肥胖儿童非酒精性脂肪肝病及代谢综合征发病情况分析

目的 研究肥胖儿童中非酒精性脂肪肝病(NAFLD)与代谢综合征(MS)的发生情况,并探索两者之间的关系.方法 对308例在本院内分泌科住院的9～14岁肥胖儿童进行腰围、体块指数、血脂、肝功能、肝脏B超、糖耐量试验及胰岛素释放试验等各项检查,根据诊断标准分别计算发生NAFLD[包括单纯性非酒精性脂肪肝(SNAFL)、非酒精性脂肪肝炎(NASH)]和MS的患病率,并将308例肥胖患儿分为无肝脏损害的肥胖儿童组(OCWLD组),SNAFL组和NASH组,比较各组胰岛素、胰岛素抵抗(IR)指标及MS的发病率和MS组成成分的发病率.结果 (1)308例中发生NAFLD的达到203例(65.9%),其中发生SNAFL者140例(45.5%),发生NASH者63例(20.5%).(2)308例中发生MS 76例(24.7%),这76例中合并有NAFLD的64例(84.2%).NAFLD组中MS 64例(31.5%),高于OCWLD组的12例(11.4%),差异有统计学意义,但SNAFL组中MS 41例(29.3%),与NASH组的23例(36.5%)比较差异无统计学意义.(3)就单个MS的组成成分来说,OCWLD组与SNALF组比较仅在高血压的发病率上差异有统计学意义,而OCWLD组与NASH组比较在高血压、高血脂、高血糖的发病率上差异均有统计学意义;SNALF组与NASH组比较在高血脂的发病率上差异有统计学意义.随OCWLD向SNAFL和NASH发展,空腹胰岛素水平逐渐上升,IR也越加明显.但NAFLD患儿与MS患儿比较各IR指标差异无统计学意义.结论 肥胖儿童中NAFLD和MS的发生率均已相当高,MS患儿合并NAFLD的比例很高,IR是NAFLD和MS共同的发病基础,且随着NAFLD患儿病情的进展,MS成分指标越来越严重,IR也越来越严重.     

肥胖儿童非酒精性脂肪性肝病发病的相关危险因素分析

目的 探讨肥胖儿童非酒精性脂肪性肝病发生的危险因素及临床特征.方法 回顾分析2003-2007年确诊为单纯性肥胖的77例患儿临床及实验诊断资料.根据是否伴有非酒精性脂肪性肝病分为脂肪肝组和非脂肪肝组进行分析比较,分析指标包括年龄、性别、肥胖持续时间、体质指数(BMI)、黑棘皮、胰岛素抵抗指数(HOMA-IR)、空腹血糖、空腹胰岛素、血脂(TG、TC、LDL-C、HDL-C)以及门冬氨酸氨基转移酶(AST)、丙氨酸氨基转移酶(ALT)等.结果 77例单纯性肥胖儿童中,脂肪肝组35例,占45.5%,男女比例为3.38:1;非脂肪肝组42例,占54.5%,男女比例为0.83:1.脂肪肝组患儿年龄较大(11.88±1.55比9.26±2.75,P=0)、肥胖持续时间较长(6.06±2.83比4.78±3.4,P=0.024)、男孩发病比女孩多(35.04%比24.67%,P=0.004)、HOMA-IR较高(2.01±0.24比1.78±0.33,P=0.001).脂肪肝组患儿伴有ALT升高15例,伴AST升高8例,ALT和AST同时升高3例;非脂肪肝组患儿转氨酶均正常.脂肪肝组患儿中30例(85.7%)、非脂肪肝组患儿中22例(52.4%)伴有黑棘皮(P=0.001).多因素Logistic回归分析发现,HOMA-IR(OR=13.755,P=0.011)是肥胖儿童脂肪肝发生的独立危险因素.结论 单纯性肥胖儿童的年龄、肥胖持续时间、黑棘皮的存在与否以及HOMA-IR与其发生脂肪性肝病密切相关,HOMA-IR是单纯性肥胖儿童发生脂肪性肝病的独立危险因素.     

肥胖儿童非酒精性脂肪肝炎

非酒精性脂肪肝炎(NASH)是指肝脏病理改变类似于酒精性脂肪肝炎而又无饮酒史的一类慢性肝脏疾病.肥胖儿童NASH与体质量指数(BMI)、高脂血症、稳态模型胰岛素抵抗指数(HOMA-IR)密切相关,是代谢综合征的肝脏表现.血清脂联素水平与肝细胞脂肪浸润呈负相关,基因的多态性对肝脏的脂类代谢和贮存功能有重要影响.肥胖儿童NASH多无症状,肝转氨酶升高,必须排除自身免疫性疾病、病毒性肝炎、药物性肝损害等.超声波检查可识别肝内脂肪浸润,帮助诊断肥胖儿童NASH.对肥胖儿童NASH的治疗仍以去除病因、控制饮食、加强锻炼、采取合理生活方式为主,也可用维生素E和葫芦素片治疗,合并2型糖尿病或代谢综合征的NASH儿童可应用胰岛素增敏剂盐酸二甲双胍治疗.     

细胞外囊泡在非酒精性脂肪肝病中的研究进展

<正>非酒精性脂肪肝病(nonalcoholic fatty liver disease,NAFLD)包括非酒精性单纯性脂肪肝(NAFL)、非酒精性脂肪肝炎(NASH)及其相关肝纤维化和肝硬化~([1])。肝活检是NAFLD诊断及分期的金标准,但因其有创性限制了其在临床中的应用。因此,急需一种简便、灵敏、可靠的生物学指标用于NAFLD的诊断、分级及预后判断。越来越     

复方甘草酸苷片治疗儿童非酒精性脂肪性肝病疗效观察

目的探讨复方甘草酸苷片治疗儿童非酒精性脂肪性肝病的临床疗效。方法将2014年6月至2016年5月就诊的65例非酒精性脂肪性肝病患儿随机分为复方甘草酸苷片治疗组(n=33)和护肝片对照治疗组(n=32),分别予以口服复方甘草酸苷片和护肝片治疗24周。两组患儿均于治疗前后检测血清丙氨酶氨基转移酶(ALT)、γ-谷氨酰转肽酶(γ-GT)、透明质酸(HA)、Ⅲ型前胶原(PCⅢ)、Ⅳ型胶原(CⅣ)和层黏连蛋白(LN)水平。结果复方甘草酸苷片组和护肝片组治疗总有效率分别为85%和50%,两组比较差异有统计学意义(P0.05);两组患儿血清ALT水平治疗后较治疗前均显著下降(P0.05),但复方甘草酸苷片组较护肝片组下降更明显(P0.01);复方甘草酸苷片组治疗后血清γ-GT水平以及肝纤维化四项指标(HA、PCⅢ、CⅣ、LN)水平较治疗前均得到明显改善(P0.05),而护肝片组上述各指标水平较治疗前均无显著变化(P0.05)。结论复方甘草酸苷片可有效改善非酒精性脂肪性肝病患儿的肝功能,并能降低肝纤维化血清学指标水平;其疗效优于护肝片治疗。     

鼠李糖乳杆菌与儿童非酒精性脂肪肝病研究进展

非酒精性脂肪肝病(NAFLD)已成为儿童最常见的慢性肝病之一,其疾病谱包括非酒精性单纯性脂肪肝、非酒精性脂肪性肝炎及其相关肝纤维化、肝硬化和肝细胞癌。在肥胖儿童中,至少有50%的儿童表现出一定程度的NAFLD。在NAFLD进展中起主要作用的是游离脂肪酸水平增加和胰岛素抵抗,致使肝细胞中三酰甘油过度聚积。鼠李糖乳杆菌是目...     

学龄儿童肥胖相关性脂肪肝及脂代谢紊乱的病例对照研究

目的 研究学龄儿童肥胖与非乙醇性脂肪肝病（nonalcoholic fatty liver disease, NAFLD）及脂肪代谢紊乱等相关因素的关系。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，在知情同意的前提下，从中抽取659名7～18岁肥胖儿童作为肥胖组，603名正常体重儿童作为对照组，进行问卷、身体测量、腹部B超脂肪肝检查及血清总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）水平，血清丙氨酸转氨酶（ALT）和天冬氨酸转氨酶（AST）等生化指标检测。超重、肥胖采用中国学龄儿童超重、肥胖BMI筛查标准进行评价；血脂异常的判定标准：静脉血清TC≥5.20 mmol·L-1，TG≥1.70 mmol·L-1，HDL-C≤1.03 mmol·L-1，LDL C≥3.12 mmol·L-1；肝功能异常：静脉血清ALT≥40.0 U·L-1和（或）AST≥45.0 U·L-1；NAFLD诊断依据2003年中华医学会肝脏病学分会脂肪肝和酒精性肝病学组公布的非酒精性脂肪性肝病诊断标准进行。统计方法包括计量资料的描述统计、协方差分析、卡方检验、二分类多因素Logistic回归分析及趋势卡方检验等。结果 肥胖组有3例未行脂肪肝B超检测，肥胖组B超脂肪肝和NAFLD的检出率分别为28.0%（184/656）和10.2%（67/656），对照组脂肪肝和NAFLD的检出率分别为0.3%（2/603）和0.2%（1/603），差异有统计学意义（P<0.01），肥胖组TG、TC、LDL-C水平明显高于对照组，HDL-C水平明显低于对照组（P<0.01）。肥胖同时罹患NAFLD时，血脂异常进一步加重，ALT及AST异常也更明显，以ALT升高为著；随着肥胖的加重，脂肪代谢紊乱及肝功能损害程度逐渐上升。结论 肥胖儿童伴发NAFLD较为普遍，单纯性肥胖对儿童的肝功能和脂肪代谢等均造成危害，并随肥胖程度逐渐加重，对中度以上肥胖儿童建议常规进行腹部B超检查。     

非酒精性脂肪肝炎患儿脂代谢紊乱及胰岛素抵抗研究

目的　探讨非酒精性脂肪肝炎(NASH)与脂代谢紊乱及胰岛素抵抗之间的关系。方法　对2 0 0 3年6～1 0月浙江大学医学院附属儿童医院收集的54例诊断为NASH的肥胖儿童及2 4例既无脂肪肝影像学改变也无肝转氨酶升高的单纯性肥胖儿童(对照组) ,进行血甘油三酯、胆固醇、空腹血糖/空腹血胰岛素比值(FGIR)的检测,分析NASH与高脂血症和胰岛素抵抗之间的关系。并对其中2 0例怀疑合并良性黑棘皮病的患儿行皮肤病理活检以确诊,分析NASH与良性黑棘皮病的关系。结果　54例NASH的患儿体重指数(BMI)为( 2 8 .1 0±4 .1 6) ,对照组BMI为( 2 3 . 91±1 . 88) ,二者相比,差异有显著性意义(t=5. 0 5,P <0 .0 1 )。NASH组中高脂血症及胰岛素抵抗(FGIR <7)的发生率分别为59. 2 6%和70 . 3 7% ,明显高于对照组(发生率为2 0 .83 % ,8 3 .3 % ,χ2 =9. 84,χ2 =2 5. 59,P <0 . 0 1 )。经相关分析,发现丙氨酸转氨酶(ALT)及天冬氨酸转氨酶(AST)与BMI、血胆固醇、血甘油三酯、FGIR呈显著相关(rs=0 . 41 3 ,0 . 2 9,0 . 3 79,-0 . 477,P <0 . 0 1 ;rs=0 . 3 590 3 4 .9,0 .3 4 8,-0 . 3 69,P <0. 0 1 )。且其中2 0例伴良性黑棘皮病(占3 7. 0 4% )。结论　NASH患儿存在严重的脂代谢紊乱及胰岛素抵抗。约1 /3以上NASH患儿合并良性     

A cross-sectional study on the prevalence rate and influencing factors of nonalcoholic fatty liver disease in overweight/obese children北大核心CSCD

目的 调查医院就诊的超重/肥胖儿童非酒精性脂肪肝病(non-alcoholic fatty liver disease,NAFLD)的患病率,并探讨NAFLD发生的影响因素,为超重/肥胖儿童NAFLD的预防提供依据。方法 招募2019年6月-2021年9月在湖南省儿童医院就诊的超重/肥胖儿童作为研究对象,调查NAFLD患病率,并采用logistic回归分析探讨NAFLD,包括单纯性脂肪肝(non-alcoholic fatty liver,NAFL)和非酒精性脂肪肝炎(non-alcoholic steatohepatitis,NASH)发生的影响因素。采用受试者操作特征曲线分析评价影响因素对NAFL及NASH的预测价值。结果 共纳入844例超重/肥胖儿童,年龄为6~17岁。NAFLD患病率为38.2%(322/844),其中NAFL和NASH患病率分别为28.8%(243/844)和9.4%(79/844)。多因素logistic回归分析显示,腰臀比(waist-to-hip ratio,WHR)增加及低高密度脂蛋白胆固醇血症与NAFL和NASH的发生有关(P<0.05)。受试者操作特征曲线分析显示:WHR和高密度脂蛋白胆固醇联合检测预测NAFL的曲线下面积为0.653 (95%CI:0.613~0.694);二者联合检测预测NASH的曲线下面积为0.771 (95%CI:0.723~0.819)。结论 医院就诊的超重/肥胖儿童NAFLD的患病率较高;WHR和高密度脂蛋白胆固醇与NAFLD的发生有关,二者联合检测对NAFLD的发生具有一定的预测价值。     

肥胖儿童非酒精性脂肪肝炎54例

目的 观察不同程度肥胖儿童非酒精性脂肪肝炎(NASH)的发病状况,探讨其可能的发病机制.方法 体质量指数(BMI)≥23的7～16岁单纯性肥胖儿童123例.按BMI分为3组:BMI≥30组34例,25≤BMI＜30组57例,23≤BMI＜25组32例.分别进行肝脏B超检查,并检测血转氨酶、胆固醇、三酰甘油(TG)及空腹血糖/空腹胰岛素比值(FlGIR).将另24例仅有肥胖而无肝脂肪病变者设为对照组.结果 123例患儿中B超发现肝脂肪病变99例(80.49%),其中符合NASH诊断标准者54例(43.90%).所有患儿中,BMI≥30组脂肪肝炎及FGIR＜7的发生率均显著高于其他2组(Pa ＜0.01).相关分析表明,ALT和AST与BMI分级、血胆固醇、TG、FGIR均有相关性(r=0.413,0.290,0.379,-0.477 Pa ＜0.01;r=0.359,0.349,0.348,-0.369 Pa ＜0,01).NASH患儿与对照组血脂、FGIR、BMI比较差异均有统计学意义(X2=9.84,25.59 Pa ＜0.01;t=5.05P＜0.01).结论 BMI ≥30是肥胖儿童发生NASH的高危因素,且脂代谢紊乱和胰岛素抵抗可能与其发病有关.     

Vitamin E treatment of nonalcoholic steatohepatitis in children: a pilot study

AIM: To determine whether supplemental oral vitamin E is effective in lowering serum aminotransferase and alkaline phosphatase levels in children with nonalcoholic steatohepatitis (NASH) associated with obesity. STUDY DESIGN: Open-label pilot study enrolling all children <16 years old with chronically elevated serum aminotransferase (alanine aminotransferase and aspartate aminotransferase) levels for greater than 3 months, who demonstrated a diffusely echogenic liver on ultrasonography, had no demonstrable reason for abnormal serum chemistry values other than obesity, and therefore were diagnosed to have NASH. Patients were prescribed oral vitamin E between 400 and 1200 IU per day. Serum chemistry values were monitored monthly during treatment. RESULTS: Eleven subjects with a mean age of 12.4 years were enrolled; treated patients were followed up for 4 to 10 months. The body mass index did not change significantly before and after treatment (32.8 +/- 3.8 kg/m(2) vs 32.5 +/- 4.4 kg/m(2), respectively). Serum alanine aminotransferase decreased from 175 +/- 106 IU/L to 40 +/- 26 IU/L (P <.001, paired Student t test), serum aspartate aminotransferase decreased from 104 +/- 61 IU/L to 33 +/- 11 IU/L (P <.002), and alkaline phosphatase decreased from 279 +/- 42 IU/L to 202 +/- 66 IU/L (P <.003) during treatment. Serum aminotransferase levels remained normal during treatment but returned to abnormal in those electing to stop treatment. Serum alpha-tocopherol levels were within the normal range before the commencement of therapy and increased significantly with supplementation. The liver remained diffusely echogenic during therapy, at the time serum aminotransferase levels were reduced. CONCLUSIONS: Daily oral vitamin E administration normalized serum aminotransferase and alkaline phosphatase levels in children with NASH. Obese children with NASH should be encouraged to lose weight as part of a comprehensive weight reduction program and to consider taking supplemental alpha-tocopherol.     

肝功能检查在婴儿肝炎综合征和先天性胆道闭锁的鉴别诊断中的价值

目的：该文采用受试者工作特征曲线（ROC曲线）对肝功能检查中常用的7项血清学指标进行分析,探讨常用的肝功能检查在婴儿肝炎综合征（infantile hepatitis syndrome,IHS）和先天性胆道闭锁（biliary atresia,BA）中的鉴别诊断价值。方法：分别检测IHS组（n=103）和BA组（n=60）的丙氨酸转氨酶（ALT）、天冬氨酸转氨酶（AST）、γ-谷氨酰基转移酶（γ-GT）、碱性磷酸酶（ALP）、血清总胆红素（TB）、结合胆红素（CB）和血清白蛋白（ALB）等7个生化指标,应用ROC曲线进行分析,评价上述各指标的敏感性和特异性,阳性预测值和阴性预测值,并得到最佳临界值。对γ-GT,TB 和CB采用联合试验,提高诊断效率。结果：与IHS组相比,BA组的ALT、AST、γ-GT、TB 和CB水平显著升高（PCB>TB>AST;CB的阴性预测值最高,TB次之。CB的阴性似然比最低;CB的Youden指数最高,γ-GT和TB次之。γ-GT、TB及CB经平行试验,敏感性和阴性预测值均提高至100%;经系列试验,特异性提高至90.4%,阳性预测值提高至87.5%。结论：γ-GT、TB和CB水平对BA有一定诊断价值,平行试验阳性者更需积极做影像学检查。［中国当代儿科杂志,2009,11（12）：953-956］     

川崎病患儿血清MMP-9与TIMP-1质量浓度变化及其临床意义

目的探讨川崎病(KD)患儿血清基质金属蛋白酶-9(MMP-9)及其特异性组织抑制剂1(TIMP-1)质量浓度的变化在预测发生冠状动脉病变(CAL)风险中的临床意义。方法观察组为2003~2004年在四川大学华西第二医院与四川省人民医院住院的KD患儿32例,静脉注射丙种球蛋白(IVIG)前后各抽取患儿外周静脉血1次,同时抽取20名正常体检儿童(正常对照组)外周静脉血。ELISA双抗体法测定血清MMP-9与TIMP-1质量浓度。用二维超声心动图观察心脏冠状动脉病变。结果观察组患儿急性期血清MMP-9、TIMP-1质量浓度及MMP-9/TIMP-1比值均较正常对照组儿童显著增高(P<0.01);IVIG干预前CAL组患儿血清MMP-9质量浓度及血清MMP-9/TIMP-1显著地高于非CAL组患儿(P<0.01);IVIG干预后观察组患儿血清MMP-9质量浓度与MMP-9/TIMP-1显著降低(P<0.01);IVIG干预后CAL组患儿血清MMP-9质量浓度及血清MMP-9/TIMP-1仍显著高于非CAL组患儿(P<0.05),而后者MMP-9/TIMP-1基本降至正常儿童水平;观察组患儿血清TIMP-1质量浓度在IVIG干预前后无显著变化。结论MMP-9与TIMP-1可作为KD合并CAL的一种关联因素,动态监测血清MMP-9质量浓度和(或)MMP-9/TIMP-1比值对预测KD并发CAL具有较重要临床意义。     

Fatty Liver Disease in Children—What Should One Do?

The world’s population is increasingly overweight and obese. According to the World Health Organization (WHO) as of 2010, 43 million children under the age of five were overweight. Once considered to be limited to developed countries, overweight and obese children are now found in low- and middle-income countries, though most commonly in urban areas. Furthermore the WHO now cites the conditions of overweight and obesity as being associated with more deaths around the globe than those associated with being underweight. With this increased prevalence of overweight and obese children has come a host of other medical problems including nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH). This review will focus on NAFLD and NASH, their definitions, epidemiology, diagnosis and treatment. The authors will also discuss NAFLD in the Indian subcontinent, and the future of NAFLD and NASH.     

巨细胞病毒肝炎婴儿外周血生长抑素、肠血管活性多肽与γ谷氨酰转肽酶水平的相关性

目的 探讨巨细胞病毒(CMV)肝炎婴儿血浆生长抑素(SST)、肠血管活性多肽(VIP)水平与血清γ谷胺酰转肽酶(γ-cT)的相关性,了解其在CMV肝炎婴儿持续性胆汁瘀积的诊断和鉴别诊断中的意义.方法 收集本院CMV肝炎婴儿60例.临床确诊依据CMV感染诊疗方案,即具备以下条件:(1)外周血或尿CMV-DNA和CMV-IgM呈阳性,甲型肝炎、乙型肝炎、丙型肝炎、丁型肝炎和戊型肝炎抗体检测均为阴性；(2)外周血ALT和结合胆红素(DB)高于正常值上限.根据最初的DB高低分组,≤136.8μ mol·L-1(瘀胆型肝炎I组)22例；＞ 136.8 μmol·L-1(瘀胆型肝炎Ⅱ组)20例,全部具备条件(1)和(2),影像学检查排除胆道闭锁(BA).BA组18例全部具备条件(1)和(2),并有B超检测胆道不显影及锝99放射扫描显像法肠道不显影.健康对照组14例.血浆SST或VIP水平测定采用放射免疫法,而血清γ-GT水平测定采用常规生物化学法.结果 健康对照组、瘀胆型肝炎Ⅰ组和瘀胆型肝炎Ⅱ组SST水平与γ-GT水平无相关性(r＝0.180,P＞0.05)；3组VIP水平与y-GT水平呈显著正相关性(r＝0.383,P＜0.05).健康对照组和BA组SST、VIP水平分别与γ-GT水平均呈显著负相关(r＝-0.743,P＜0.01;r＝-0.918,P＜0.01).结论 CMV肝炎患儿外周血VIP水平可作为反映肝内胆汁瘀积的良好指标.此外,外周血SST或VIP水平可作为瘀胆型肝炎和BA鉴别诊断的敏感指标之一.     

Tissue inhibitor of metalloproteinases-1 and matrix metalloproteinase-3 in Japanese healthy children and in Kawasaki disease and their clinical usefulness in juvenile rheumatoid arthritis

BACKGROUND AND METHODS: To determine the clinical values of tissue inhibitor of metalloproteinases-1 (TIMP-1) and matrix metalloproteinase-3 (MMP-3) in juvenile rheumatoid arthritis (JRA), we measured serum levels of these enzymes with rapid one-step sandwich enzyme immunoassay. Forty-one JRA patients, 48 normal healthy children (NC) and 10 Kawasaki disease (KD) patients were investigated. RESULTS: Serum TIMP-1 levels in NC corresponded to those in normal adults reported in the literature, while MMP-3 levels were lower than those in healthy children and the ratio of MMP-3/TIMP-1 decreased. The TIMP-1 levels in JRA and KD at the first clinic examination were statistically higher than those in NC (P < 0.05) and MMP-3 levels and MMP-3/TIMP-1 in JRA were significantly higher than those in NC (P < 0.0001 and 0.0005, respectively) and KD (P < 0.001 and 0.0005, respectively). In JRA, MMP-3 levels of patients with arthritis were statistically higher than those of patients without arthritis (P < 0.05) and MMP-3 levels were correlated with C-reactive protein (rs = 0.465, P < 0.05), while TIMP-1 did not (rs = 0.340). There was a positive correlation between serum levels of MMP-3 and TIMP-1 and prognosis (rs = 0.733, P < 0.05). CONCLUSION: In JRA, the serum MMP-3 level is a useful marker to evaluate joint damage, while serum TIMP-1 remains an acute phase reactant.     

Decreased serum adiponectin: an early event in pediatric nonalcoholic fatty liver disease

OBJECTIVE: To evaluate the relative concentrations of cytokines in pediatric nonalcoholic fatty liver disease (NAFLD). STUDY DESIGN: Thirty children were evaluated at a fasting morning visit to a pediatric research unit. RESULTS: Compared with normal-weight children (n = 12) and children who were overweight (n = 11), children who had presumed NAFLD (elevated Alanine aminotransferase [ALT] with negative work-up) (n = 7) had significantly lower mean serum adiponectin levels (P = .004). Adiponectin negatively correlated with body mass index (r = -0.60, P = .001), insulin (r = -0.74, P < .001), glucose (r = -0.52, P = .004), and ALT (r = -0.53, P = .003). There was no difference between normal-weight, obese, and presumed NAFLD subjects in mean serum tumor necrosis factor alpha and interleukin-6 and -8 concentrations nor in tumor necrosis factor alpha and interleukin-8 and -10 levels in an ex vivo lipopolysaccharide-stimulated system. CONCLUSIONS: Serum adiponectin is reduced in children with elevated ALT, similar to adults. However, children with presumed NAFLD do not have elevated pro-inflammatory cytokine levels. This suggests that depressed adiponectin plays a more proximal role than elevated levels of circulating pro-inflammatory cytokines in the development of NAFLD in children.     

肥胖儿童非酒精性脂肪肝病与心血管疾病的相关性

目的：探讨肥胖儿童非酒精性脂肪肝病（NAFLD）与心血管疾病(CVD)的关系。方法：231例肥胖儿童以及24例非肥胖儿童(对照组)进行临床、生化指标及颈动脉内膜-中层厚度（IMT）各项检查,根据诊断标准将231例肥胖儿童分为肥胖无肝脏损伤组（OCWLD）75例和NAFLD组156例。比较各组儿童临床、生化各项指标及IMT。结：果NAFLD组患儿IMT为0.066±0.021 cm,显著高于OCWLD组和对照组（分别为0.060±0.011 cm,0.037±0.007 cm,均P＜0.05）,OCWLD组亦显著高于对照组,P<0.05。NAFLD组患儿高血压、高脂血症患病率分别为39.7%和40.4%,明显高于OCWLD组（分别为22.7%,29.3%）和正常对照组（分别为4.2%,12.6%）（P<0.05）。经逐步线性回归分析显示IMT与BMI、NAFLD、ALT呈正相关（调整R2=0.316,P<0.01）。结论：肥胖儿童NAFLD的出现不仅是CVD发生的早期标志,而且是CVD发生的早期状态。NAFLD的早期诊断和治疗是预防心血管疾病发生发展的关键。［中国当代儿科杂志,2010,12（7）：547-550］