肥胖非酒精性脂肪肝儿童核磁肝内脂肪半定量分析及胰岛β细胞功能的研究

发布时间：2018-01-07 09:07

本文关键词：肥胖非酒精性脂肪肝儿童核磁肝内脂肪半定量分析及胰岛β细胞功能的研究　出处：《天津医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：随着人们生活方式的改变和饮食结构的调整,儿童和青少年的肥胖的发病率逐年上升,其患病率正在世界范围内不断的增加,已成为令世界瞩目的公共卫生问题。非酒精性脂肪肝(nonalcoholic fatty liver disease, NAFLD)是常见的肥胖并发症,NAFLD在欧美等西方国家占慢性肝病的比例已大于30%m,并且其发病率呈明显的上升趋势。近年来的研究表明胰岛素抵抗和全身能量代谢的失衡是NAFLD的发病机制之一,而胰岛素抵抗和β细胞功能衰竭是2型糖尿病的发病基础。一、儿童肥胖非酒精性脂肪肝与胰岛β细胞功能关系的研究目的：探讨儿童肥胖非酒精性脂肪肝与胰岛β细胞功能的关系。方法：对2007年6月—2011年4月天津医科大学总医院儿科内分泌门诊就诊的362例肥胖儿童,经腹部B超检查分为伴有非酒精性脂肪肝(NAFLD)组170例及不伴非酒精性脂肪肝且肝功能正常的单纯肥胖不伴NAFLD组192例,164例正常查体体重正常的儿童作为对照组；所有儿童进行血甘油三酯、胆固醇、空腹血糖(FPG)及空腹胰岛素(FINS)、bAlc的检测;肥胖儿童行口服葡萄糖耐量及胰岛素释放试验。计算胰岛素敏感指数(QUICKI法),胰岛素抵抗指数(HOMA-IR),胰岛β细胞功能指数(HOMA-β)。结果：1. NAFLD组FPG、FINS、胰岛素抵抗指数、胰岛β细胞功能指数及HbA1c明显高于肥胖不伴NAFLD组及对照组(P0.05)； 2.NAFDL组胰岛素敏感指数明显低于肥胖不伴NAFLD组及对照组(p0.05)；NAFLD组糖代谢异常检出率明显高于无NAFLD组(p0.05)。结论：儿童肥胖伴非酒精性脂肪肝患儿存在胰岛β细胞功能受损和糖脂代谢异常,胰岛β细胞功能受损可能是儿童非酒精性脂肪肝的发病机制之一。二、量化评估儿童非酒精性脂肪肝肝内脂肪的临床意义目的：量化评估儿童非酒精性脂肪肝肝内脂肪的临床意义。方法：对56例肥胖儿童进行形体学参数、肝功能、血脂、血糖及胰岛素释放试验和肝脏B超等检查,采用同、反相位(IP/OP)序列定量测定肝内脂肪(IHF)含量,并按传统诊断标准将其分为肥胖不伴NAFLD组(24例)、肥胖伴NAFLD病组(32例)。观察IHF含量在组间的变化情况,分析IHF含量与各临床生化指标的相关关系。结果：肥胖伴NAFLD组IHF含量比不伴NAFLD组高,差异有统计学意义(P0.05)。单因素相关分析表明IHF含量与腰围、臀围、腰臀比、体重指数、丙氨酸氨基转移酶、门冬氨酸氨基转移酶、γ-谷氨酰转肽酶、空腹甘油三酯、低密度脂蛋白、口服葡萄糖耐量试验(OGTT)2h血糖、空腹胰岛素、2h胰岛素和胰岛素抵抗指数呈正相关,与高密度脂蛋白呈显著负相关。结论：量化的IHF可成为儿科NAFLD病情评估中敏感而又可靠的方法之一。定量检测并评价肝细胞内脂肪含量对儿童NAFLD的早期诊断、病情判断至关重要。
[Abstract]:With the changes in lifestyle and diet adjustment, child and adolescent obesity incidence increased year by year, the prevalence of the world is increasing, has become a public health problem worldwide. Non alcoholic fatty liver (nonalcoholic fatty liver disease, NAFLD) is a common complication of obesity, NAFLD in Europe and other western countries, accounting for chronic liver disease have been greater than the proportion of 30%m, and the incidence rate increased obviously. Recent studies have shown that insulin resistance and systemic imbalance of energy metabolism is one of the pathogenesis of NAFLD and insulin resistance and beta cell dysfunction is the pathogenesis of type 2 diabetes.
Study on the relationship between obese nonalcoholic fatty liver and islet beta cell function in children
Objective: To investigate the relationship between obese nonalcoholic fatty liver and islet beta cell function in children.
Methods: 362 cases of obese children on June 2007 - April 2011 in General Hospital Affiliated to Tianjin Medical University pediatric endocrine clinic, abdominal B-ultrasound is associated with nonalcoholic fatty liver disease (NAFLD) group and 170 cases without nonalcoholic fatty liver and normal liver function in simple obesity with NAFLD group of 192 cases, 164 cases of normal body weight normal the children as a control group; all the children's blood triglyceride, cholesterol, fasting blood glucose (FPG) and fasting insulin (FINS), the detection of bAlc in obese children; oral glucose tolerance and insulin releasing test. Insulin sensitivity index (QUICKI), insulin resistance index (HOMA-IR), islet beta cell function index (HOMA- 3).
Results: 1. NAFLD group FPG, FINS, insulin resistance index, islet beta cell function index and HbA1c were significantly higher than those of obesity without NAFLD group and control group (P0.05).
The insulin sensitivity index of group 2.NAFDL was significantly lower than that of obesity without NAFLD group and control group (P0.05), and the abnormal rate of glucose metabolism in group NAFLD was significantly higher than that in no NAFLD group (P0.05).
Conclusion: children with obesity and non-alcoholic fatty liver disease suffer from impaired islet beta cell function and abnormal glucose and lipid metabolism. The dysfunction of pancreatic beta cells may be one of the pathogenesis of nonalcoholic fatty liver disease in children.
Two, quantitative evaluation of the clinical significance of intrahepatic fat in nonalcoholic fatty liver of children
Objective: to quantify the clinical significance of intrahepatic fat in nonalcoholic fatty liver (nonalcoholic) liver in children.
Methods: physical parameters, liver function, blood lipid of 56 obese children, blood glucose and insulin release test and liver ultrasound examination, using the same, anti phase (IP/OP) sequence of quantitative determination of liver fat content (IHF), and according to the traditional diagnostic criteria will be divided into obesity without NAFLD group (24 cases), obese patients with NAFLD disease group (32 cases). To observe the change of IHF in groups, the relationship of IHF content and the clinical and biochemical indicators.
Results: the obese group with NAFLD content of IHF than with the NAFLD group, the difference was statistically significant (P0.05). Correlation analysis showed that the content of IHF and waist circumference, hip circumference, waist hip ratio, body mass index, alanine aminotransferase, aspartate aminotransferase, gamma glutamyl transpeptidase, fasting triglyceride, low density lipoprotein, oral glucose tolerance test (OGTT) and 2H glucose, fasting insulin, 2h insulin and insulin resistance index were positively correlated, negatively correlated with high density lipoprotein.
Conclusion: quantitative IHF can be one of the sensitive and reliable methods in pediatric NAFLD condition assessment. Quantitative detection and evaluation of fat content in liver cells is very important for early diagnosis and judgement of NAFLD in children.

【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R725.7;R723.14

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