合并非酒精性脂肪肝的肥胖儿童肾功能改变的研究
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摘要
目的通过研究合并非酒精性脂肪肝(NAFLD)的肥胖儿童肾功能变化特点,分析NAFLD与儿童肾功能损害之间的关系及相关影响机制。方法根据是否合并NAFLD,将212例肥胖儿童分为合并NAFLD组与单纯肥胖儿童组,对比分析两组间的各项临床、生化指标及尿微量白蛋白含量;针对合并NAFLD组,进一步研究尿微量白蛋白与其它代谢指标间的关系。结果合并NAFLD的肥胖儿童尿微量白蛋白含量明显高于单纯肥胖组(P<0.05),且尿微量白蛋白与甘油三脂及餐后2小时血糖呈明显正相关(P<0.05)。结论合并NAFLD的肥胖儿童可出现肾功能的早期损伤,且这种损伤可能与包含NAFLD在类的全身代谢性改变相关,在此类儿童中尽早筛查发现早期损伤可最大程度避免此类疾病的发生和发展。
Objective To investigate the characteristics of renal function changes in obese children with non-alcoholic fatty liver disease( NAFLD) and analyze the relationship between the NAFLD and children impaired renal function and its mechanisms.Methods Two hundred and twelve obese children were divided into NAFLD group and simple obese group according to whether they were diagnosed as NAFLD.The clinical and biochemical parameters and the urinary microalbumin level were compared between the two groups.In the NAFLD group,we further analyzed the relationship between urinary microalbumin and other metabolized parameters. Results The urinary microalbumin was higher in the NAFLD group than that in the simple obese group( P < 0. 05).Furthermore,there was a positive correlation between urinary microalbumin and triglyceride/2 hour postprandial blood glucose( P < 0. 05).Conclusion The obese children with NAFLD could appear early impaired renal function.The impairment is connected with the whole-body-metabolized-change including NAFLD.Early assessment of the impaired renal function in obese children could almost avoid the development of the renal disease.
Objective To investigate the characteristics of renal function changes in obese children with non-alcoholic fatty liver disease( NAFLD) and analyze the relationship between the NAFLD and children impaired renal function and its mechanisms.Methods Two hundred and twelve obese children were divided into NAFLD group and simple obese group according to whether they were diagnosed as NAFLD.The clinical and biochemical parameters and the urinary microalbumin level were compared between the two groups.In the NAFLD group,we further analyzed the relationship between urinary microalbumin and other metabolized parameters. Results The urinary microalbumin was higher in the NAFLD group than that in the simple obese group( P < 0. 05).Furthermore,there was a positive correlation between urinary microalbumin and triglyceride/2 hour postprandial blood glucose( P < 0. 05).Conclusion The obese children with NAFLD could appear early impaired renal function.The impairment is connected with the whole-body-metabolized-change including NAFLD.Early assessment of the impaired renal function in obese children could almost avoid the development of the renal disease.
引文
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[14]Gansevoort RT,Matsushita K,van der Velde M,et al.Chronic Kidney Disease Prognosis Consortium.Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes.A collaborative meta-analysis of general and high-risk population cohorts[J].Kidney Int,2011,80(1):93-104.
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[17]Vlassara H,Torreggiani M,Post JB,et al.Ro1e of oxidants/inflammation in declining renal function in chronic kidney disease and normal aging[J].Kidney Int Suppl,2009,12(114):S3-S11.
[18]Manco M,Ciampalini P,De Vito R,et al.Albuminuria and insulin resistance in children with biopsy proven non-alcoholic fatty liver disease[J].Pediatr Nephrol,2009,24(6):1211-1217.
[2]Chatterjee R,Mitra A.An overview of effective therapies and recent advances in biomarkers for chronic liver diseases and associated liver cancer[J].Int Immunopharmacol,2015,24(2):335-345.
[3]Schwimmer JB,Pardee PE,Lavine JE,et al.Cardiovascular risk factors and the metabolic syndrome in pediatric nonalcoholic fatty liver disease[J].Circulation,2011,118(3):277-283.
[4]D'Adamo E,Cali AM,Weiss R,et al.Central role of fatty liver in the pathogenesis of insulin resistance in obese adolescents[J].Diabetes Care,2010,33(8):1817-1822.
[5]Targher G,Day CP,Bonora E.Risk of cardiovascular disease in patients with nonalcoholic fatty liver disease[J].N Engl J Med,2010,363(14):1341-1350.
[6]Pacifico L,Martino MD,Merulis AD,et al.Left ventricular dysfunction in obese children and adolescents with nonalcoholic fatty liver disease[J].Hepatology,2014,59(2):461-470.
[7]Pan LL,Zhang HJ,Huang ZF,et al.Intrahepatic triglyceride content is independently associated with chronic kidney disease in obese adults:A cross-sectional study[J].Metabolism,2015,64(9):1077-1085.
[8]张增秀,彭俊铮,李少霞.超敏C-反应蛋白与肥胖儿童代谢综合征的关系[J].实用医院临床杂志,2017,14(3):41-44.
[9]Speliotes EK,Massaro JM,Hoffmann U,et al.Fatty liver is associated with dyslipidemia and dysglycemia independent of visceral fat:The Framingham Heart Study[J].Hepatology,2010,51(6):1979-1987.
[10]Grundy SM.Metabolic syndrome pandemic[J].Arteriosclerosis Thrombosis&Vascular Biology,2008,28(4):629-636.
[11]Cheng HT,Huang JW,Chiang CK,et al.Metabolic syndrome and insulin resistance as risk factors for development of chronic kidney disease and rapid decline in renal function in elderly[J].J Clin Endocrinol Metab,2012,97(4):1268-1276.
[12]Athyros VG,Tziomalos K,Katsiki N,et al.Cardiovascular risk across the histological spectrum and the clinical manifestations of non-alcoholic fatty liver disease:An update[J].World J Gastroenterol,2015,21(22):6820-6834.
[13]Musso G,Gambino R,Tabibian JH,et al.Association of non-alcoholic fatty liver disease with chronic kidney disease:A systematic review and meta-analysis[J].PLo S Med,2014,11(7):e1001680.
[14]Gansevoort RT,Matsushita K,van der Velde M,et al.Chronic Kidney Disease Prognosis Consortium.Lower estimated GFR and higher albuminuria are associated with adverse kidney outcomes.A collaborative meta-analysis of general and high-risk population cohorts[J].Kidney Int,2011,80(1):93-104.
[15]Cheung CR,Kelly DA.Non-alcoholic fatty liver disease in children[J].BMJ,2011,18,343:d4460.
[16]Ix JH,Sharma K.Mechanisms linking obesity,chmnic kidney disease,and fatty liver disease:the role of fetuin-A,adiponectin,and AMPK[J].J Am Soc Nephrol,2010,21(3):406-412.
[17]Vlassara H,Torreggiani M,Post JB,et al.Ro1e of oxidants/inflammation in declining renal function in chronic kidney disease and normal aging[J].Kidney Int Suppl,2009,12(114):S3-S11.
[18]Manco M,Ciampalini P,De Vito R,et al.Albuminuria and insulin resistance in children with biopsy proven non-alcoholic fatty liver disease[J].Pediatr Nephrol,2009,24(6):1211-1217.