中国实用儿科杂志

中国实用儿科杂志

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儿童非酒精性脂肪性肝炎临床与病理特点分析

王丽，张鸿飞，董漪，徐志强，陈大为，甘雨，王福川，朱世殊   

  1. 作者单位： 解放军302医院青少年肝病诊疗与研究中心，
  • 出版日期:2014-12-06 发布日期:2014-12-08
  • 通讯作者: 朱世殊

The clinical and pathological characteristics of nonalcoholic steatohepatitis in children.

WANG Li-min， ZHANG Hong-fei， DONG Yi， XU Zhi-qiang， CHEN Da-wei， GAN Yu， WANG Fu-chuan， ZHU Shi-shu.   

  1. The Pediatric Liver Disease Therapy and Research Center， Beijing 302 Hospital， Beijing 100039， China
  • Online:2014-12-06 Published:2014-12-08

摘要：

目的 探讨儿童非酒精性脂肪性肝炎（NASH）的临床与肝脏病理特点的关系。方法 收集2008年1月至2013年12月解放军302医院的105例儿童NASH患者的临床及肝脏病理资料，进行统计学分析。结果 （1）本组患者中92.38%为男性，年龄以11～13岁多见，病程6～72个月，中位数为19个月。46.67%为肥胖患者，0.95%合并高血压病，33.33%有家族史。（2）本组患者丙氨酸氨基转移酶（ALT）平均值（224.90±115.55） μ/L、天冬氨酸氨基转移酶（AST）（118.57±64.38） μ/L。50.48%的患者三脂酰甘油（TG）升高，2.86%合并2型糖尿病，22.86%的胰岛素高于正常。83.81%的患者超声提示脂肪肝。（3）肝脏病理：本组56.19%的患者F≥3，29.53%的患者 G≥2级，20.95%的患者S≥3。NAS积分5～6分的患者41.90%，7～8分的58.10%。F≥3组患者BMI、ALT、AST的平均值，高TG、G≥2、S≥3的比例大于均F＜3组，且BMI和AST平均值及高TG、S≥3的比例两组差异有统计学意义。依据BMI分组，肥胖组高TG和F≥3的比例高于非肥胖组。（4）肝脏纤维化（S）的多因素非条件Logistic回归分析，肝脏的脂肪变性（F）、BMI为肝脏纤维化的影响因素。结论 儿童NASH重度脂肪变性患者BMI、AST平均值及高TG、中晚期纤维化的比例均高于轻中度脂肪变性患者。肥胖患者高TG和F≥3的比例高于非肥胖患者。中晚期肝纤维化与重度脂肪变性及BMI值相关。

关键词: 非酒精性脂肪性肝炎, 儿童, 肝脏病理, 临床特征

Abstract:

Abstract：Objective To explore relation skip between clinical and liver pathological characteristics of nonalcoholic steatohepatitis in children. Methods The data of 105 cases of nonalcoholic steatohepatitis children，who had been hospitalized from January 2008 to December 2012， were summarized and analyzed. Results （1）About 92.38% of all the group were male，11～13 years old were the most，46.67% were adiposity，0.95% had hypertension，and 33.33% had family history. （2）The patients ALT averaged 224.90±115.55 μ/L，AST 118.57±64.38 μ/L. About 50.48% of all TG was above normal，2.86% had diabetes， and 22.86% of insulin was above normal. About 83.81% had fatty liver by ultrasonogrophy. （3）Liver pathology: 56.19% of all had F≥3，29.53% of all G≥2，20.95% of all S≥3. NAS score 5～6 cent accounted for 41.90% of all，7～8 cent for 58.10% of all. The group of patients with F≥3 were higher than the group of F＜3 in average BMI，AST and the percentage of hyperglyceride and S≥3.（4）Liver fibrosis logistic analysis revealed that liver F grade and BMI affected liver fibrosis in NASH children. Conclusion NASH is more common in boys，and 11～13 years old is more. The group of patients F≥3 had higher than the group of F＜3 in average BMI，AST and the percentage of hyperglyceride，S≥3，liver F grade and BMI affect liver fibrosis.

Key words: nonalcoholic steatohepatitis （NASH）, child, liver pathology, clinical characteristics

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