中国儿童非酒精性脂肪性肝病患病率的Meta分析

doi:10.11852/zgetbjzz2021-1338

摘要/Abstract

摘要： 目的系统评价中国儿童及超重肥胖儿童非酒精性脂肪性肝病(NAFLD)患病率,为儿童及超重肥胖儿童 NAFLD 的流行病学研究和临床防治提供数据基础。方法计算机检索中国知网、维普网、万方数据知识平台、中国生物医学文献数据库、PubMed、The Cochrane Library、EMbase、Web of Science,收集 2000-2021 年之间的关于中国儿童及超重肥胖儿童 NAFLD 患病率的中英文研究。采用R语言(version 4.0.5)对提取数据进行 Meta 分析,以随机效应模型合并数据,运用漏斗图、Egger's test、Begg's test评估偏倚风险。结果共纳入 25项研究,其中 8 项研究为儿童NAFLD患病率,17 项研究为超重肥胖儿童 NAFLD 患病率,研究样本量总计 35 300例,其中肥胖儿童样本量为 7 649 例。Meta 分析结果显示,中国儿童 NAFLD 患病率为6.3%(95%CI:4.6%~7.9%),超重肥胖儿童 NAFLD 患病率为40.4%(95%CI:31.5%~49.9%)。亚组分析结果显示,不同性别、研究地区、研究时间的儿童及超重肥胖儿童NAFLD患病率存在差异。结论我国儿童及超重肥胖儿童 NAFLD 患病率较高,儿童 NAFLD 正逐渐成为我国重大公共卫生问题之一。

关键词: 非酒精性脂肪性肝病, 儿童, 肥胖, 患病率, Meta分析, 中国

Abstract: Objective To systematically evaluate the prevalence of non-alcoholic fatty liver disease (NAFLD) in Chinese children and obese children, so as to provide basis for epidemiological studies and clinical prevention and treatment of NAFLD. Methods CNKI, VIP, WanFang Data, CBM, PubMed, Cochrane Library, Embase and Web of Science were searched to collect studies on the prevalence of NAFLD in Chinese children and obese children from 2000 to 2021 in home and abroad.Meta-analysis was performed using R language (version 4.0.5).Random effect model was used to merge data, funnel plot, Egger's test and Begg's test were used to evaluate the risk of bias. Results A total of 25 studies were included, including 8 studies on the prevalence of NAFLD in children, and 17 studies on the prevalence of NAFLD in obese children.The total sample size of the study was 35 300, and the sample size of obese children was 7 649.Meta-analysis showed that the prevalence of NAFLD in Chinese children was 6.3% (95%CI: 4.6% - 7.9%), and the prevalence of NAFLD in obese children was 40.4% (95%CI: 31.5% - 49.9%).Subgroup analysis showed that the prevalence of NAFLD was significantly different by gender, research areas and research time. Conclusions The prevalence of NAFLD among Chinese children and obesity children is relatively high.NAFLD in children is gradually becoming one of the major public health problems in China.

Key words: non-alcoholic fatty liver disease, children, obesity, prevalence, Meta-analysis, China

中图分类号:

R725.7

王雨, 杨志然, 陈润花. 中国儿童非酒精性脂肪性肝病患病率的Meta分析[J]. 中国儿童保健杂志, 2022, 30(7): 764-769.

WANG Yu, YANG Zhi-ran, CHEN Run-hua. Meta-analysis of the prevalence of non-alcoholic fatty liver disease in Chinese children[J]. Chinese Journal of Child Health Care, 2022, 30(7): 764-769.

参考文献

[1] 周雪莲,傅君芬.儿童非酒精性脂肪肝病诊断与治疗专家共识[J].中国实用儿科杂志,2018,33(7):487-492.
[2] Nobili V, Alisi A, Valenti L, et al.NAFLD in children: new genes, new diagnostic modalities and new drugs[J].Nat Rev Gastroenterol Hepatol, 2019,16(9):517-530.
[3] Nobili V, Alisi A, Newton KP, et al.Comparison of the phenotype and approach to pediatric vs adult patients with nonalcoholic fatty liver disease[J].Gastroenterology, 2016,150(8):1798-1810.
[4] Welsh JA, Karpen S, Vos MB.Increasing prevalence of nonalcoholic fatty liver disease among United States adolescents, 1988-1994 to 2007-2010[J].J Pediatr,2013,162(3):496-500.
[5] 张薇,魏来.非酒精性脂肪性肝病在亚洲的流行情况[J].中华肝脏病杂志,2013,21(11):801-804.
[6] Do A, Lim JK.Epidemiology of nonalcoholic fatty liver disease: A primer[J].Clin Liver Dis (Hoboken), 2016,7(5):106-108.
[7] Atsawarungruangkit A, Elfanagely Y, Pan J, et al.Prevalence and risk factors of steatosis and advanced fibrosis using transient elastography in the United States' adolescent population[J].World J Hepatol, 2021,13(7):790-803.
[8] Conjeevaram Selvakumar PK, Kabbany MN, Alkhouri N.Nonalcoholic fatty liver disease in children: Not a small matter[J].Paediatr Drugs, 2018,20(4):315-329.
[9] 柯莹,黄玉英,刘爱胜,等.深圳市龙华区中小学生非酒精性脂肪性肝病流行现状及影响因素分析[J].中西医结合肝病杂志,2021,31(1):70-73.
[10] Yang S, Zhong J, Ye M, et al.Association between the non-HDL-cholesterol to HDL-cholesterol ratio and non-alcoholic fatty liver disease in Chinese children and adolescents: A large single-center cross-sectional study[J].Lipids Health Dis,2020;19(1):242.
[11] 吕卓超,蔡海芳,何春霞,等.丽水地区儿童肥胖和NAFLD的流行现状及危险因素分析[J].中国妇幼健康研究,2019,30(6):673-677.
[12] 党桂娟,张佳琳,裴丹,等.洛阳市7～17岁儿童青少年肥胖及相关代谢异常情况调查[J].实用预防医学,2015,22(9):1092-1093.
[13] Zhang X, Wan Y, Zhang S, et al.Nonalcoholic fatty liver disease prevalence in urban school-aged children and adolescents from the Yangtze River delta region: A cross-sectional study[J].Asia Pac J Clin Nutr.2015;24(2):281-288.
[14] 张晓敏,万燕萍,张时君,等.小学生非酒精性脂肪性肝病与慢性代谢性疾病的关系[J].临床儿科杂志,2013,31(9):825-829.
[15] Meng L, Luo N, Mi J.Impacts of types and degree of obesity on non-alcoholic fatty liver disease and related dyslipidemia in Chinese school-age children? [J].Biomed Environ Sci.2011,24(1):22-30.
[16] 万燕萍,徐仁应,方华,等.上海地区1180名在校儿童非酒精性脂肪性肝病检出率及危险因素分析[J].中华肝脏病杂志,2007,15(9):644-648.
[17] 李印东,李梦龙,段军伟,等.北京市超重肥胖儿童内脏脂肪指数与非酒精性脂肪肝的关系[J].中国学校卫生,2021,42(5):659-662.
[18] 陈新春,寇永妹,刘晓璐,等.唐山市7～14岁肥胖儿童非酒精性脂肪肝流行现状及危险因素初步分析[J].中国儿童保健杂志,2021,29(6):669-673.
[19] Peng L, Wu S, Zhou N, et al.Clinical characteristics and risk factors of nonalcoholic fatty liver disease in children with obesity[J].BMC Pediatr, 2021,21(1):122.
[20] 林先强,符清宇,沙丹.肥胖儿童非酒精性脂肪性肝病的危险因素分析[J].肝脏,2019,24(11):1306-1309.
[21] 代东伶,周少明,柳国胜,等.脂质代谢相关基因变异与肥胖儿童非酒精性脂肪肝易感性分析[J].临床儿科杂志,2017,35(4):241-246.
[22] 田江宣,留佩宁,郑超,等.温州超重肥胖少年儿童临床表型分析[J].中华全科医学,2016,14(5):790-792.
[23] 王莲革,赵小元,段佳丽,等.北京市密云县肥胖中小学生心血管代谢异常调查[J].中国学校卫生,2015,36(10):1582-1585.
[24] 徐玲玲,陈红珊,李燕虹,等.肥胖儿童代谢综合征临床特征及其代谢成分异常的相关性分析[J].中山大学学报(医学科学版),2015,36(2):301-305.
[25] 闫银坤,侯冬青,段佳丽,等.肥胖儿童尿酸水平与心血管代谢异常及非酒精性脂肪肝的关系[J].中华实用儿科临床杂志, 2015,30(13):1000-1003.
[26] 周歆,侯冬青,段佳丽,等.北京市387名肥胖中学生非酒精性脂肪肝等代谢异常罹患状况调查[J].中华流行病学杂志,2013,34(5):446-450.
[27] 康如彤,钟燕,蒋耀辉,等.肥胖儿童非酒精性脂肪肝影响因素分析[J].实用预防医学,2013,20(3):277-279.
[28] 朱蓓,张海瑛,蔡锡顶.肥胖儿童非酒精脂肪肝与糖、脂代谢的关系[J].中华全科医学,2013,11(11):1732-1821.
[29] 陆喜燕.肥胖儿童胰岛素抵抗与体脂、血脂及抵抗素、白细胞介素-6的关系[D].广州:南方医科大学, 2012.
[30] 范歆,陈少科,唐晴,等.南宁市超重、肥胖儿童非酒精性脂肪肝患病情况分析[J].中国儿童保健杂志, 2012,20(2):124-126.
[31] 盛秋明,李卫国,张海涛.超重肥胖儿童非酒精性脂肪肝病与代谢综合征相关性研究[J].中国儿童保健杂志,2010,18(6):456-458.
[32] 蒋萍.浙江省肥胖儿童非酒精性脂肪肝病及其他相关代谢紊乱疾病现状的研究[D].杭州:浙江大学,2010.
[33] Chan DF, Li AM, Chu WC, et al.Hepatic steatosis in obese Chinese children[J].Int J Obes Relat Metab Disord.2004;28(10):1257-1263.
[34] Anderson EL, Howe LD, Jones HE, et al.The prevalence of non-alcoholic fatty liver disease in children and adolescents: A systematic review and meta-analysis[J].PLoS One, 2015,10(10):e140908.
[35] Zhang X, Wu M, Liu Z, et al.Increasing prevalence of NAFLD/NASH among children, adolescents and young adults from 1990 to 2017: A population-based observational study[J].BMJ Open, 2021,11(5):e42843.
[36] Sung H, Siegel RL, Torre LA, et al.Global patterns in excess body weight and the associated cancer burden[J].CA Cancer J Clin, 2019,69(2):88-112.
[37] 杨丽丽,席波.儿童期肥胖与靶器官损害关系的研究进展[J].中华预防医学杂志,2019,20(7):731-736.
[38] Shapiro WL, Noon SL, Schwimmer JB.Recent advances in the epidemiology of nonalcoholic fatty liver disease in children[J].Pediatr Obes,2021,16(11):e12849.
[39] 贲秀鸾,季凤华.儿童单纯性肥胖症与非酒精性脂肪性肝病的相关性研究[J].肝脏,2016,21(8):705-707.
[40] Duncan M, Zong W, Biank VF, et al.Nonalcoholic fatty liver disease in pediatrics[J].Pediatr Ann, 2016,45(2):e54-e58.
[41] Villanueva-Ortega E, Garcés-Hernández MJ, Herrera-Rosas A, et al.Gender-specific differences in clinical and metabolic variables associated with NAFLD in a Mexican pediatric population[J].Ann Hepatol,2019,18(5):693-700.
[42] 马冠生.中国儿童肥胖报告[M].北京:人民卫生出版社,2017.
[43] 谭琪,徐勇.中国儿童青少年1985-2010年肥胖发展趋势及预测研究[J].中国学校卫生,2013,34(5):570-572.
[44] Younossi ZM, Blissett D, Blissett R, et al.The economic and clinical burden of nonalcoholic fatty liver disease in the United States and Europe[J].Hepatology, 2016,64(5):1577-1586.
[45] Araújo AR, Rosso N, Bedogni G, et al.Global epidemiology of non-alcoholic fatty liver disease/non-alcoholic steatohepatitis: What we need in the future[J].Liver Int, 2018,38(Suppl 1):47-51.