超重/肥胖儿童并发非酒精性脂肪性肝病的影响因素分析

Influencing factors for nonalcoholic fatty liver disease in overweight and obese children

摘要

目的 探讨超重/肥胖儿童并发非酒精性脂肪性肝病(NAFLD)的影响因素,并绘制列线图模型预测患病风险。方法 回顾性选取2020年7月—2025年7月石河子大学第一附属医院就医的147例超重/肥胖儿童,将其分为NAFLD组(41例)和非NAFLD组(106例)。采用多因素回归分析探讨超重/肥胖患儿并发NAFLD的影响因素,并通过受试者操作特征(ROC)曲线和R语言构建列线图模型评估其预测价值。结果 NAFLD中超重儿童占7.3%,肥胖儿童占92.7%。单因素分析显示,年龄、超重/肥胖、体质量指数(BMI)、丙氨酸氨基转移酶(ALT)、尿酸(UA)、白细胞计数(WBC)及胰岛素与超重/肥胖儿童合并NAFLD相关(P＜0.05)。多因素logistic回归提示BMI、ALT、WBC是超重/肥胖儿童并发NAFLD的独立相关因素(P＜0.05),ROC曲线提示BMI、WBC、ALT联合预测NAFLD的曲线下面积AUC为0.896(95%CI:0.847~0.946),其灵敏度为97.6%,特异度为68.9%。结论 肥胖儿童并发NAFLD的风险高于超重儿童。BMI、ALT、WBC指标越高,NAFLD的患病风险越大,三者联合检测超重/肥胖儿童并发NAFLD具有较高的临床预测价值。

Abstract

Objective To investigate the influencing factors of nonalcoholic fatty liver disease (NAFLD) in overweight and obese children, and to construct a nomogram model for predicting the risk of NAFLD. Methods A total of 147 overweight or obese children who visited The First Affiliated Hospital of Shihezi University from July 2020 to July 2025 were enrolled in this study, and were divided into an NAFLD group (n=41) and a non-NAFLD group (n=106). Multivariate logistic regression analysis was conducted to identify the independent influencing factors for NAFLD. Receiver operating characteristic (ROC) curve analysis was performed, and a nomogram model was constructed using R software to evaluate the predictive value. Results Among the NAFLD cases, 92.7% were obese and 7.3% were overweight. Univariate analysis showed that age, overweight/obesity, body mass index (BMI), alanine aminotransferase (ALT), uric acid (UA), white blood cell count (WBC), and insulin levels were significantly associated with NAFLD (P<0.05). Multivariate logistic regression indicated that BMI, ALT, and WBC were independent related factors for NAFLD (P < 0.05). ROC curve analysis demonstrated that the combined assessment of BMI, WBC, and ALT yielded an area under the curve (AUC) of 0.896 (95%CI: 0.847 - 0.946) for predicting NAFLD, with a sensitivity of 97.6% and a specificity of 68.9%. Conclusions Obese children have a significantly higher risk of NAFLD compared to overweight children. Elevated levels of BMI, ALT, and WBC are associated with an increased risk of NAFLD. The combined assessment of these three indicators has significant predictive value for the development of NAFLD.

关键词

超重 / 肥胖 / 非酒精性脂肪性肝病

Key words

overweight / obesity / nonalcoholic fatty liver disease

[1] 中国居民营养与慢性病状况报告(2020年)[J]. 营养学报, 2020, 42(6): 521.
Report on the nutrition and chronic diseases status of Chinese residents 2020[J]. Acta Nutr Sin, 2020, 42(6): 521.(in Chinese)
[2] Zhou J, Zhou F, Wang W, et al.Epidemiological features of NAFLD from 1999 to 2018 in China[J]. Hepatology, 2020, 71(5):1851-1864.
[3] 李东丹, 闫洁, 王美辰, 等. 非酒精性脂肪性肝病肥胖儿童人体成分及其影响因素分析[J]. 中国实用儿科杂志, 2023, 38(7): 525-529.
Li DD, Yan J, Wang MC, et al. Analysis of body composition and risk factors of non-alcoholic fatty liver disease in obese children[J]. Chin J Pract Pediatr, 2023, 38(7): 525-529. (in Chinese)
[4] 中华人民共和国国家卫生健康委员会医政司. 肥胖症中国诊疗指南(2024年版)[J]. 协和医学杂志, 2025, 16(1): 90-108.
Department of Medical Administration, National Health Commission of the People's Republic of China. Chinese Guidelines for the Clinical Management of Obesity (2024 Edition)[J]. Medical Journal of Peking Union Medical College Hospital, 2025, 16(1): 90-108. (in Chinese)
[5] 李婕, 任万华. 儿童非酒精性脂肪性肝病的诊治对策[J]. 中华肝脏病杂志, 2020, 28(3): 208-212.
Li J, Ren WH. Diagnosis and therapeutic strategies for non-alcoholic fatty liver disease in children[J]. Chin J Hepatol, 2020, 28(3): 208-212. (in Chinese)
[6] 李辉, 季成叶, 宗心南, 等. 中国0～18岁儿童、青少年体块指数的生长曲线[J]. 中华儿科杂志, 2009, 47(7): 493-498.
Li H, Ji CY, Zong XN, et al. Body mass index growth curves for Chinese children and adolescents aged 0 to 18 years[J]. Chin J Pediatr, 2009, 47(7): 493-498. (in Chinese)
[7] 周雪莲, 傅君芬. 儿童非酒精性脂肪肝病诊断与治疗专家共识[J]. 中国实用儿科杂志, 2018, 33(7): 487-492.
Zhou XL, Fu JF. Expert consensus on the diagnosis and treatment of nonalcoholic fatty liver disease in children[J]. Chin J Pract Pediatr, 2018, 33(7): 487-492. (in Chinese)
[8] 范晖, 闫银坤, 米杰. 中国3～17岁儿童性别、年龄别和身高别血压参照标准[J]. 中华高血压杂志, 2017, 25(5): 428-435.
Fan H, Yan YK, Mi J. Updating blood pressure references for Chinese children aged 3-17 years[J]. Chin J Hypertens, 2017, 25(5): 428-435. (in Chinese)
[9] Eslam M, Alkhouri N, Vajro P, et al. Defining paediatric metabolic (dysfunction)-associated fatty liver disease: An international expert consensus statement[J]. Lancet Gastroenterol Hepatol, 2021, 6(10): 864-873.
[10] Rinella ME, Lazarus JV, Ratziu V, et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature[J].Hepatology, 2023, 78(6): 1966-1986.
[11] 王雨, 杨志然, 陈润花. 中国儿童非酒精性脂肪性肝病患病率的Meta分析[J]. 中国儿童保健杂志, 2022, 30(7): 764-769.
Wang Y, Yang ZR, Chen RH. Meta-analysis of the prevalence of non-alcoholic fatty liver disease in Chinese children[J]. Chin J Child Health Care, 2022, 30(7): 764-769. (in Chinese)
[12] 陈新春, 寇永妹, 刘晓璐, 等. 唐山市7～14岁肥胖儿童非酒精性脂肪肝流行现状及危险因素初步分析[J]. 中国儿童保健杂志, 2021, 29(6): 669-673.
Chen XC, Kou YM, Liu XL, et al. Prevalence and risk factors of nonalcoholic fatty liver disease among obesity children aged 7 to 14 years in Tangshan city[J]. Chin J Child Health Care, 2021, 29(6): 669-673. (in Chinese)
[13] Qin L, Zhao W, Lin Z, et al. Clinical and lipid metabolic responses to diacylglycerol oil administration in Chinese adults with overweight/obesity or central obesity: A randomized, double-blind, placebo-controlled trial[J]. Food Funct, 2026, 17(1): 243-258.
[14] Wang D, Zhang J, Yang X, et al. Acetylation of the mitochondrial chaperone GRP75 governs ER-mitochondrial calcium homeostasis and hepatocyte insulin resistance[J]. Adv Sci, 2025, 12(46): e08991.
[15] 王宪红, 高志峰. 非酒精性脂肪肝患者病情严重程度与炎性因子的相关性研究[J]. 实验与检验医学, 2021, 39(5): 1159-1160, 1171.
[16] 刘勤, 牛春燕. 由“二次打击”到“多重打击”: 发病机制的演变带给非酒精性脂肪性肝病的治疗启示[J]. 世界华人消化杂志, 2019, 27(19): 1171-1178.
Liu Q, Niu CY. From “two hit theory” to “multiple hit theory”: Implications of evolution of pathogenesis concepts for treatment of non-alcoholic fatty liver disease[J]. World Chin J Dig, 2019, 27(19): 1171-1178. (in Chinese)
[17] Li J, Li Y, Zhou X, et al. Adipocytes orchestrate obesity-related chronic inflammation through β2-microglobulin[J].Sig Transduct Target Ther, 2025, 10: 394.
[18] Yin J, Gao Z, He Q, et al. Role of hypoxia in obesity-induced disorders of glucose and lipid metabolism in adipose tissue[J]. Am J Physiol Endocrinol Metab, 2009, 296(2): E333-E342.
[19] Huang Y, Sulek K, Stinson SE, et al. Lipid profiling identifies modifiable signatures of cardiometabolic risk in children and adolescents with obesity[J]. Nat Med, 2025, 31(1): 294-305.
[20] Mann J, Valenti L, Scorletti E, et al. Nonalcoholic fatty liver disease in children[J]. Semin Liver Dis, 2018, 38(1):1-13.
[21] 丁剑波, 金爱华, 李秀惠, 等. 尿酸在非酒精性脂肪性肝病发生发展中的作用及机制[J]. 肝脏, 2025, 30(2): 272-275.
[22] Vos MB, Abrams SH, Barlow SE, et al. NASPGHAN clinical practice guideline for the diagnosis and treatment of nonalcoholic fatty liver disease in children[J]. J Pediatr Gastroenterol Nutr, 2017, 64(2): 319-334.
[23] Lu Y, Wang Q, Yu L, et al. Revision of serum ALT upper limits of normal facilitates assessment of mild liver injury in obese children with non-alcoholic fatty liver disease[J]. J Clin Lab Anal, 2020, 34(7): e23285.
[24] 史俊奇, 张慧, 周海燕, 等. 非酒精性脂肪肝病儿童干预前后血清细胞因子水平的纵向变化[J]. 浙江临床医学, 2024, 26(3): 394-397.
[25] Yang L, Li M, Zhao M, et al. Resolution of metabolic dysfunction improves liver health among Chinese children: Evidence from two prospective cohorts[J]. Clin Gastroenterol Hepatol, 2026,24(6):1635-1643.
[26] 李宁, 郑红霞, 邰苏豫, 等. 军事飞行人员非酒精性脂肪肝病患者白细胞计数、C反应蛋白、尿酸与糖脂代谢、胰岛素抵抗和肝纤维化指标的相关性研究[J]. 现代生物医学进展, 2022, 22(20): 3962-3965, 3971.
Li N, Zheng HX, Tai SY, et al. Correlation study between leukocyte count, C-reactive protein, uric acid and glucose and lipid metabolism, insulin resistance and liver fibrosis indexes in military pilots with nonalcoholic fatty liver disease[J]. Prog Mod Biomed, 2022, 22(20): 3962-3965, 3971. (in Chinese)
[27] Talukdar S, Oh DY, Bandyopadhyay G, et al. Neutrophils mediate insulin resistance in mice fed a high-fat diet through secreted elastase[J]. Nat Med, 2012, 18(9): 1407-1412.
[28] Crespo M, Gonzalez-Teran B, Nikolic I, et al. Neutrophil infiltration regulates clock-gene expression to organize daily hepatic metabolism[J]. eLife, 2020, 9: e59258.
[29] 吴钟英, 李鹏. 非酒精性脂肪性肝病的病理生理机制研究进展[J]. 贵州医药, 2022, 46(3): 357-359.
[30] 王英, 骆培良, 白华, 等. 血尿酸及性激素水平与肥胖合并非酒精性脂肪肝儿童的相关性[J]. 安徽医药, 2024, 28(11): 2205-2212.
Wang Y, Luo PL, Bai H, et al. Correlation between serum uric acid, sex hormones and non-alcoholic fatty liver disease in obese children[J]. Anhui Med Pharm J, 2024, 28(11): 2205-2212. (in Chinese)

基金资助

兵团儿童白血病及血液系统重大疾病流行病学调查及规范化诊治技术集成推广的应用研究(NO.2023ZD010)