目的 探讨兰州市学龄期儿童肥胖非酒精性脂肪肝(nonalcoholic fatty liver disease, NAFLD)、血脂代谢异常及其相关因素。方法 2011年6-10月选取3所小学1至6年级7~14岁小学生作为研究对象。选取年龄、性别匹配体质指数(body mass index, BMI)正常儿童作为对照。行腹部B超、采空腹静脉血5 mL进行实验室检查, 包括天冬氨酸氨基转移酶(aspartate aminotransferase, AST)、丙氨酸氨基转移酶(alanine aminotransferase, ALT)、谷氨酰转肽酶(gamma glutamyl transpeptidase, GGT)、总胆固醇(total cholesterol, CHOL)、甘油三酯(triglyceride, TG)、高密度脂蛋白胆固醇(high-density lipoprotein cholesterol, HDL-C)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol, LDL-C)。结果 筛查出肥胖儿童80例, 与51例正常对照儿童比较, 肥胖组儿童的AST、ALT、GGT、CHOL、TG、LDL-C增高, HDL-C减低, 差异有统计学意义(P<0.05)。AST、ALT、GGT、TG、LDL-C与NAFLD发病呈正相关且为危险因素;HDL-C呈负相关为保护因素。肥胖儿童NAFLD检出率为27.5%(22/80);对照组未检出NAFLD, 肥胖儿童的NAFLD发生率明显高于正常儿童(P<0.05)。肥胖伴有NAFLD组较肥胖不伴NAFLD组AST、ALT、GGT、TG升高, HDL-C降低;差异具有统计学意义(P<0.05)。结论 肥胖导致学龄期儿童的肝功能损害、血脂代谢异常甚至可造成非酒精性脂肪肝的发生;非酒精性脂肪肝更进一步加重了肝功能损害及血脂代谢紊乱。

Objective To study the nonalcoholic fatty liver disease (NAFLD) and blood lipid metabolism and its related factors in school-aged obesity children in Lanzhou. Methods Grades 1~6 pupils aged 7 to 14 were selected from 3 schools.BMI were chosen as normal control.Abdominal ultrasound was taken, and 5 mL fasting venous blood samples was collected to detect aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma glutamyl transpeptidase (GGT), total cholesterol (CHOL), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C). Results A total of 80 obese children were detected from 3 000 children.Compared with 51 normal controls, AST, ALT, GGT, CHOL, TG, LDL-C were higher while HDL-C was lower in obese children (P<0.05).AST, ALT, GGT, TG, LDL-C as the risk factors and was positively associated with NAFLD while HDL-C as the protective factors and was negatived.The detection rate of obese children with NAFLD was 27.5% (22/80);The control group did not detecet NAFLD, the incidence of obese children with NAFLD was obviously higher than that of normal children (P<0.05).Compared with the obesity group without NAFLD, AST, ALT, GGT, TG were higher while HDL-C was lower (P<0.05). Conclusion Obesity can lead to liver damage, blood lipid metabolic abnormalities, even the occurrence of nonalcoholic fatty liver disease in school-aged children, NAFLD could increase liver function damage and lipid metabolism disorders furtherly.