摘要
目的：研究肝纤维化指标透明质酸（HA）、层粘连蛋白（LN）、血清Ⅲ型前胶原肽（PCⅡ）、Ⅳ型胶原（CIV）及血清铁蛋白（SF）在肥胖儿童非酒精性脂肪肝病（NAFLD）中的临床意义。方法：对101例在本院内分泌科住院的6～15岁肥胖儿童和30例9～14岁正常健康儿童进行腰围（WC）、体块指数（BMI）、肝转氨酶（ALT、AST）、肝纤维化指标、血清铁蛋白、肝脏B超等各项检查，根据诊断标准将其分为单纯性肥胖组（SOC）、单纯性非酒精性脂肪肝组（SNAFL）、非酒精性脂肪肝炎组（NASH）和正常对照组，比较各组间肝酶、肝纤维化指标和血清铁蛋白情况。结果：与正常对照组相比，S（）C组的HA、PCⅢ水平明显升高（P〈0．05），尤其以PCⅢ明显；SNAFL和NASH组的HA、PCⅡ、SF、ALT、AST水平均明显高于正常对照组（P〈0．05）。随着单纯性肥胖向单纯性脂肪肝、脂肪肝炎发展，SF、PCⅡ、ALT、AST逐步升高，差异显著（P〈0．05）；经两两相关分析发现：SF与PCⅢ、ALT、AST相关（r=0．33、0．63、0．69，P〈0．05），PCⅡ与ALT、AST相关（r=0．55、0．56，P〈0．05）；所有病例中SF≥300μg／L者6例，均为NASH患者，且其均值与NASH组其他惠儿相比，在肝纤维化指标和肝转氨酶上都明显增高（P〈0．05）。结论：纤维化指标中PCⅡ是一早期敏感的指标，与非酒精性脂肪肝病的发展密切相关。血清铁蛋白的增加是反应肝损伤的另一个重要指标，其可能是NASH发生发展的重要因子之一。
Objective. To determine the clinical value of hepatic fibrosis parameters and serum ferritin （SF） in obese children with nonalcoholic fatty liver disease. Methods.. One hundred and one obese children aged 6-15 years and 30 healthy children aged 9--14 years were enrolled in the study. Body mass index （BMI）, waist circumference （WC）, alanine aminotransferase （ALT）,aspartate aminotransferase （AST）,hepatic fibrosis parameters including hyaturome acid, laminin （LN） ,serum type Ⅲ procollagen （PC Ⅲ ） and type N collagen （CIV） ,serum ferritin and hepatic B-ultrasonography were assessed. All subjects were divided into 4 subgroups .simple obese children （SOC）,simple nonalcoholic farty liver （SNAFL）,nonalcoholic steatohepatitis （NASH） and control group. ALT,AST,hepatic fibrosis parameters and serum ferritin were compared in these four groups. Results： Compared with control group, the serum levels of HA and PC increased significantly in SOC group （P〈0.05）; Serum levels of HA,PC Ⅱ ,SF,ALT and AST also elevated markedly in SNAFL group and NASH group compared with those in control group. PC Ⅱ ,SF,ALT,AST increased stepwise as the disease developed from SOC to SNAFL and NASH （P〈0. 05）. SF was correlated with PCⅡ ,ALT and AST （r=0. 33,0.63,0. 69,P〈0. 05） and PC Ⅱ was well related to ALT and AST （r=0.55,0.56,P〈0. 05）. There were only 6 cases with SF≥300 μg/I. among all obese children,they were all NASH. The average levels of HA, CIV, PC Ⅱ ,ALT, AST of these 6 cases were significantly higher than those of other NASH children. Conclusions： Among all hepatic fibrosis parameters,serum PC Ⅲ level is an early and sensitive indicator of NAFLD and is correlated with the disease progress. SF may be also involved in early iniury of fatty liver and the process of NAFLD.
出处
《浙江大学学报（医学版）》
CAS
CSCD
2008年第3期245-249,共5页
Journal of Zhejiang University(Medical Sciences)
基金
浙江省自然基金资助项目(J20060685)
浙人口计生委资助项目[2007]72号
