论文部分内容阅读
目的探讨儿童非酒精性脂肪性肝炎(NASH)的临床与肝脏病理特点的关系。方法收集2008年1月至2013年12月解放军302医院的105例儿童NASH患者的临床及肝脏病理资料,进行统计学分析。结果 (1)本组患者中92.38%为男性,年龄以11~13岁多见,病程6~72个月,中位数为19个月。46.67%为肥胖患者,0.95%合并高血压病,33.33%有家族史。(2)本组患者丙氨酸氨基转移酶(ALT)平均值(224.90±115.55)μ/L、天冬氨酸氨基转移酶(AST)(118.57±64.38)μ/L。50.48%的患者三脂酰甘油(TG)升高,2.86%合并2型糖尿病,22.86%的胰岛素高于正常。83.81%的患者超声提示脂肪肝。(3)肝脏病理:本组56.19%的患者F≥3,29.53%的患者G≥2级,20.95%的患者S≥3。NAS积分5~6分的患者41.90%,7~8分的58.10%。F≥3组患者BMI、ALT、AST的平均值,高TG、G≥2、S≥3的比例大于均F<3组,且BMI和AST平均值及高TG、S≥3的比例两组差异有统计学意义。依据BMI分组,肥胖组高TG和F≥3的比例高于非肥胖组。(4)肝脏纤维化(S)的多因素非条件Logistic回归分析,肝脏的脂肪变性(F)、BMI为肝脏纤维化的影响因素。结论儿童NASH重度脂肪变性患者BMI、AST平均值及高TG、中晚期纤维化的比例均高于轻中度脂肪变性患者。肥胖患者高TG和F≥3的比例高于非肥胖患者。中晚期肝纤维化与重度脂肪变性及BMI值相关。
Objective To investigate the relationship between clinical and hepatic pathological features of children with non-alcoholic steatohepatitis (NASH). Methods The clinical data and liver pathology data of 105 children with NASH from 302 hospital of PLA from January 2008 to December 2013 were collected for statistical analysis. Results (1) 92.38% of the patients in this group were males. The age was 11 to 13 years old, with a duration of 6 to 72 months and a median of 19 months. 46.67% were obese, 0.95% had hypertension, 33.33% had family history. (2) The mean alanine aminotransferase (ALT) in this group was (224.90 ± 115.55) μ / L, aspartate aminotransferase (AST) was (118.57 ± 64.38) μ / L. 50.48% patients had elevated triglycerides (TG), 2.86% had type 2 diabetes, and 22.86% had insulin above normal. 83.81% of patients showed fatty liver ultrasound. (3) Liver pathology: F≥3 in 56.19% of the patients, G≥2 in 19.53% of the patients, S≥3 in 20.95% of the patients. 41.90% of patients with NAS score of 5 to 6, and 58.10% of 7 to 8 patients. The ratio of BMI, ALT, AST, TG, G≥2 and S≥3 were higher in patients with F≥3 than those in patients with F <3, and the mean of BMI and AST and the ratio of high TG and S≥3 The difference was statistically significant. According to the BMI group, the proportion of high TG and F≥3 in obesity group was higher than that in non-obese group. (4) Multivariate Logistic regression analysis of liver fibrosis (S), hepatic steatosis (F) and BMI were the influencing factors of liver fibrosis. Conclusion The average BMI, AST, high TG, advanced fibrosis in children with NASH severe steatosis are higher than those in mild to moderate steatosis patients. Obese patients with high TG and F≥3 ratio higher than non-obese patients. In advanced liver fibrosis and severe fatty degeneration and BMI related.