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目的比较不同糖代谢状态肥胖儿童血脂、肝功能及脂肪肝和非酒精性脂肪性肝炎的发生率,探讨单纯生活方式和加用二甲双胍对其治疗效果的差异。方法选择肥胖儿童132例,根据口服葡萄糖耐量试验结果分为3组。组1:糖代谢正常的肥胖儿童;组2:高胰岛素血症者,又分为单纯生活方式干预者(组2A)和加用二甲双胍者(组2B);组3:糖代谢异常者。结果各组基线时脂肪肝的发病率组1为41.9%,组2为65.9%,组3为86.3%;脂肪性肝炎发病率分别为35.5%、53.7%、68.6%,3组比较有显著性差异(P<0.05)。脂肪肝、脂肪性肝炎好转率组1分别为38.5%、54.5%,组2A分别为31.3%、30.7%,组2B分别为82.4%、64.2%,组3分别为68%、60%。结论本组肥胖患儿脂肪肝和脂肪性肝炎发病率随代谢状况进展而逐渐升高,二甲双胍联合生活方式治疗高胰岛素血症脂肪肝和脂肪性肝炎的效果较合并糖代谢异常者更好,提示早期联合药物治疗效果好。
Objective To compare the incidence of lipids, liver function, fatty liver and non-alcoholic steatohepatitis in obese children with different glucose metabolism status and to explore the differences between the simple lifestyle and metformin treatment. Methods 132 obese children were selected and divided into 3 groups according to oral glucose tolerance test. Group 1: Obese children with normal glucose metabolism; Group 2: Patients with hyperinsulinemia were further divided into simple lifestyle interventions (Group 2A) plus metformin (Group 2B); Group 3: Patients with abnormal glucose metabolism. Results The baseline incidence of fatty liver in group 1 was 41.9%, group 2 was 65.9%, group 3 was 86.3%, and the incidence of steatohepatitis was 35.5%, 53.7% and 68.6%, respectively Difference (P <0.05). The improvement rates of steatohepatitis and steatohepatitis were 38.5% and 54.5% respectively in group 1, 31.3% and 30.7% in group 2A and 82.4% and 64.2% in group 2B and 68% and 60% in group 3, respectively. Conclusion The incidence of steatohepatitis and steatohepatitis in children with obesity increased gradually with the progression of metabolic status. Metformin combined with lifestyle treatment of hyperinsulinemia and steatohepatitis was more effective than those with abnormal glucose metabolism Early combination therapy is effective.