利用磁共振波谱定量评价肥胖儿童青少年肝内脂肪含量
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摘要
目的:利用磁共振波谱技术量化评估肥胖儿童青少年肝内脂肪(IHL)含量,探讨其临床意义。方法:对75例新诊断肥胖儿童青少年进行人体学特征检测、肝功能、血脂、OGTT及胰岛素释放试验等检查,并采用氢质子磁共振波谱技术定量测定肝内脂肪(IHL)含量,并将肥胖患儿分为单纯性肥胖组(n=45)及肥胖伴有代谢综合征组(n=30),20例健康儿童青少年作为对照组,观察IHL含量在组间的变化情况,分析IHL含量与各临床治疗的相关性以及探寻IHL含量改变的影响因素。结果:正常对照组、单纯性肥胖组、肥胖伴有代谢综合征组IHL含量分别为0.69%(0.37%～0.98%)、3.45%(1.23%～4.86%)、21.2%(15.32%～42.08%),组间两两相比较差异均有统计学意义(P<0.05)。单因素相关分析表明IHL含量与腰围、腰臀比、体重指数、收缩压、丙氨酸转氨酶、血清甘油三酯、口服糖耐量试验(OGTT)2h血糖、胰岛素峰值、胰岛素抵抗指数呈显著正相关,与高密度脂蛋白呈显著负相关。多元线性回归分析发现增加的腰围、增高的OGTT2h血糖、降低的高密度脂蛋白水平是IHL含量升高的独立危险因素。结论:单纯性肥胖儿童早期就可出现IHL增高,而伴发代谢综合征时IHL呈显著升高。量化的IHL与诸多临床、血液指标相关,其中腰围、OGTT2h血糖、高密度脂蛋白是IHL含量的独立影响因素。IHL含量可作为肥胖儿童青少年临床评估较为敏感的指标。
Purpose: To quantitatively evaluate the clinical significance of intrahepatic lipid( IHL) content in obese children and adolescents by proton magnetic resonance spectroscopy(1 H-MRS). Methods: Seventy-five obese children and adolescents were enrolled in this study. Anthropometric data, liver function, serum lipids, oral glucose tolerance test(OGTT) and insulin related parameters were measured. IHL content was quantified by 1 H-MRS. Patients were classified as simple obesity(n= 45) and obesity with metabolic syndrome(MS)(n=30). Twenty healthy children and adolescents served as a control group. The differences of IHL content among these three groups were compared. The relationship of IHL content with clinical parameters were analyzed. Results: IHL content measured by 1 H-MRS was 0.69%(0.37% ～ 0.98%), 3.45%(1.23% ～ 4.86%) and 21.2%(15.32% ～ 42.08%) respectively in the control, simple obesity and obesity with MS groups. There were significant differences in IHL content among the groups. Univariate correlation analysis demonstrated that IHL content was with positive correlation with waist circumference, waist-to-hip ratio, body mass index, systolic blood pressure, alanine aminotransferase, triglyceride, OGTT 2-hour plasma glucose, insulin peak value and insulin resistance index, and with negative correlation with high-density lipoprotein. Multivariate linear regression analysis demonstrated that three independent risk factors were correlated with increased IHL content: increased waist circumference, decreased high-density lipoprotein and increased 2-hour plasma glucose levels. Conclusions: IHL content were increased in the early stage of simple obese children and adolescents, and it was significantly increased in the obesity with MS group. There is a significant correlation between some clinical parameters and IHL content. Among them, waist circumference, decreased high-density lipoprotein and increased 2-hour plasma glucose are independent factors influencing IHL content. IHL content can be used as a sensitive index for clinical evaluation of obese children and adolescents.
Purpose: To quantitatively evaluate the clinical significance of intrahepatic lipid( IHL) content in obese children and adolescents by proton magnetic resonance spectroscopy(1 H-MRS). Methods: Seventy-five obese children and adolescents were enrolled in this study. Anthropometric data, liver function, serum lipids, oral glucose tolerance test(OGTT) and insulin related parameters were measured. IHL content was quantified by 1 H-MRS. Patients were classified as simple obesity(n= 45) and obesity with metabolic syndrome(MS)(n=30). Twenty healthy children and adolescents served as a control group. The differences of IHL content among these three groups were compared. The relationship of IHL content with clinical parameters were analyzed. Results: IHL content measured by 1 H-MRS was 0.69%(0.37% ～ 0.98%), 3.45%(1.23% ～ 4.86%) and 21.2%(15.32% ～ 42.08%) respectively in the control, simple obesity and obesity with MS groups. There were significant differences in IHL content among the groups. Univariate correlation analysis demonstrated that IHL content was with positive correlation with waist circumference, waist-to-hip ratio, body mass index, systolic blood pressure, alanine aminotransferase, triglyceride, OGTT 2-hour plasma glucose, insulin peak value and insulin resistance index, and with negative correlation with high-density lipoprotein. Multivariate linear regression analysis demonstrated that three independent risk factors were correlated with increased IHL content: increased waist circumference, decreased high-density lipoprotein and increased 2-hour plasma glucose levels. Conclusions: IHL content were increased in the early stage of simple obese children and adolescents, and it was significantly increased in the obesity with MS group. There is a significant correlation between some clinical parameters and IHL content. Among them, waist circumference, decreased high-density lipoprotein and increased 2-hour plasma glucose are independent factors influencing IHL content. IHL content can be used as a sensitive index for clinical evaluation of obese children and adolescents.
引文
[1]Lobstein T,Baur L,Uauy R.Obesity in children and young people:a crisis in public health.Obesity Reviews,2004,5:4-85.
[2]Ma G D A,Monereo M S,Merino V M,et al.Prevalence of metabolic syndrome in a population of obese children and adolescents.Endocrinología Y Nutriciónórgano De La Sociedad Espa?ola De Endocrinología Y Nutrición,2012,59:155.
[3]Joy D,Thava V R,Scott B B.Diagnosis of fatty liver disease:is biopsy necessary?Eur J Gastroenterol Hepatol,2003,15:539-543.
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[6]中华医学会儿科学分会内分泌遗传代谢学组,傅君芬,梁黎.中国儿童青少年代谢综合征定义和防治建议.中华儿科杂志,2012,50:420-422.
[7]Rinella M E.Nonalcoholic Fatty Liver Disease:A Systematic Review.Jama,2015,313:2263-2273.
[8]Miyazaki Y,Defronzo R A.Visceral fat dominant distribution in male type 2 diabetic patients is closely related to hepatic insulin resistance,irrespective of body type.Cardiovascular Diabetology,2009,8:1-9.
[9]Demerath E W,Reed D,Rogers N,et al.Visceral adiposity and its anatomical distribution as predictors of the metabolic syndrome and cardiometabolic risk factor levels.American Journal of Clinical Nutrition,2008,88:1263-1271.
[10]Wajchenberg B L.Subcutaneous and visceral adipose tissue:their relation to the metabolic syndrome.Endocrine Reviews,2000,21:697.
[11]Kukuk G M,Hittatiya K,Sprinkart A M,et al.Comparison between modified Dixon MRI techniques,MR spectroscopic relaxometry,and different histologic quantification methods in the assessment of hepatic steatosis.European Radiology,2015,25:2869-2879.
[12]Lange T,Buechert M,Baumstark M W,et al.Value of MRI and MRS fat measurements to complement conventional screening methods for childhood obesity.Journal of Magnetic Resonance Imaging,2015,42:1214-1222.
[13]Cordes C,Dieckmeyer M,Ott B,et al.MR-detected changes in liver fat,abdominal fat,and vertebral bone marrow fat after a four-week calorie restriction in obese women.Journal of Magnetic Resonance Imaging,2015,42:1272-1280.
[14]Aixuan H,Juan G,Smita T,et al.Nonalcoholic fatty liver disease and bariatric surgery in adolescents.Seminars in Pediatric Surgery,2014,23:49-57.
[15]Browning J D,Szczepaniak L S,Dobbins R,et al.Prevalence of hepatic steatosis in an urban population in the United States:impact of ethnicity.Hepatology,2010,40:1387-1395.
[16]Prati D,Taioli E,Zanella A,et al.Updated definitions of healthy ranges for serum alanine aminotransferase levels.Annals of Internal Medicine,2002,137:1-10.
[17]Schwimmer J B,Newton K P,Awai H I,et al.Paediatric gastroenterology evaluation of overweight and obese children referred from primary care for suspected non-alcoholic fatty liver disease.Aliment Pharmacol Ther,2013,38:1267-1277.
[2]Ma G D A,Monereo M S,Merino V M,et al.Prevalence of metabolic syndrome in a population of obese children and adolescents.Endocrinología Y Nutriciónórgano De La Sociedad Espa?ola De Endocrinología Y Nutrición,2012,59:155.
[3]Joy D,Thava V R,Scott B B.Diagnosis of fatty liver disease:is biopsy necessary?Eur J Gastroenterol Hepatol,2003,15:539-543.
[4]Saadeh S,Younossi Z M,Remer E M,et al.The utility of radiological imaging in nonalcoholic fatty liver disease.Gastroenterolo gy,2002,123:745-750.
[5]季成叶.中国学龄儿童青少年超重、肥胖筛查体重指数值分类标准.中华流行病学杂志,2004,25:97-102.
[6]中华医学会儿科学分会内分泌遗传代谢学组,傅君芬,梁黎.中国儿童青少年代谢综合征定义和防治建议.中华儿科杂志,2012,50:420-422.
[7]Rinella M E.Nonalcoholic Fatty Liver Disease:A Systematic Review.Jama,2015,313:2263-2273.
[8]Miyazaki Y,Defronzo R A.Visceral fat dominant distribution in male type 2 diabetic patients is closely related to hepatic insulin resistance,irrespective of body type.Cardiovascular Diabetology,2009,8:1-9.
[9]Demerath E W,Reed D,Rogers N,et al.Visceral adiposity and its anatomical distribution as predictors of the metabolic syndrome and cardiometabolic risk factor levels.American Journal of Clinical Nutrition,2008,88:1263-1271.
[10]Wajchenberg B L.Subcutaneous and visceral adipose tissue:their relation to the metabolic syndrome.Endocrine Reviews,2000,21:697.
[11]Kukuk G M,Hittatiya K,Sprinkart A M,et al.Comparison between modified Dixon MRI techniques,MR spectroscopic relaxometry,and different histologic quantification methods in the assessment of hepatic steatosis.European Radiology,2015,25:2869-2879.
[12]Lange T,Buechert M,Baumstark M W,et al.Value of MRI and MRS fat measurements to complement conventional screening methods for childhood obesity.Journal of Magnetic Resonance Imaging,2015,42:1214-1222.
[13]Cordes C,Dieckmeyer M,Ott B,et al.MR-detected changes in liver fat,abdominal fat,and vertebral bone marrow fat after a four-week calorie restriction in obese women.Journal of Magnetic Resonance Imaging,2015,42:1272-1280.
[14]Aixuan H,Juan G,Smita T,et al.Nonalcoholic fatty liver disease and bariatric surgery in adolescents.Seminars in Pediatric Surgery,2014,23:49-57.
[15]Browning J D,Szczepaniak L S,Dobbins R,et al.Prevalence of hepatic steatosis in an urban population in the United States:impact of ethnicity.Hepatology,2010,40:1387-1395.
[16]Prati D,Taioli E,Zanella A,et al.Updated definitions of healthy ranges for serum alanine aminotransferase levels.Annals of Internal Medicine,2002,137:1-10.
[17]Schwimmer J B,Newton K P,Awai H I,et al.Paediatric gastroenterology evaluation of overweight and obese children referred from primary care for suspected non-alcoholic fatty liver disease.Aliment Pharmacol Ther,2013,38:1267-1277.