Razi Journal of Medical Sciences

en بررسی شیوع کبد چرب و ریسک فاکتورهای محتمل در کودکان مراجعه کننده به بخش سونوگرافی بیمارستان حضرت علی اصغر تهران در سال 1398 Evaluation of Prevalevce and Relative Risk Factors for Non-alcoholic Fatty Liver in Children Referred to Ultrasound Ward of Ali Asghar Hospital in Tehran 2019 to 2020 بیماری‌های اطفال Pediatric Disease پژوهشي Research زمینه و هدف: بیماری کبد چرب غیرالکلی نوعی بیماری کبد چرب است که در آن ذخیره چربی در کبد بنا به علت‌ های غیر الکلی افزایش پیدا می‌کند و با شماری از ریسک ‌فاکتورهای متابولیکی ارتباط دارد. این ریسک فاکتورها شامل مقاومت به انسولین، دیس‌لیپیدمی و اضافه وزن (بیشترین ارتباط) می‌باشند و در جمعیت اطفال یکی از شایع‌ترین بیماری‌های مزمن کبد محسوب می‌شود. این مطالعه جهت تعیین شیوع بیماری کبد چرب و ریسک فاکتورهای محتمل در کودکان مراجعه کننده به بیمارستان حضرت علی اصغر تهران انجام شده است. روش کار: تمامی کودکان مبتلا به کبد چرب غیرالکلی که در سال 1398 به بیمارستان کودکان حضرت علی اصغر مراجعه کرده بودند، مورد بررسی قرار گرفتند. یافته‌‌های سونوگرافی بیمار، گرید کبدچرب و میزان درگیری، اطلاعات موجود در آزمایش‌ها و پرونده‌ی این افراد برای بررسی ریسک فاکتور‌ها جمع آوری شد. سپس اطلاعات را در نرم افزار SPSS V.22 وارد کرده و با آنالیز آماری درصد فراوانی و ریسک فاکتور های کبد چرب غیر الکلی در این گروه کودکان را بررسی و مقایسه کردیم. یافته‌ها: در این مطالعه تعداد 5052 کودک شرکت کردند 74 کودک مبتلا به کبد چرب بودند. توزیع سنی افراد زیر ده سال  و بالای ده سال تقریبا برابر است. میزان کبد چرب در پسران بیشتر از دختران بود. میزان میانگین BMI در کودکان کبد چرب 6/28 محاسبه گردید. میزان شیوع کبد چرب در کودکان که دارای شاخص توده بدنی بالای 30 بودند بیشترین میزان را داشت.میانگین AST با افزایش گرید کبد چرب افزایش می یابد.میزان FBS در گرید 1 کبد چرب بیشترین مقدار را دارد. با افزایش گرید کبد چرب میانگین ALT افزایش می یابد. نتیجه‌گیری: در این مطالعه نشان داده شد که میزان شیوع کبد چرب با افزایش توده بدنی افزایش پیدا کرد. همچنین شیوع آن با بیماری‌های متابولیک در ارتباط است، از این رو مـی‌تـوان پیش بینی کرد که بیماری‌های قلبی عروقی نیز افازیش می‌یابد. بنـابراین اصلاح شیوه‌ی زندگی و کنترل چـاقی کودکان باید از اولویـت‌هـای بهداشـتی باشــد و برنامه‌هایی در این راستا و در جهت ترغیب کودکان و نوجوانان به داشتن وزن طبیعی ارائه شود.   Background & Aims: fat in the liver increases due to non-alcoholic causes. The disease is seen in the population from simple steatosis to non-alcoholic steatohepatitis (NASH). NAFLD is associated with a number of metabolic risk factors. These risk factors include insulin resistance, dyslipidemia, and overweight (most commonly). NAFLD is one of the most common chronic liver diseases in the pediatric population. It is currently the most common cause of defective liver function tests in the UK. The prevalence of NAFLD in the pediatric population is estimated at 3 to 12 percent, which is 70 to 80 percent in people at risk for overweight. NAFLDs are also the second most likely liver transplant candidate in the United States. Given that NAFLD is highly associated with various diseases, including cardiovascular disease, type 2 diabetes, and low bone mineral density, it is also significantly more prevalent in the overweight population. Increases the risk of liver transplantation. In this study, we try to investigate the prevalence and risk factors of this disease in the pediatric population. Metabolic syndrome is a combination of clinical disorders including type 2 diabetes, high blood pressure, high blood cholesterol and high blood triglycerides. Due to the association of nonalcoholic fatty liver with metabolic syndrome, fatty liver disease can be associated with obesity, diabetes, hyperlipidemia, hypertension, as well as hyperuricemia and polycystic ovary disease. Non-alcoholic fatty liver has been identified as a major cause of liver death. Due to the importance of this disease, it seems necessary to conduct more studies in this field, so this study was performed to determine the prevalence of fatty liver disease and possible risk factors in children referred to Hazrat Ali Asghar Hospital in Tehran, hoping that the results It can improve health programs at the community level, especially in schools to prevent the spread of obesity in children, and also encourage physician colleagues to seriously participate in health programs to prevent the spread of obesity in children. Methods: The information required for this study is examined by reviewing medical records and ultrasound information of all children with non-alcoholic fatty liver who referred to Hazrat Ali Asghar Children's Hospital in 1398.Ultrasound findings of the patient include fatty liver grade and the degree of involvement.In addition to ultrasound, information from the tests and records of these individuals is collected to assess risk factors. The prevalence of fatty liver disease is determined by age and sex. The prevalence of the disease is compared in girls and boys. The prevalence of the disease is compared in the age group of 0 to 10 years and the age group of 10 years and above. Height, weight and BMI of patients with fatty liver are measured by scales and meters and the frequency of obesity and overweight variables in patients is determined and the prevalence of the disease is examined separately for obesity and overweight. Obese group (BMI high (30 and overweight group) BMI between 25 to 30) and normal weight group (BMI) between 18.5 to (25 and lean group) BMI below (18.5) is compared with the Diabetes Questionnaire in patients with fatty liver and the frequency is studied It is determined and the prevalence of the disease is examined separately for diabetes, and the frequency of each of the degrees of the disease (1, 2, and 3), which can be detected by ultrasound, is determined and compared with each other. Ultrasound criteria for fatty liver severity are: 1mild: Liver echogenicity increases slightly and the diaphragm and intrahepatic vessels are normal. Grade 2 moderate: The echogenicity of the liver is moderately increased and the area around the diaphragm or intrahepatic arteries is slightly blurred. Grade 3: Liver echogenicity is greatly increased and the area around the diaphragm and intrahepatic vessels and the posterior part of the right lip of the liver is blurred or observed to a small extent. Then we enter the information in SPSS V.22 software and compare rhem by statistical analysis of the frequency and risk factors of non-alcoholic fatty liver in this group of children. Results: 5052 children participated in this study, 74 children had fatty liver. The age distribution of people under ten and over ten is almost equal. Fatty liver was higher in boys than girls. The mean BMI in children with fatty liver was 6.28. The prevalence of fatty liver was highest in children with a body mass index above 30. The mean AST increased with increasing grade of fatty liver. The rate of FBS in grade 1 of fatty liver was highest. The average ALT increases with increasing fatty liver grade. Conclusion: The results of this study show that the prevalence of fatty liver in obese children and adolescents is clearly higher than in normal weight people. In addition to what can be seen in the results of this study, there is a sex difference in fatty liver disease and it was observed in boys more than girls. High body mass index and blood sugar are associated with the progression of liver dysfunction to fibrosis and cirrhosis. Therefore, lifestyle modification and control of childhood obesity can be health priorities. On the other hand, media can be effective in creating a culture of healthier living. Given that many habits and lifestyles are transmitted to this group through the media, these media should have programs to improve the lifestyle and encourage children and adolescents to have a normal weight. In general, it can be expected that the education of children and adolescents through schools, kindergartens, the media and their parents will improve their way of life and prevent the development of obesity and obesity.   کبدچرب, سونوگرافی, کودکان, چاقی Fatty liver, Ultrasound, Children, Obesity 1 9 http://rjms.iums.ac.ir/browse.php?a_code=A-10-5870-1&slc_lang=en&sid=1 Bahareh Hemmati بهاره همتی Baharline@yahoo.com 3900319475328460089523 3900319475328460089523 Yes Pediatric Resident, Department of Pediatrics, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran رزیدنت کودکان، گروه کودکان، دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران Shahrbanoo Nakhaei شهربانو نخعی 3900319475328460089524 3900319475328460089524 No Associate Professor, Department of Pediatrics, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran دانشیار، گروه کودکان، دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران Rozita Hoseini shamsabadi رزیتا حسینی شمس آبادی 3900319475328460089525 3900319475328460089525 No Associate Professor, Department of Pediatrics, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran دانشیار، گروه کودکان، دانشکده پزشکی، دانشگاه علوم پزشکی ایران، تهران، ایران