呼和浩特市超重肥胖儿童非酒精性脂肪肝患病现状及相关因素

于琼; 李建英; 曹璞丽; 刘冬; 张健; 李瑞凤

doi:10.16835/j.cnki.1000-9817.2024142

呼和浩特市超重肥胖儿童非酒精性脂肪肝患病现状及相关因素

doi: 10.16835/j.cnki.1000-9817.2024142

内蒙古自治区妇幼保健院儿内科，呼和浩特 010020

基金项目:

内蒙古自治区卫生健康委医疗卫生科技计划项目 202201135

详细信息

作者简介:
于琼(1983-)，女，辽宁义县人，硕士，副主任医师，主要研究方向为小儿消化系统疾病

通讯作者:
李瑞凤，E-mail：nm_fyliruifeng@163.com

利益冲突声明 所有作者声明无利益冲突。
中图分类号: R179 R723.14 R725.7
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- 被引次数: 0
出版历程
- 收稿日期: 2024-01-08
- 修回日期: 2024-04-18
- 网络出版日期: 2024-05-30
- 刊出日期: 2024-05-25

Prevalence of non-alcoholic fatty liver disease and associated factors in overweight and obese children in Hohhot

Maternal and Child Health Hospital of Inner Mongolia Autonomous Region, Hohhot (010020), Inner Mongolia Autonomous Region, China

摘要

摘要: 目的探索呼和浩特市超重肥胖儿童非酒精性脂肪肝(NAFLD)患病现状及其相关因素，为制定健康教育计划和实施儿童NAFLD防治工作提供理论依据。方法于2022年8月28日至2023年3月5日，采用整群抽样方法从呼和浩特市4所小学抽取156名超重/肥胖儿童纳入研究；收集呼和浩特市超重/肥胖儿童基本信息，并抽取清晨空腹血液检测空腹血糖(GLU)、丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、γ谷氨酰基转移酶(γ-GGT)、尿酸(uric)、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、胰岛素(insulin)。采用t检验、χ²检验和Fisher确切概率法进行单因素分析，多因素分析采用Logistic回归分析并进行受试者特征曲线绘制。结果无NAFLD组和NAFLD组超重/肥胖儿童在年龄、腰围、臀围、GLU、ALT、AST、γ-GGT、uric和TG上差异均有统计学意义(U/t=1 070.0~2 164.0，P值均 < 0.05)。多因素分析中，AST升高和uric升高与NAFLD发生风险增高均相关[OR值(95%CI)分别为1.16(1.04~1.28)，1.01(1.00~1.01)，P值均 < 0.05]。受试者特征曲线下面积分别为AST=0.737，uric=0.665。结论呼和浩特地区超重/肥胖儿童NAFLD患病率较高，AST升高和uric升高可能会导致超重/肥胖儿童患NAFLD风险升高。应重点关注超重/肥胖儿童NAFLD的患病情况，建议在NAFLD的防治中同时降低BMI和uric水平，以达到更好的治疗效果。
- 超重 /
- 肥胖症 /
- 脂肪肝 /
- 患病率 /
- 回归分析 /
- 儿童 /
- 少数民族
Abstract: Objective To explore prevalence and associated factors of non-alcoholic fatty liver disease (NAFLD) in overweight and obese children in Hohhot City, so as to provide the oretical basis for developing health education plans and implementing prevention and treatment of NAFLD in children. Methods A total of 156 overweight and obese children was enrolled from 4 primary schools in Hohhot City using cluster sampling method during 28th Aug. 2022 to 5th Mar. 2023. Height and weight were measured and body mass index was calculated, and fasting blood was taken in the early morning for fasting blood glucose, alanine aminotransferase, aspartate aminotransferase. Single factor analysis was conducted using t-test, χ² test and Fisher's exact probability method, while multivariate analysis was conducted using Logistic regression analysis and subject characteristic curves. Results The differences in age, waist circumference, hip circumference, fasting glucose, alanine aminotransferase, aspartate aminotransferase, gamma glutamyltransferase, uric acid, and triglyceride were statistically significant between the non-NAFLD and the NAFLD group (U/t=1 070.0-2 164.0, P < 0.05). Significant differences were observed in aspartate aminotransferase (AST) and uric acid levels (AST OR=1.16, 95%CI=1.04-1.28; uric OR=1.01, 95%CI=1.00-1.01, P < 0.05). The area under a receiver operating characteristic were 0.737 for aspartate aminotransferase and 0.665 for uric acid, respectively. Conclusions The prevalence of NAFLD is high in overweight/obese children in Hohhot, and both elevated aspartate aminotransferase and hyperuricemia could increase the risk of NAFLD in overweight/obese children. Special attention should be paid to the NAFLD in overweight and obese children. It is recommended to reduce both BMI and uric level in the prevention and treatment of NAFLD to achieve better treatment outcomes.
- Overweight /
- Obesity /
- Fatty liver /
- Prevalence /
- Regression analysis /
- Child /
- Minority groups
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图 1 AST和uric预测超重/肥胖儿童NAFLD的ROC曲线

Figure 1. ROC curves of AST and uric for predicting NAFLD in overweight/obese children

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表 1 呼和浩特市6~14岁超重肥胖儿童NAFLD影响因素的单因素分析[M(P₂₅，P₇₅)]

Table 1. Univariate analysis of factors affecting NAFLD in overweight and obese children aged 6-14 years in Hohhot City[M(P₂₅, P₇₅)]

组别	人数	腰围/cm	臀围/cm	GLU/(mmol·L^-1)^*	ALT/(U·L^-1)	AST/(U·L^-1)	γ-GGT/(U·L^-1)
非NAFLD	84	74(67.5，80.5)	86(78.0，94.0)	4.8±0.4	14.7(10.8，18.7)	21.2(17.6，24.8)	15.0(11.5，18.5)
NAFLD	72	87(80.0，94.0)	97(89.5，104.5)	4.9±0.5	28.1(17.9，38.4)	24.1(19.1，29.1)	21(17.0，25.0)
U/t值		1 258.0	1 458.5	-1.9	1 070.0	2 026.5	1 391.5
P值		<0.01	<0.01	0.06	<0.01	<0.01	<0.01

组别	人数	uric/ (μmol·L^-1)	TC/ (mmol·L^-1)^*	TG/ (mmol·L^-1)	LDL/ (mmol·L^-1)^*	HDL/ (mmol·L^-1)^*	insulin/ pmol/L
非NAFLD组	84	350.5(305.0，396.0)	4.0±1.5	1.0(0.7，1.3)	2.4±0.5	1.3±0.3	119.5(76.8，162.1)
NAFLD组	72	421.5(357.0，486.0)	4.1±0.8	1.2(0.7，1.7)	2.4±0.7	1.3±0.3	244.9(154.3，335.5)
U/t值		1 593.5	-1.1	2 164.0	-0.7	0.4	1 318.5
P值		<0.01	0.27	<0.01	0.47	0.69	<0.01
注：*符合正态分布，采用(x ±s)表示。

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表 2 呼和浩特市6~14岁超重肥胖儿童NAFLD影响因素的多因素Logistic回归分析(n=156)

Table 2. Multivariate Logistic regression analysis of the influencing factors of NAFLD in overweight and obese children aged 6-14 years in Hohhot City(n=156)

自变量	β值	标准误	OR(95%CI)	P值
性别	0.08	0.49	1.08(0.41~2.85)	0.88
就诊年龄	-0.17	0.16	0.85(0.62~1.17)	0.31
腰围	0.02	0.05	1.02(0.93~1.13)	0.69
臀围	0.08	0.06	1.08(0.96~1.21)	0.19
GLU	0.56	0.61	1.75(0.53~5.72)	0.36
ALT	0.00	0.02	1.00(0.97~1.04)	0.83
AST	0.14	0.05	1.16(1.04~1.28)	0.01
γ-GGT	0.01	0.02	1.01(0.96~1.05)	0.81
uric	0.01	0.00	1.01(1.00~1.01)	0.03
TG	0.29	0.40	1.34(0.61~2.93)	0.47
insulin	0.00	0.00	1.00(1.00~1.01)	0.06

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