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目的探讨腰围预测肥胖儿童发生非酒精性脂肪性肝病(NAFLD)的价值。方法2003-06—2006-09对浙江大学医学院附属儿童医院儿科197例9~14岁肥胖儿童进行腰围、体质指数(BMI)测定,作肝脏B超检查、血清肝酶测定,并与正常对照组比较。同时对肥胖儿童进行腰围、BMI与脂肪肝严重程度、血清ALT水平的相关性分析,以及腰围、BMI诊断肥胖儿童发生NAFLD曲线下面积的ROC分析。结果肥胖组腰围[(91.99±11.03)cm]显著大于正常对照组[(66.27±4.76)cm],BMI、肝酶水平也显著高于正常对照组。197例9~14岁肥胖患儿中诊断为NAFLD者147例,占74.62%;肥胖组NAFLD患儿腰围、BMI均大于非NAFLD患儿。肥胖患儿腰围、BMI与脂肪肝严重程度、血清ALT水平均呈正相关(r=0.478、0.356、0.302、0.205,均P<0.01);腰围和BMI诊断NAFLD的ROC曲线下面积分别为0.767、0.717(均P<0.01)。结论9~14岁肥胖儿童NAFLD发生与腰围密切相关,腰围、BMI对肥胖儿童发生NAFLD有一定的预测价值。
Objective To investigate the value of waist circumference prediction of non-alcoholic fatty liver disease (NAFLD) in obese children. Methods A total of 197 obese children aged 9 ~ 14 years old from Children’s Hospital of Zhejiang University School of Medicine were measured for waist circumference and body mass index (BMI) from 2003-06-2006-09. Liver biopsy and serum liver enzymes were measured and compared with normal controls Group comparison. At the same time, we analyzed the correlation between waist circumference, BMI, severity of fatty liver and ALT in obese children, and ROC analysis of waist area and BMI in diagnosing obese children with NAFLD. Results The waist circumference of obese patients [(91.99 ± 11.03) cm] was significantly higher than that of the normal controls [(66.27 ± 4.76) cm], and the levels of BMI and liver enzymes were also significantly higher than those of the normal controls. 147 cases of NAFLD were diagnosed in 197 cases of obese children aged 9-14 years, accounting for 74.62%. The waist circumference and BMI of obese children with NAFLD were significantly higher than those of non-NAFLD children. The area under the curve of ROC of waist circumference and BMI in diagnosis of NAFLD was 0.767 and 0.717 respectively in obese children with BMI and severity of fatty liver and serum ALT level (r = 0.478,0.356,0.302,0.205, all P <0.01) (All P <0.01). Conclusion The incidence of NAFLD in obese children aged 9 ~ 14 years is closely related to the waist circumference. The waist circumference and BMI have some predictive value for the occurrence of NAFLD in obese children.