儿童肥胖与代谢综合征及胰岛素抵抗的关系
- 王红丽,金薇,高毅
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Relationship between obesity,metabolic syndrome and insulin resistance in children.
- WANG Hong-li,JIN Wei,GAO Yi.
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文章历史
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摘要
目的 研究儿童肥胖与代谢综合征(metabolic syndrome,MS)组分及胰岛素抵抗的关系。方法 选择本院儿科门诊筛选的46例肥胖儿童患者[年龄(12.6±2.1)岁]为研究对象,51例正常体重儿童[年龄(12.5±1.9)岁]作为对照组,比较两组的临床特征及MS组分的差异,并分析胰岛素抵抗的影响因素。结果 1)肥胖组儿童的体质指数(body mass index,BMI)、腰围(waist circumference,WC)、血糖、血压、血脂水平(包括总胆固醇、甘油三酯、低密度脂蛋白、非高密度脂蛋白)及胰岛素抵抗程度均明显高于对照组,而高密度脂蛋白(high-density lipoprotein cholesterol,HDL-c)明显低于对照组(均P<0.05);2)肥胖组中高血压儿童7例(15.2%),高甘油三酯(TG)血症14例(30.4%),低HDL-c或高非HDL-c血症2例(4.3%),血糖异常3例(6.5%),可诊断为MS的儿童有8例(17.4%),而正常对照组仅2例TG增高(3.9%);3)多元逐步回归显示WC(标准化β=0.432,P<0.01)及TG(标准化β=0.207,P<0.05)为胰岛素抵抗的独立影响因素。 结论 肥胖儿童易存在不同程度的代谢异常,更易患代谢综合征。腰围及甘油三酯为胰岛素抵抗的独立影响因素。
Abstract
Objective To investigate the relationship between obesity,the components of metabolic syndrome(MS),and insulin resistance in children. Methods Forty-six obese children aged 12.6±2.1 years were selected from pediatrics outpatient clinic as subjects,and another 51 children with normal weight aged 12.5±1.9 years were enrolled as controls.Clinical characteristics and the components of MS were compared between the two groups,and the influencing factors of insulin resistance were evaluated. Results 1) Compared with normal weight children,obese children had significantly higher body mass index(BMI),waist circumference(WC),glucose levels,blood pressure,lipid profile including total cholesterol,triglyceride,low-density lipoprotein cholesterol,and non-high-density lipoprotein cholesterol,as well as insulin resistance(HOMA-IR),but lower high-density lipoprotein cholesterol(HDL-c)(all P<0.05).2) In obese group,7 children(15.2%) had hypertension,14(30.4%) had hypertriglyceridemia,2(4.3%) had low HDL-c or high non-HDL-c,3(6.5%) had hyperglycemia,and 8(17.4%) was diagnosed as MS;while only 2 children with normal weight(3.9%) had hypertriglyceridemia.3) Multiple regression analysis showed that WC(standardized β=0.432,P<0.05) and TG(standardized β=0.207,P<0.05) were independently correlated with HOMA-IR. Conclusions Obese children are prone to suffer more different metabolic disorders and MS.WC and TG are independently correlated with insulin resistance.
关键词
Key words
obesity / metabolic syndrome / insulin resistance / children
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参考文献
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[13] 万乃君,米杰,王天有,等.北京市超重和肥胖学龄儿童中代谢综合征的流行特征[J].中华儿科杂志,2007,45:417-421.
[14] 梁黎,傅君芬,杜军保.中国儿童青少年代谢综合征定义的探索及意义[J].中华儿科杂志,2012,50:401-404.
[15] Nemet D,Barkan S,Epstein Y,et al.Short- and long-term beneficial effects of a dombined dietary-behavioal-physical activity intervention for the treatment of childhood obesity[J].J Pediatr,2005,115:443-449.
[2] Schubert CM,Sun SS,Burns TL,et al.Predictive ability of childhood metabolic components for adult metabolic syndrome and type 2 diabetes[J].J Pediatr,2009,155(S6):e1-7.
[3] Huang TT,Sun SS,Daniels SR.Understanding the nature of metabolic syndrome components in children and what they can and cannot do to predict adult disease[J].J Pediatr,2009,155(S6):e13-14.
[4] 中国肥胖问题工作组.中国学龄儿童青少年超重、肥胖筛查体重指数值分类标准[J].中华流行病学杂志,2004,25:97-102.
[5] Matthews D,Hosker J,Rudenski A,et al.Homeostasis model assessment:insulin resistance and β-cell function from fasting plasma glucose and insulin concentrations in man[J].Diabetologia,1985,28:412-419.
[6] 中华医学会儿科学分会内分泌学组,心血管学组,儿童保健学组.中国儿童青少年代谢综合征定义和防治建议[J].中华儿科杂志,2012,50:420-422.
[7] Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents;National Heart,Lung,and Blood Institute.Expert panel on integrated guidelines for cardiovascular health and risk reduction in children and adolescents:summary report[J].Pediatrics,2011,128(S5):213-256.
[8] 曾畿生,王德芬.现代儿科内分泌临床与基础[M].上海:上海科学技术文献出版社,2001:400-413.
[9] Chen F,Wang Y,Shan X,et al.Association between childhood obesity and metabolic syndrome:evidence from a large sample of Chinese children and adolescents[J].Plos one,2012,7:e47380. [10] Calcaterra V,Klersy C,Muratori T,et al.Prevalence of metabolic syndrome in children and adolescents with varying degrees of obesity[J].Clin Endocrinol,2008,68:868-872.
[11] Li Y,Yang X,Zhai F,et al.Prevalence of the metabolic syndrome in Chinese adolescents[J].Br J Nutr,2008,99:565-570.
[12] Cruz ML,Weigensberg MJ,Huang TT,et al.The metabolic syndrome in overweight Hispanic youth and the role of insulin sensitivity[J].J Clin Endocrinol Metab,2004,89:108-113.
[13] 万乃君,米杰,王天有,等.北京市超重和肥胖学龄儿童中代谢综合征的流行特征[J].中华儿科杂志,2007,45:417-421.
[14] 梁黎,傅君芬,杜军保.中国儿童青少年代谢综合征定义的探索及意义[J].中华儿科杂志,2012,50:401-404.
[15] Nemet D,Barkan S,Epstein Y,et al.Short- and long-term beneficial effects of a dombined dietary-behavioal-physical activity intervention for the treatment of childhood obesity[J].J Pediatr,2005,115:443-449.
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