单纯性肥胖儿童发生代谢相关脂肪性肝病的危险因素分析

摘要/Abstract

摘要： 目的探讨发生代谢相关脂肪性肝病(MAFLD)的高危因素。方法纳入2021年1月至2023年6月海安市人民医院诊断的140例单纯性肥胖儿童,其中MAFLD组52例,非MAFLD组88例。记录研究对象的基线资料和临床指标。单因素和logistic多因素单纯性肥胖儿童并发MAFLD高危因素,受试者工作特征曲线下面积(AUC)判断高危因素的预测价值。结果 MAFLD组的男性比例、体质量指数(BMI)、脂质蓄积指数(LAP)、丙氨酸转移酶(ALT)、碱性磷酸酶(ALP)、三酰甘油(TG)、尿酸(UA)、铁蛋白(SF)分别为71.54%、27.46 kg/m²、37.98±6.35、68 U/L、56 U/L、1.08 mmol/L、(423.58±27.36)μmol/L、(124.95±13.46)ng/mL,高于非MAFLD组的52.27%、25.19 kg/m²、46.82±7.04、29 U/L、47 U/L、0.81 mmol/L、(346.75±21.08)μmol/L、(95.38±7.45)ng/mL,差异有统计学意义(t/χ²/Z=3.517,6.254,8.472,9.596,6.528,5.329,9.427,9.781,均P<0.05)。logistics回归分析显示,LAP、ALT、UA和SF为单纯性肥胖儿童发生MAFLD的独立影响因素(95%CI为1.047～1.092、1.012～1.157、1.020～1.059、1.017～1.063,OR=1.063、1.084、1.035、1.049)。ROC分析显示,LAP、ALT、UA和SF的AUC分别为0.741、0.849、0.783和0.682,敏感度为86.27%、81.35%、72.86%、87.94%,特异度为73.85%、91.27%、78.13%、70.36%。结论 LAP、ALT、UA和SF升高是单纯性肥胖儿童发生MAFLD的独立影响因素,可作为早期识别、诊断和评价单纯性肥胖儿童发生MAFLD的预测指标。

关键词: 单纯性肥胖, 代谢相关脂肪性肝病, 危险因素, 儿童保健

Abstract: Objective To analyze the relevant indicators in children with simple obesity and explore the high-risk factors associated with the development of metabolism-related fatty liver disease (MAFLD), with the ultimate goal of providing valuable insights for children's healthcare. Methods A total of 140 children with simple obesity were included in the study and categorized into either MAFLD group (n=52) or non-MAFLD group (n=88) based on the presence or absence of MAFLD. Baseline data and clinical indicators of the subjects were meticulously examined and recorded. The predictive value of MAFLD risk factors was evaluated through receiver operating characteristic curve (ROC) analysis in children with simple obese, both through univariate and Logistic multiple factors. Results Among the 140 children with simple obesity, a total of 52 cases were diagnosed with MAFLD, resulting in a prevalence rate of 37.12%. In the MAFLD group, the proportion of males, body mass index (BMI), lipid storage index (LAP), alanine aminotransferase (ALT), alkaline phosphatase (ALP), triglyceride (TG), uric acid (UA) and ferritin (SF) were noted as 71.54%, 27.46 kg/m², 37.98±6.35, 68 U/L, 5 6 U/L, 1.08 mmol/L, 423.58±27.36 μmol/L, 124.95±13.46 ng/mL, respectively. On the other hand, in the non-MAFLD group, these values were 52.27%, 25.19 kg/m², 46.82±7.04, 29 U/L, 47 U/L, 0.81 mmol/L, 346.75±21.08 μmol/L, 95.38±7.45 ng/mL. The differences between the two groups were statistically significant (t/χ²/Z=3.517, 6.254, 8.472, 9.596, 6.528, 5.329, 9.427, 9.781, all P<0.05). Logistic regression analysis indicated that LAP, ALT, UA and SF were independent influencing factors for MAFLD in children with simple obesity (95% CI: 1.047-1.092, 1.012-1.157, 1.020-1.059, 1.017-1.063, 95% CI was 1.047-1.092, 1.012-1.157, 1.020-1.059, 1.017-1.063, OR=1.063, 1.084, 1.035, 1.049, all P<0.05). Additionally, ROC analysis showed that the area under the curve (AUC) of LAP, ALT, UA and SF were 0.741, 0.849, 0.783 and 0.682, respectively, with corresponding sensitivities of 86.27%, 81.35%, 72.86% and 87.94%, and specificities of 73.85%, 91.27%, 78.13%, 70.36%. Conclusion Elevations in LAP, ALT, UA and SF are identified as independent influencing factors for MAFLD in children with simple obesity. These findings suggest that these parameters can serve as non-invasive predicators for the early identification, diagnosis and evaluation of MAFLD in this population.

Key words: Simple obesity, MAFLD, Risk factors, Child health

张怡, 崔蕾, 袁伯稳. 单纯性肥胖儿童发生代谢相关脂肪性肝病的危险因素分析[J]. 肝脏, 2024, 29(3): 308-312.

ZHANG Yi, CUI Lei, YUAN Bo-wen. Analysis of risk factors for developing metabolism-related fatty liver disease in children with simple obesity[J]. Chinese Hepatolgy, 2024, 29(3): 308-312.

参考文献

[1] 王晓琳,谢青.非酒精性脂肪肝的继发因素及诊断[J].肝脏,2022,27(1):109-113.
[2] 王雨,杨志然,陈润花,等.中国儿童非酒精性脂肪性肝病患病率的Meta分析[J].中国儿童保健杂志,2022,30(7):764-769.
[3] Saha M, Hossain MZ, Gope S, et al. Prevalence of sonologically detected non-alcoholic fatty liver disease among school children of sylhet city[J]. Mymensingh Med J, 2022, 31(2): 412-415.
[4] Sadeghian M, Vafadar M, Torabi A, et al. Prevalence of fatty liver and its related factors in children[J]. J Family Med Prim Care., 2022, 11(9): 5604-5608.
[5] 何春霞,蔡海芳,刘晟,等.浙西南地区肥胖儿童的非酒精性脂肪肝的发生特点危险因素及针对性预防措施研究[J].中国妇幼保健,2020,35(20):3821-3824.
[6] 郑冬梅,梁学军,靳景璐,等.中国儿童肥胖的评估、治疗和预防指南[J].中国妇幼健康研究,2021,32(12):1716-1722.
[7] 王琴,魏来.国内外儿童与成人非酒精性脂肪性肝病诊疗指南的比较与解析[J].临床肝胆病杂志,2017,33(12):2265-2269.
[8] Lu YL, Li WY, Gong XB, et al. Prevalence of fatty liver among children under multiple machine learning models[J]. South Med J, 2022, 115(8): 622-627.
[9] Brandt S, v Schnurbein J, Denzer C, et al. Lower circulating leptin levels are related to non-alcoholic fatty liver disease in children with obesity[J]. Front Endocrinol, 2022, 23(13): e881982.
[10] 张毅,廖燕薇,麻静.超重肥胖儿童泌乳素水平及其与非酒精性脂肪肝发病风险的关系[J].中国优生与遗传杂志,2022,30(6):1040-1044.
[11] Zorena K, Jachimowicz DO, Ślezak D, et al. Adipokines and obesity potential link to metabolic disorders and chronic complications[J]. Int J Mol Sci, 2020, 21(10): 3570.
[12] Sheng G, Lu S, Xie Q, et al. The usefulness of obesity and lipid-related indices to predict the presence of non-alcoholic fatty liver disease[J]. Lipids Health Dis, 2021, 20(1): 134.
[13] Shi Y, Hu L, Li M, et al. Relationship between the lipid accumulation product index and arterial stiffness in the Chinese population with hypertension: a report from the China H-type hypertension registry study[J]. Front Cardiovasc Med, 2022, 21(8): e760361.
[14] Golabi S, Ajloo S, Maghsoudi F, et al. Associations between traditional and non-traditional anthropometric indices and cardiometabolic risk factors among inpatients with type 2 diabetes mellitus: a cross-sectional study[J]. J Int Med Res, 2021, 49(10): 030006052110499.
[15] Wang Y, Liu WM, Sun LL, et al. A novel indicator, childhood lipid accumulation product, is associated with hypertension in Chinese children and adolescents[J]. Hypertens Res, 2020, 43(3): 305-312.
[16] 段小龙,王丽明,康玉蓉,等.人体测量指标预测肥胖儿童非酒精性脂肪肝的研究[J].中国儿童保健杂志,2022,30(5):475-479.
[17] Crimmins NA, Mouzaki M, Delbello MP, et al. A novel indicator, childhood lipid accumulation product, is associated with hypertension in Chinese children and adolescents[J]. Diabetes, 2022, 71(1): 1432.
[18] Ma XF, Liu SS, Zhang J, et al. Proportion of NAFLD patients with normal ALT value in overall NAFLD patients: a systematic review and meta-analysis[J]. BMC Gastroenterol, 2020, 20(15): 862-873.
[19] Chao GQ, Chen LY. Study on the independent effect of thyroid hormone based on uric acid level on NAFLD[J]. Health Popul Nutr, 2021, 40(1): 21.
[20] Hoi J, Joe H, Oh JE, et al. The correlation between NAFLD and serum uric acid to serum creatinine ratio[J]. PLoS One, 2023, 18(7): e0288666.
[21] Park H, Park KY, Kim M, et al. Association between serum uric acid level and non-alcoholic fatty liver disease in Koreans[J]. Asian Biomed, 2022, 28(1): 15-22.
[22] Jung JY, Shim JJ, Park SK, et al. Serum ferritin level is associated with liver steatosis and fibrosis in Korean general population[J]. Hepatol Int, 2019, 13(2): 222-233.
[23] Armandi A, Younes R, Caviglia GP, et al. Increased serum ferritin levels predict long-term mortality in patients with NAFLD[J]. Digest Liver Dis, 2021, 53(S1): 28.