目的 探讨不同程度的减重对肥胖儿童青少年非酒精性脂肪肝病(NAFLD)受试者的体脂、血脂、血糖、肝功及肝脏形态的影响。方法 2023年7—9月,从封闭式减肥训练营招募肥胖儿童青少年NAFLD受试者70人,进行为期4周的减重干预,在干预开始前1天与干预4周后分别采集受试者的各项测试指标。根据受试者的减重百分比(WL)及临床指南推荐,分为低减重组(WL<5%)、中等减重组(5%≤WL<7%)、高减重组(WL≥7%)。采用配对样本t检验比较组内指标的变化,单因素方差分析比较组间改善效果的差异,采用广义回归模型分析体重变化与血糖、血脂、肝酶的关系。结果 共有61名受试者纳入分析。4周减重干预后,三组 NAFLD患者的脂肪量(BF)(t=6.471、9.991、13.351)、脂肪百分比(FP)(t=6.240、5.549、7.616)出现显著下降(P＜0.05);低密度脂蛋白胆固醇(LDL-C)在三组中(t=3.403、9.218、7.844)显著改善(P＜0.05),血清总胆固醇(TC)的下降只在5%≤WL<7%与WL≥7%组(t=7.114、6.735)差异有统计学意义(P＜0.05);三组患儿血清γ-谷氨酰转肽酶(GGT)(t=5.082、4.275、5.003)、血清胆碱酯酶(ChE)(t=6.708、9.254、10.941)均显著降低(P＜0.05)。碱性磷酸酶(ALP)(t=3.842、4.584)、乳酸脱氢酶(LDH)(t=3.065、3.869)在5%≤WL<7%、WL≥7%组出现显著下降,天门冬氨酸氨基转移酶(AST)在WL≥7%组(t=2.115)显著下降,差异有统计学意义(P＜0.05)。以体重变化百分比为自变量,采用广义线性回归模型进行趋势性检验,发现TC、ALP、LDL-C、TG、ChE在体重变化分组中存在线性趋势(P＜0.05)。结论 减重干预可以显著改善肥胖儿童青少年NAFLD受试者的糖、脂代谢与肝功能,且随着减重量的增加,NAFLD儿童肝酶改善程度表现出提升的趋势。
Abstract
Objective To investigate the effects of different levels of weight loss on body fat, blood lipids, blood glucose, liver function, and liver morphology in obese children and adolescents with non-alcoholic fatty liver disease (NAFLD). Methods From July to September 2023, seventy obese children and adolescents with NAFLD were recruited from a closed weight loss camp and underwent a 4-week weight loss intervention. Various test indicators were collected from the participants one day before the intervention and four weeks after the intervention. Based on the percentage of weight loss (WL) and clinical guideline recommendations, the participants were divided into a low WL group (WL<5%), a moderate WL group (5%≤WL<7%), and a high WL group (WL≥7%). The paired-sample t-test was used to compare changes in indicators within groups, one-way ANOVA was used to compare differences in improvement effects between groups, and a generalized regression model was used to analyze the relationship between weight change and blood glucose, blood lipids, and liver enzymes. Results A total of 61 participants were included in the analysis. After the 4-week weight loss intervention, there were significant decreases in body fat (BF) (t=6.471, 9.991, 13.351) and fat percentage (FP) (t=6.240, 5.549, 7.616) in the three NAFLD groups (P<0.05). Low-density lipoprotein cholesterol (LDL-C) significantly improved in all three groups (t=3.403, 9.218, 7.844, P<0.05), and the decrease in serum total cholesterol (TC) was statistically significant only in the 5%≤WL<7% and WL≥7% groups (t=7.114, 6.735,P<0.05). Serum gamma-glutamyltransferase (GGT) (t=5.082, 4.275, 5.003) and serum cholinesterase (ChE) (t=6.708, 9.254, 10.941) were significantly reduced (P<0.05). Alkaline phosphatase (ALP) (t=3.842, 4.584) and lactate dehydrogenase (LDH) (t=3.065, 3.869, P<0.05) decreased significantly in the 5%≤WL<7% and WL≥7% groups, and aspartate aminotransferase (AST) decreased significantly in the WL≥7% group (t=2.115, P<0.05). Using the percentage of weight change as the independent variable and a generalized linear regression model for trend testing, it was found that serum TC, ALP, LDL-C, TG, and ChE exhibited a linear trend across weight change groups (P<0.05). Conclusion Weight loss intervention can significantly improve glucose and lipid metabolism and liver function in obese children and adolescents with NAFLD, and with increasing amounts of weight loss, there is a trend of increased improvement in NAFLD liver enzymes.
关键词
儿童青少年 /
非酒精性脂肪肝病 /
减重 /
肥胖
Key words
children and adolescents /
non-alcoholic fatty liver disease /
weight loss /
obesity
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基金
国家社会科学基金重点项目(23ATY007)
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