人体测量指标预测肥胖儿童非酒精性脂肪肝的研究

doi:10.11852/zgetbjzz2021-1509

摘要/Abstract

摘要： 目的研究人体测量指标对儿童肥胖伴非酒精性脂肪肝的预测作用,探讨不同指标筛查非酒精性脂肪肝的切点值。方法选取自2018年6月—2019年12月在西安交通大学第二附属医院小儿内分泌门诊就诊的94例肥胖儿童为研究对象,进一步分为肥胖伴非酒精性脂肪肝组与肥胖不伴非酒精性脂肪肝组,52例正常儿童为对照组。测量身高(H)、体重(W)、腰围(WC)、臀围(HC)和血甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C);行肝脏B超的检查。计算体质指数(BMI)、腰臀比(WHR)、腰高比(WHtR)、腹部体积指数(AVI)、脂质蓄积指数(LAP)和内脏脂肪指数(VAI)等指标。通过绘制人体测量指标的受试者工作特征曲线(ROC曲线)评估人体测量指标与肥胖儿童非酒精性脂肪肝的相关性,并比较各项人体测量指标的曲线下面积(AUC)确定切点值。结果肥胖组BMI、WC、WHR、WHtR、AVI、LAP、VAI及TG均高于对照组(t=23.090、21.068、12.547、22.855、17.578、8.159、5.394、6.183,P＜0.001)。肥胖伴非酒精性脂肪肝组BMI、WC、AVI、LAP、VAI均高于肥胖不伴非酒精性脂肪肝组(t=2.180、2.389、2.362、3.643、2.839,P＜0.05)。人体测量指标的ROC曲线下面积按从大到小的顺序依次为 LAP、VAI、 WC、 AVI、 BMI。对肥胖伴非酒精性脂肪肝的联合诊断指标进行筛查效能分析结果显示,LAP+AVI 曲线下面积为0.706(95%CI:0.595~0.817,P＜0.001);AVI+VAI 曲线下面积为0.685(95%CI:0.570~0.800,P＜0.01);BMI+WC 曲线下面积为0.652(95%CI:0.537~0.768,P＜0.05)。联合指标的ROC曲线下面积从大到小为LAP+AVI、AVI+VAI、BMI+WC。结论 LAP联合AVI对儿童肥胖伴非酒精性脂肪肝具有较好的筛查作用。

关键词: 儿童期肥胖, 腹部体积指数, 脂质蓄积指数, 内脏脂肪指数, 非酒精性脂肪肝

Abstract: Objective To study the correlation between new anthropometric indicators and childhood obesity with nonalcoholic fatty liver (NAFL), and to explore the cut-off point value of anthropometric indicators in screening NAFL. Methods A total of 94 obese children were selected from the Pediatric Endocrine Clinic of the Second Affiliated Hospital of Xi'an Jiaotong University from June 2018 to December 2019, and were further divided into obesity with NAFL(n=59) and obesity without NAFL(n=35). Meanwhile, 52 normal children is control group. Both groups were measured height(H), weight (W), waist circumference (WC), hip circumference (HC). serum levels of triglycerides (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and low density lipoprotein cholesterol (LDL-C) were tested. And abdominal ultrasound examination was conducted in all participants. Furthermore, the body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), abdominal volume index (AVI), lipid accumulation product (LAP) and visceral adiposity index (VAI) and other indicators were calculated. The tangent point value was determined by drawing the receiver operating characteristic (ROC) curve of the anthropometric index and comparing the area under curve (AUC) of each anthropometric index. Results BMI, WC, WHR, WHtR, AVI, LAP, VAI and TG of the obesity group were significantly higher than those of the control group (t=23.090, 21.068, 12.547, 22.855, 17.578, 8.159, 5.394, 6.183, P<0.001). Children in the obesity with NAFL group has higher BMI, WC, AVI, LAP and VAI than those in obesity without NAFL group (t=2.180, 2.389, 2.362, 3.643, 2.839, P<0.05). Taking obesity with or without NAFL as the dependent variable, ROC curves of BMI, WC, AVI, LAP, and VAI were drawn, respectively. The area under the ROC curve from large to small was as follows:LAP, VAI, WC, AVI and BMI. The areas under the LAP+AVI curve, AVI+VAI curve and BMI+WC curves were 0.706 (95%CI:0.595 - 0.817, P<0.001), 0.685(95%CI:0.570 - 0.800, P<0.01) and 0.652, (95%CI:0.537 - 0.768, P<0.05), respectively. The area under the ROC curve of the combined indicator from large to small was ranked as LAP+AVI, AVI+VAI, BMI+WC. Conclusion LAP combined with AVI can better screen childhood obesity with NAFL.

Key words: childhood obesity, abdominal volume index;lipid accumulation product, visceral adiposity index, nonalcoholic fatty liver

中图分类号:

段小龙, 王丽明, 康玉蓉, 易晓青, 王思思, 肖延风. 人体测量指标预测肥胖儿童非酒精性脂肪肝的研究[J]. 中国儿童保健杂志, 2022, 30(5): 475-479.

DUAN Xiao-long, WANG Li-ming, KANG Yu-rong, YI Xiao-qing, WANG Si-si, XIAO Yan-feng. Correlation between anthropometric indexes and nonalcoholic fatty liver disease in obese children[J]. Chinese Journal of Child Health Care, 2022, 30(5): 475-479.

参考文献

[1] Cotter TG, Rinella M. Nonalcoholic fatty liver disease 2020:the state of the disease[J]. Gastroenterology, 2020, 158(7):1851-1864.
[2] Tutunchi H, Ebrahimi-mameghani M, Ostadrahimi A, et al. What are the optimal cut-off points of anthropometric indicesfor prediction of overweight and obesity? Predictive validity of waist circumference, waist-to-hip and waist-to-height ratios[J]. Health Promot Perspect, 2020, 10(2):142-147.
[3] Wang Y, Liu WM, Sun LL, et al. A novel indicator, childhood lipid accumulation product, is associated with hypertension in Chinese children and adolescents[J]. Hypertens Res, 2020, 43(4):305-312.
[4] Zhang YF, Hu JY, Li ZQ, et al. A novel indicator of lipid accumulation product associated with metabolic syndrome iIn Chinese children and adolescents[J]. Diabetes Metab Syndr Obes, 2019, 12:2075-2083.
[5] 于连龙,张坚,李素云,等.山东省6～17岁儿童青少年超重肥胖对血清维生素D与空腹血糖的影响[J].卫生研究,2021,50(4):547-551.
[6] 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.
[7] Perona JS, Rio-ValleJS, Ramirez-Velez R, et al. Waist circumference and abdominal volume index are the strongest anthropometric discriminators of metabolic syndrome in Spanish adolescents[J]. Eur J Clin Invest, 2019, 49(3):e13060.
[8] Ozcabi B, Demirhan S, Akyol M, et al. Lipid accumulation product is a predictor of nonalcoholic fatty liver disease in childhood obesity[J]. Korean J Pediatri, 2019, 62(12):450-455.
[9] BagyuraZ, Kiss L, Lux A, et al. Csaba Csobay-Novák association between coronary atherosclerosis and visceral adiposity index[J]. Nutr Metab Cardiovasc Dis, 2020, 30(5):796-803.
[10] Navarro-Jarabo JM, Ubina-Aznar E, Tapia-Ceballos L, et al. Hepatic steatosis and severity-related factors in obese children[J]. J Gastroenterol Hepatol, 2013, 28(9):1532-1538.
[11] Feldstein AE, Charatcharoenwitthaya P, Treeprasertsuk S, et al.The natural history of non-alcoholic fatty liver disease in children:a follow-up study for up to 20 years[J]. Gut, 2009, 58(11):1538-1544.
[12] Ayundini G, Astrella C, Tahapary D, et al. A systematic review on the association between lipid accumulation product index and type 2 diabetes mellitus[J].J Asean Fed Endocr Soc, 2019,34(1):16-20.
[13] Perona JS, Rio-Valle JS, Ramirez-Velez R, et al. Waist circumference and abdominal volume index are the strongest anthropometric discriminators of metabolic syndrome in Spanish adolescents[J]. Eur J Clin Invest, 2019, 49(3):e13060.
[14] Wang Z, He S, Chen X. Capacity of different anthropometric measures to predict diabetes in a Chinese population in southwest China:a 15-year prospective study[J]. Diabet Med, 2019, 36(10):1261-1267.
[15] BagyuraZ, Kiss L, Lux A, et al. Association between coronary atherosclerosis and visceral adiposity index[J]. Nutr Metab Cardiovasc Dis,2020, 30(5):796-803.
[16] Gu DF, DingYA, Zhao YF, et al. Visceral adiposity index was a useful predictor of prediabetes[J]. Exp Clin Endocrinol Diabetes, 2018,126(10):596-603.
[17] YangJ, Li HX, Han LH, et al. Association between visceral adiposity index and hypertension among Chinese adults:a nationwide cross-sectional study in the China health and nutrition survey[J]. Blood Press Monit, 2020,25(5):271-277.
[18]zcab B, Salih Demirhan S, Akyol M, et al. Lipid accumulation product is a predictor of nonalcoholic fatty liver disease in childhood obesity[J]. Korean J Pediatr, 2019,62(12):450-455.
[19] Xu CN, Ma ZM, Wang YF,et al. Visceral adiposity index as a predictor of NAFLD:A prospective study with 4-year follow-up[J]. Liver Int, 2018,38(12):2294-2300.