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目的研究肥胖及伴非酒精性脂肪肝病(NAFLD)儿童、青少年的血脂代谢特征及血清脂联素水平与代谢综合征(MS)的关系。方法采用典型整群抽样方法选取北京市海淀区中等水平的4所小学和4所中学的7～18岁儿童及青少年,在知情同意的前提下,进行问卷、身体测量、腹部B超脂肪肝检查及血生化检测。从中选取各项调查资料完整的609例作为研究对象,其中单纯肥胖儿童280例,肥胖伴NAFLD儿童65例(肥胖伴NAFLD组),正常体质量儿童264例作为健康对照组。经统计分析,正态分布测量数据以x-±s表示;血清三酰甘油(TG)、脂联素、ALT和AST生化指标呈偏态分布,以几何均数和四分位间距(P25～P75)表示,经自然对数转化为正态分布后进行分析。采用方差分析、Logistic回归分析等。结果肥胖组及肥胖伴NAFLD组体质量指数(BMI)及腰围(WC)显著高于健康对照组,3组间差异有统计学意义(P<0.001);3组儿童的空腹血浆葡萄糖、血脂、脂联素及转氨酶水平比较差异均有显著统计学意义;肥胖伴NAFLD组儿童的ALT、AST明显升高;控制可能的影响因素年龄、性别后进行多因素Logistic回归分析显示,与单纯肥胖组比较,肥胖伴NAFLD组MS及组分高TG、高血压的检出率明显增加,罹患MS的相对风险增加尤为显著(P<0.001)。结论肥胖及肥胖伴NAFLD对儿童、青少年的肝功能和血脂代谢均造成危害,其血清脂联素水平随肥胖程度的增加而降低,脂联素作为胰岛素的增敏激素,连接脂肪组织和整体糖代谢,脂联素可作为MS的评估指标之一。
Objective To investigate the relationship between serum lipid metabolism and serum adiponectin level and metabolic syndrome (MS) in children and adolescents with obesity and non-alcoholic fatty liver disease (NAFLD). Methods A typical cluster sampling method was used to select children and adolescents aged from 7 to 18 in 4 middle schools and 4 middle schools in Haidian District of Beijing. Under the condition of informed consent, questionnaires, physical measurements, abdominal B-fatty liver tests And blood biochemical detection. A total of 609 cases were selected from the survey data, including 280 obese children, 65 obese children with NAFLD (obese with NAFLD group) and 264 normal children as healthy controls. Statistical analysis showed that the data of normal distribution were expressed as x- ± s. The biochemical indexes of serum triglyceride (TG), adiponectin, ALT and AST showed a skewed distribution. The geometric mean and quartile spacing (P25 ~ P75), said the natural logarithm transformed into normal distribution analysis. Using analysis of variance, Logistic regression analysis. Results Body mass index (BMI) and waist circumference (WC) in obese and obese patients with NAFLD were significantly higher than those in healthy controls (P <0.001). Fasting plasma glucose, blood lipids, Adiponectin and aminotransferase levels were significantly different statistically significant; obesity with NAFLD children ALT, AST was significantly increased; control factors that may influence the age, sex and multivariate logistic regression analysis showed that compared with the simple obesity group , And the detection rate of MS, high TG and high blood pressure were significantly increased in obese patients with NAFLD, and the relative risk of MS was more significantly increased (P <0.001). Conclusions Both obesity and obesity with NAFLD are harmful to the liver function and blood lipid metabolism of children and adolescents. The level of serum adiponectin is decreased with the increase of obesity. Adiponectin is used as the sensitizing hormone of insulin to connect adipose tissue and monosaccharide Metabolism, adiponectin can be used as one of the indicators of MS.