中国超重/肥胖儿童青少年非酒精性脂肪性肝病患病率及危险因素的Meta分析

doi:10.7499/j.issn.1008-8830.2408148

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摘要目的系统评价中国超重/肥胖儿童青少年非酒精性脂肪性肝病（non-alcoholic fatty liver disease, NAFLD）患病率及其危险因素。方法检索中国知网、万方数据、维普、中国生物医学文献数据库、PubMed、Embase、Web of Science和Cochrane Library等数据库，检索时限为各数据库建库至2024年10月。由2名研究人员严格按照纳入和排除标准独立筛选文献，提取资料并评价文献质量，采用Stata 16.0软件进行Meta分析。结果最终纳入42篇文献，涉及16 481例超重/肥胖儿童青少年。Meta分析结果显示，中国超重/肥胖儿童NAFLD患病率为43%（95%CI：37%~48%）。男孩（OR=1.61，95%CI：1.17~2.04）、体重增加（MD=10.33，95%CI：9.08~11.57）、腰围增加（MD=5.49，95%CI：3.36~7.62）、肥胖持续时间较长（MD=0.31，95%CI：0.02~0.61）、体重指数增加（MD=3.11，95%CI：2.07~4.16）、空腹血糖水平较高（MD=0.17，95%CI：0.06~0.29）、甘油三酯水平较高（MD=0.32，95%CI：0.17~0.47）、总胆固醇水平较高（MD=0.15，95%CI：0.10~0.21）、低密度脂蛋白胆固醇水平较高（MD=0.14，95%CI：0.04~0.23）、谷丙转氨酶水平较高（MD=24.39，95%CI：18.57~30.20）、谷草转氨酶水平较高（MD=12.49，95%CI：9.67~15.32）、血清胰岛素水平较高（MD=4.47，95%CI：2.57~6.36）、稳态模型胰岛素抵抗指数较高（MD=0.45，95%CI：0.30~0.59）以及尿酸水平较高（MD=55.91，95%CI：35.49~76.32）是超重/肥胖儿童青少年NAFLD的危险因素（P<0.05）。结论中国超重/肥胖儿童青少年NAFLD患病率较高。男孩、体重增加、腰围增加、肥胖持续时间较长、体重指数增加、血脂异常，以及空腹血糖、肝酶、血清胰岛素、稳态模型胰岛素抵抗指数和尿酸水平升高可能增加超重/肥胖儿童青少年NAFLD的患病风险。

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关键词 ：非酒精性脂肪性肝病, 超重, 肥胖, 患病率, 危险因素, Meta分析, 儿童, 青少年

Abstract：Objective To systematically evaluate the prevalence and risk factors of non-alcoholic fatty liver disease (NAFLD) in overweight and obese children and adolescents in China. Methods Databases including China National Knowledge Infrastructure, Wanfang Data, VIP Database, China Biomedical Literature Database, PubMed, Embase, Web of Science, and Cochrane Library were searched, from database inception to October 2024. Two researchers independently screened the literature, extracted data, and assessed the quality of the studies according to inclusion and exclusion criteria. A Meta analysis was conducted using Stata 16.0 software. Results A total of 42 studies involving 16 481 overweight and obese children and adolescents were included. The Meta analysis results showed that the prevalence of NAFLD among overweight and obese children in China was 43% (95%CI: 37%-48%). Factors associated with NAFLD included being male (OR=1.61, 95%CI: 1.17-2.04), increased weight (MD=10.33, 95%CI: 9.08-11.57), increased waist circumference (MD=5.49, 95%CI: 3.36-7.62), longer duration of obesity (MD=0.31, 95%CI: 0.02-0.61), higher body mass index (MD=3.11, 95%CI: 2.07-4.16), elevated fasting blood glucose levels (MD=0.17, 95%CI: 0.06-0.29), higher triglyceride levels (MD=0.32, 95%CI: 0.17-0.47), elevated total cholesterol levels (MD=0.15, 95%CI: 0.10-0.21), higher low-density lipoprotein cholesterol levels (MD=0.14, 95%CI: 0.04-0.23), increased alanine aminotransferase levels (MD=24.39, 95%CI: 18.57-30.20), increased aspartate aminotransferase levels (MD=12.49, 95%CI: 9.67-15.32), elevated serum insulin levels (MD=4.47, 95%CI: 2.57-6.36), higher homeostasis model assessment-insulin resistance (MD=0.45, 95%CI: 0.30-0.59), and elevated uric acid levels (MD=55.91, 95%CI: 35.49-76.32) (P<0.05). Conclusions The prevalence of NAFLD among overweight and obese children and adolescents in China is high. Male gender, increased weight, increased waist circumference, prolonged obesity duration, higher body mass index, dyslipidemia, and elevated levels of fasting blood glucose, liver enzymes, serum insulin, homeostasis model assessment-insulin resistance, and uric acid are potential risk factors for NAFLD in this population.

Key words： Non-alcoholic fatty liver disease Overweight Obesity Prevalence Risk factor Meta analysis Child Adolescent

收稿日期: 2024-08-29

通讯作者: 余雨枫，女，副教授。Email：1393109559@qq.com。 E-mail: 1393109559@qq.com

作者简介: 肖益，女，硕士研究生；

引用本文:

肖益,潘宇帆,戴雨等. 中国超重/肥胖儿童青少年非酒精性脂肪性肝病患病率及危险因素的Meta分析[J]. 中国当代儿科杂志, 2025, 27(4): 410-419.

XIAO Yi,PAN Yu-Fan,DAI Yu et al. Meta analysis of the prevalence and risk factors of non-alcoholic fatty liver disease in overweight and obese children and adolescents in China[J]. CJCP, 2025, 27(4): 410-419.

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