDS or Z-score), waist-to-hip ratio, HOMA-IR index and serum ferritin in the NASH group were obviously higher than those in the NAFL group [2.3 ± 0.3 vs.2.1 ± 0.3, P =0.020;1.0 ± 0.0 vs.0.9 ± 0.1,P=0.014;4.0±1.7 vs.2.9±1.8, P=0.006;(104.1 ±49.6) μg/Lvs.(68.4 ±22.7) μg/L, P=0.004] and the SOC group [2.3 ±0.3 vs.1.9 ±0.3, P=0.000;1.0±0.0vs.0.9 ±0.1, P=0.012;4.0 ±1.7 vs.2.5 ±1.6, P=0.001;(104.1 ±49.6) μg/Lvs.(59.2 ±28.9) μg/L, P=0.001], while there was no significant difference in body mass index Z-score [2.8 ± 0.5 vs.2.7 ± 0.6, P =0.524;2.8 ± 0.5 vs.2.7 ± 0.6, P =0.662].There were no significant differences between the NAFL group and the SOC group in the above indicators [2.1 ±0.3 vs.1.9 ±0.3, P =0.260;0.9 ±0.1 vs.0.9 ±0.1, P =0.952;2.9 ± 1.8vs.2.5±1.6, P=0.283;(68.4±22.7) μg/Lvs.(59.2±28.9) μg/L, P=0.161].Mter controlling age, body mass index, waist circumference, waist-to-hip ratio, triglyceride, and HOMA-IR index, serum ferritin was still positively correlated with the magnitude of nonalcoholic fatty liver diseases in obese children (r =0.335, P =0.002).Conclusion Serum ferritin is probably an independent risk factor for NASH in obese children.