發(fā)布時間：2018-01-07 09:07

  本文關(guān)鍵詞：肥胖非酒精性脂肪肝兒童核磁肝內(nèi)脂肪半定量分析及胰島β細(xì)胞功能的研究　出處：《天津醫(yī)科大學(xué)》2014年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 非酒精性脂肪肝 肥胖 兒童 胰島β細(xì)胞功能 肝內(nèi)脂肪含量 梯度回波雙回波技術(shù)

【摘要】：隨著人們生活方式的改變和飲食結(jié)構(gòu)的調(diào)整,兒童和青少年的肥胖的發(fā)病率逐年上升,其患病率正在世界范圍內(nèi)不斷的增加,已成為令世界矚目的公共衛(wèi)生問題。非酒精性脂肪肝(nonalcoholic fatty liver disease, NAFLD)是常見的肥胖并發(fā)癥,NAFLD在歐美等西方國家占慢性肝病的比例已大于30%m,并且其發(fā)病率呈明顯的上升趨勢。近年來的研究表明胰島素抵抗和全身能量代謝的失衡是NAFLD的發(fā)病機(jī)制之一,而胰島素抵抗和β細(xì)胞功能衰竭是2型糖尿病的發(fā)病基礎(chǔ)。 一、兒童肥胖非酒精性脂肪肝與胰島β細(xì)胞功能關(guān)系的研究 目的：探討兒童肥胖非酒精性脂肪肝與胰島β細(xì)胞功能的關(guān)系。 方法：對2007年6月—2011年4月天津醫(yī)科大學(xué)總醫(yī)院兒科內(nèi)分泌門診就診的362例肥胖兒童,經(jīng)腹部B超檢查分為伴有非酒精性脂肪肝(NAFLD)組170例及不伴非酒精性脂肪肝且肝功能正常的單純肥胖不伴NAFLD組192例,164例正常查體體重正常的兒童作為對照組；所有兒童進(jìn)行血甘油三酯、膽固醇、空腹血糖(FPG)及空腹胰島素(FINS)、bAlc的檢測;肥胖兒童行口服葡萄糖耐量及胰島素釋放試驗。計算胰島素敏感指數(shù)(QUICKI法),胰島素抵抗指數(shù)(HOMA-IR),胰島β細(xì)胞功能指數(shù)(HOMA-β)。 結(jié)果：1. NAFLD組FPG、FINS、胰島素抵抗指數(shù)、胰島β細(xì)胞功能指數(shù)及HbA1c明顯高于肥胖不伴NAFLD組及對照組(P0.05)； 2.NAFDL組胰島素敏感指數(shù)明顯低于肥胖不伴NAFLD組及對照組(p0.05)；NAFLD組糖代謝異常檢出率明顯高于無NAFLD組(p0.05)。 結(jié)論：兒童肥胖伴非酒精性脂肪肝患兒存在胰島β細(xì)胞功能受損和糖脂代謝異常,胰島β細(xì)胞功能受損可能是兒童非酒精性脂肪肝的發(fā)病機(jī)制之一。 二、量化評估兒童非酒精性脂肪肝肝內(nèi)脂肪的臨床意義 目的：量化評估兒童非酒精性脂肪肝肝內(nèi)脂肪的臨床意義。 方法：對56例肥胖兒童進(jìn)行形體學(xué)參數(shù)、肝功能、血脂、血糖及胰島素釋放試驗和肝臟B超等檢查,采用同、反相位(IP/OP)序列定量測定肝內(nèi)脂肪(IHF)含量,并按傳統(tǒng)診斷標(biāo)準(zhǔn)將其分為肥胖不伴NAFLD組(24例)、肥胖伴NAFLD病組(32例)。觀察IHF含量在組間的變化情況,分析IHF含量與各臨床生化指標(biāo)的相關(guān)關(guān)系。 結(jié)果：肥胖伴NAFLD組IHF含量比不伴NAFLD組高,差異有統(tǒng)計學(xué)意義(P0.05)。單因素相關(guān)分析表明IHF含量與腰圍、臀圍、腰臀比、體重指數(shù)、丙氨酸氨基轉(zhuǎn)移酶、門冬氨酸氨基轉(zhuǎn)移酶、γ-谷氨酰轉(zhuǎn)肽酶、空腹甘油三酯、低密度脂蛋白、口服葡萄糖耐量試驗(OGTT)2h血糖、空腹胰島素、2h胰島素和胰島素抵抗指數(shù)呈正相關(guān),與高密度脂蛋白呈顯著負(fù)相關(guān)。 結(jié)論：量化的IHF可成為兒科NAFLD病情評估中敏感而又可靠的方法之一。定量檢測并評價肝細(xì)胞內(nèi)脂肪含量對兒童NAFLD的早期診斷、病情判斷至關(guān)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.

【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R725.7;R723.14

【參考文獻(xiàn)】

相關(guān)期刊論文 前8條

1 朱嬋艷;范建高;;兒童非酒精性脂肪性肝病[J];實用肝臟病雜志;2013年06期

2 Lucia Pacifico;Valerio Nobili;Caterina Anania;Paola Verdecchia;Claudio Chiesa;;Pediatric nonalcoholic fatty liver disease,metabolic syndrome and cardiovascular risk[J];World Journal of Gastroenterology;2011年26期

3 柳懌;陳亞青;;超聲測量腎周及腎旁脂肪厚度在評估非酒精性脂肪肝患者肝脂肪浸潤程度中的意義[J];臨床超聲醫(yī)學(xué)雜志;2011年05期

4 劉飛奇;廖利珍;;2型糖尿病與胰島β細(xì)胞功能[J];實用糖尿病雜志;2010年04期

5 梁長虹;劉于寶;張忠林;謝淑飛;王秋實;;脂肪肝MR氫質(zhì)子波譜成像定量分析的初步研究[J];中華放射學(xué)雜志;2007年01期

6 ;非酒精性脂肪性肝病診療指南[J];中華肝臟病雜志;2006年03期

7 季成葉,孫軍玲,陳天嬌;中國學(xué)齡兒童青少年1985～2000年超重、肥胖流行趨勢動態(tài)分析[J];中華流行病學(xué)雜志;2004年02期

8 中國肥胖問題工作組 ,季成葉;中國學(xué)齡兒童青少年超重、肥胖篩查體重指數(shù)值分類標(biāo)準(zhǔn)[J];中華流行病學(xué)雜志;2004年02期

，

本文編號：1391888