儿童非酒精性脂肪性肝病的临床特征及肝纤维化危险因素分析

摘要/Abstract

摘要： 目的分析儿童非酒精性脂肪性肝病(NAFLD)的临床表现,并识别与肝纤维化相关的危险因素,为早期诊断和干预提供理论依据。方法本研究纳入2022年5月至2024年5月期间,蒙城县第一人民医院就诊的83名NAFLD儿童患者。根据肝纤维化的严重程度,患者被分为非显著肝纤维化组与显著肝纤维化组。研究通过比较两组临床参数和实验室检测指标,探讨不同因素对肝纤维化的影响。采用多因素分析方法进一步筛选出与肝纤维化相关的独立危险因素,并利用受试者工作特征(ROC)曲线评估关键临床指标在预测显著肝纤维化方面的诊断能力。结果与非显著肝纤维化组相比,显著肝纤维化组在BMI、ALT、AST以及HbA1c等指标上呈显著升高(P<0.05)。治疗后,非显著肝纤维化组的BMI为(18.62±1.95)kg/m²,ALT为(40.28±13.80)U/L,AST为(31.18±8.45)U/L,HbA1c为(5.46±0.35)%;而显著肝纤维化组的BMI为(25.14±2.23)kg/m²,ALT为(56.32±17.90)U/L,AST为(38.66±9.22)U/L,HbA1c为(5.77±0.42)%。多因素分析表明,较高的BMI、ALT、AST及HbA1c水平与肝纤维化的发生密切相关。通过ROC曲线评估发现,BMI、ALT、AST和HbA1c联合使用能有效预测肝纤维化,其曲线下面积(AUC)为0.968,具有较高的灵敏度(85.7%)和特异度(97.9%)。模型的拟合度较好,Hosmer-Lemeshow检验结果显示无显著偏差(χ²=4.138,P=0.844)。结论 BMI、ALT、AST和HbA1c可以作为儿童NAFLD肝纤维化的有效预测指标,且这四个因素的联合评估能显著提高早期诊断的准确性,为临床干预提供参考。

关键词: 非酒精性脂肪性肝病, 儿童, 肝纤维化, 危险因素, 预测模型

Abstract: Objective To investigate the clinical features of non-alcoholic fatty liver disease (NAFLD) in children and explore the risk factors of liver fibrosis, providing a basis for early diagnosis and intervention. Methods A total of 83 pediatric patients with NAFLD, who were treated at the First People's Hospital of Mengcheng County from May 2022 to May 2024, were enrolled. Based on the degree of liver fibrosis, patients were divided into a non-significant liver fibrosis group (n=48) and a significant liver fibrosis group (n=35). The clinical characteristics and laboratory results between the two groups were compared. Logistic regression analysis was used to identify independent risk factors for liver fibrosis. The diagnostic performance of key indicators in predicting significant liver fibrosis was assessed using receiver operating characteristic (ROC) curves. Results Compared to the mild fibrosis group, the severe fibrosis group showed the significantly higher levels of body mass index (BMI), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and glycated haemoglobin A1c (HbA1c) (P<0.05). Specifically, after treatment, the BMI in the mild fibrosis group was (18.62±1.95) kg/m², ALT was (40.28±13.80) U/L, AST was (31.18±8.45) U/L, and HbA1c was (5.46±0.35)%, while in the severe fibrosis group, the BMI was (25.14±2.23) kg/m², ALT was (56.32±17.90) U/L, AST was (38.66±9.22) U/L, and HbA1c was (7.05±0.74)%. Multivariate analysis further revealed that the higher levels of BMI, ALT, AST, and HbA1c were closely associated with the occurrence of hepatic fibrosis. ROC curve analysis indicated that the combination of BMI, ALT, AST, and HbA1c effectively predicted significant hepatic fibrosis with an area under the curve (AUC) of 0.968, which demonstrating high sensitivity (85.7%) and specificity (97.9%). The model showed good fit, with no significant deviation indicating by the Hosmer-Lemeshow test (χ²=4.138, P=0.844). Conclusion BMI, ALT, AST, and HbA1c can serve as effective indicators for predicting liver fibrosis in children with NAFLD. The combined model of the four factors improves the accuracy of early diagnosis and provides reference for clinical intervention.

Key words: Non-alcoholic fatty liver disease, Children, Liver fibrosis, Risk factors, Prediction model

陈雷, 龚倩, 刘金广, 沈怀云. 儿童非酒精性脂肪性肝病的临床特征及肝纤维化危险因素分析[J]. 肝脏, 2025, 30(6): 820-824.

CHEN Lei, GONG Qian, LIU Jin-guang, SHEN Huai-yun. Clinical features and risk factors of liver fibrosis in children with non-alcoholic fatty liver disease[J]. Chinese Hepatolgy, 2025, 30(6): 820-824.

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