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目的探讨儿童非酒精性脂肪肝(NAFLD)发病与胰岛素抵抗的关系。方法对26例肥胖患儿分为非NAFLD组(14例)、NAFLD组(12例)及20例正常儿童进行体格检查,采用标准方法检测谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆固醇(TCH)、甘油三脂(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FBG)、空腹胰岛素(FINS),并计算稳态模型胰岛素抵抗指数(HOMA-IR)。结果 NAFLD组、非NAFLD组较对照组相比,体重、体质指数(BMI)、腰臀比(WHR)、FINS、IR、ALT、AST差异有统计学意义(P<0.05),3组相比,腰臀比(WHR)、FINS、IR、ALT、AST差异有统计学意义(P<0.05),而TCH、TG、LDL-C、HDL-C、FBG 3组之间差异无统计学意义(P>0.05)。NAFLD的发生与HOMA-IR、高胰岛素血症有明显的相关性,而HOMA-IR值与WHR、TG呈正相关(r=0.62,P<0.01,0.47,P<0.05)。结论肥胖儿童腰臀比对非酒精性脂肪肝(NAFLD)发病有一定的预测价值,胰岛素抵抗可能系儿童非酒精性脂肪肝发病的主要因素,肝功能损害是继发性因素。
Objective To investigate the relationship between non-alcoholic fatty liver disease (NAFLD) and insulin resistance in children. Methods Twenty-six obese children were divided into non-NAFLD group (n = 14), NAFLD group (n = 12) and normal children in 20 normal subjects. The ALT, AST, TCH, TG, LDL-C, HDL-C, fasting blood glucose (FBG) and fasting insulin (FINS) Model Insulin Resistance Index (HOMA-IR). Results Compared with the control group, the body weight, body mass index (BMI), WHR, FINS, IR, ALT and AST in NAFLD group and non-NAFLD group were significantly different (P <0.05) (WHR), FINS, IR, ALT and AST were significantly different (P <0.05), but there was no significant difference between TCH, TG, LDL-C, HDL- P> 0.05). The incidence of NAFLD was significantly correlated with HOMA-IR and hyperinsulinemia, while HOMA-IR was positively correlated with WHR and TG (r = 0.62, P <0.01,0.47, P <0.05). Conclusion The waist-hip ratio of obese children has a certain predictive value for the pathogenesis of NAFLD. Insulin resistance may be the main factor of children with non-alcoholic fatty liver disease, and hepatic impairment is a secondary factor.