目的 探讨肥胖儿童肺通气功能与糖化血红蛋白(HbA1c)的相关性,为肥胖儿童的综合管理提供新视角。方法 收集2019年1月—2022年12月在北京积水潭医院儿科门诊就诊的肥胖儿童255例,测量身高、体重、血清糖化血红蛋白(HbA1c)及肺通气功能。HbA1c按其三分位数分为3组(Q1、Q2、Q3),比较不同HbA1c水平分组的肥胖儿童肺功能指标,并通过多元线性回归分析构建HbA1c与肺功能指标的模型,绘制受试者工作特征(ROC)曲线,评估该模型在预测肺功能指标方面的价值。结果 轻中度肥胖组142例(55.69%),重度肥胖组113例(44.31%),轻中度肥胖组用力肺活量(FVC)低于重度肥胖组(t=2.541,P=0.012),第1秒用力呼气容积与用力肺活量的比值(FEV1/FVC,简称一秒率)、一秒率实际值占预计值的百分比(FEV1/FVC%)、50%肺活量时的呼气流量(FEF50)高于重度肥胖组(t=2.277、2.215、2.075,P＜0.05),HbA1c低于重度肥胖组(t=3.097,P=0.002)。不同HbA1c水平分组其FEV1/FVC、FEV1/FVC%、25%肺活量时的呼气流量(FEF25)、FEF50、75%肺活量时的呼气流量(FEF75)、最大呼气中期流量(MMEF)差异均有统计学意义(F=7.813、7.804、6.493、8.209、6.193、6.855,P＜0.01),Q1组各项肺功能指标均优于Q2及Q3组(P＜0.05)。多元线性回归模型显示,肥胖儿童的HbA1c与肺功能指标FEF25、FEF50、FEF75和MMEF均呈负相关(β=-0.186、-0.201、-0.148、-0.182,P＜0.05)。ROC曲线分析结果表明,肥胖儿童的HbA1c≥5.8%时,其肺功能指标可能会显著受到影响。结论 重度肥胖儿童血清HbA1c水平更高,肥胖儿童HbA1c与多项肺功能指标呈线性负相关,高水平的HbA1c可能引起小气道功能受损。HbA1c与肺功能指标的多元回归模型在预测肥胖儿童肺功能指标方面具有良好的预测性能。
Abstract
Objective To explore the correlation between pulmonary ventilation function and glycated hemoglobin (HbA1c) in obese children, in order to provide a new perspective for the comprehensive management of obese children. Methods A total of 255 obese children who visited the pediatric outpatient clinic of Beijing Jishuitan Hospital from January 2019 to December 2022 were included. Height, weight, serum HbA1c levels, and pulmonary ventilation function were measured. HbA1c levels were divided into three groups (Q1, Q2, Q3) based on tertiles. Pulmonary function indicators were compared among the different HbA1c groups. Multiple linear regression analysis was used to construct a model for the relationship between HbA1c and pulmonary function indicators. Receiver operating characteristic (ROC) curves were plotted to evaluate the predictive value of the model for changes in pulmonary function. Results Among the participants, 142 cases (55.69%) were in the mild-to-moderate obesity group, and 113 cases (44.31%) were in the severe obesity group. The forced vital capacity (FVC) in the mild-to-moderate obesity group was significantly lower than that in the severe obesity group (t=2.541, P=0.012), while the FEV1/FVC ratio, FEV1/FVC%, and expiratory flow at 50% of vital capacity (FEF50) were higher in the mild-to-moderate obesity group (t=2.277, 2.215, 2.075, P＜0.05). HbA1c levels were lower in the mild-to-moderate obesity group compared to the severe obesity group (t=3.097, P<0.05). Significant differences were observed in FEV1/FVC, FEV1/FVC%, FEF25, FEF50, FEF75, and maximal mid-expiratory flow (MMEF) among the different HbA1c groups (F=7.813, 7.804, 6.493, 8.209, 6.193, 6.855, P<0.01). All pulmonary function indicators in the Q1 group were superior to those in the Q2 and Q3 groups (P<0.05). Multiple linear regression analysis showed that HbA1c in obese children was negatively correlated with pulmonary function indicators FEF25, FEF50, FEF75, and MMEF (β=-0.186,-0.201,-0.148,-0.182, P<0.05). ROC curve analysis indicated that when HbA1c levels in obese children were ≥5.8%, pulmonary function indicators might be significantly affected. Conclusions Severe obesity in children is associated with higher serum HbA1c levels. HbA1c in obese children is linearly and negatively correlated with multiple pulmonary function indicators, and elevated HbA1c levels may lead to impaired small airway function. The multiple regression model of HbA1c and pulmonary function indicators demonstrates good predictive performance for assessing changes in pulmonary function in obese children.
关键词
肥胖 /
肺功能 /
糖化血红蛋白 /
儿童
Key words
obesity /
pulmonary function /
glycosylated hemoglobin /
children
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] Jebeile H, Kelly AS, O′Malley G, et al. Obesity in children and adolescents: Epidemiology, causes, assessment, and management[J]. Lancet Diabetes Endo, 2022,10(5): 351-365.
[2] Yang G, Han Y, Forno E, et al. Glycated hemoglobin a1c, lung function, and hospitalizations among adults with asthma[J]. JACI: In Practice, 2020,8(10): 3409-3415.
[3] 李辉, 宗心南, 季成叶, 等. 中国2～18岁儿童青少年超重和肥胖筛查体重指数界值点的研究[J]. 中华流行病学杂志, 2010,31(6): 616-620.
Li H, Zong XN, Ji CY,et al. Body mass index cut-offs for overweight and obesity in Chinese children and adolescents aged 2-18 years[J].Chin J Epidemiol, 2010,31(6): 616-620.(in Chinese)
[4] Styne DM, Arslanian SA, Connor EL, et al. Pediatric obesity—assessment, treatment, and prevention: An endocrine society clinical practice guideline[J]. J Clin Endocrinol Metab, 2017,102(3): 709-757.
[5] 中华医学会儿科学分会呼吸学组肺功能协作组中华实用儿科临床杂志编辑委员会. 儿童肺功能系列指南(二):肺容积和通气功能[J]. 中华实用儿科临床杂志, 2016,31(10): 744-750.
Pulmonary Function Group, Respiratory Branch of Chinese Pediatric Society of Chinese Medical Association, Editorial Board of Chinese Journal of Applied Clinical Pediatrics. Series guidelines for pediatric pulmonary function (partⅡ): lung volume and spirometry[J].Chin J Appl Clin Pediatr, 2016,31(10): 744-750.(in Chinese)
[6] Lister NB, Baur LA, Felix JF, et al. Child and adolescent obesity[J]. Nat Rev Dis Primers, 2023,9(1): 24.
[7] Lobstein T, Jackson-Leach R. Planning for the worst: Estimates of obesity and comorbidities in school-age children in 2025[J]. Pediatr Obes, 2016,11(5): 321-325.
[8] Ferreira MS, Marson FAL, Wolf VLW, et al. Association between pulmonary function and body composition in children and adolescents with and without obesity[J]. J Clin Med, 2022,11(24): 7410.
[9] Engwa GA, Anye C, Nkeh-Chungag BN. Association between obesity and lung function in south african adolescents of African ancestry[J]. BMC Pediatr, 2022,22(1): 109.
[10] 刘艳冬,曲书强. 儿童肥胖与哮喘的相关性研究进展[J]. 中国儿童保健杂志,2018,26(11):1211-1213.
Liu YD,Qu SQ. Research progress on the correlation between childhood obesity and asthma[J].Chin J Child Health Care,2018,26(11):1211-1213.(in Chinese)
[11] Arismendi E, Bantula M, Perpina M, et al. Effects of obesity and asthma on lung function and airway dysanapsis in adults and children[J]. J Clin Med, 2020,9(11).
[12] Manuel S, Luis G. Nutrition, obesity and asthma inception in children. The role of lung function[J]. Nutrients, 2021,13(11): 3837.
[13] Yang C, Li S, Wu L, et al. Prevalence of prediabetes by the fasting plasma glucose and HbA1C screening criteria among the children and adolescents of shenzhen, china[J]. Front Endocrinol, 2024,15: 1301921.
[14] Hovestadt I, Kiess W, Lewien C, et al. Hba1c percentiles and the association betweenbmi, age, gender, puberty, and HbA1c levels in healthy german children and adolescents[J]. Pediatr Diabetes, 2022,23(2): 194-202.
[15] Ghaddar R, Hudson EA, Jeans MR, et al. Ethnicity/race, parent educational attainment, and obesity associated with prediabetes in children[J]. Nutr Diabetes, 2023,13(1): 15.
[16] Al-Mansoori L, Al-Jaber H, Prince MS, et al. Role of inflammatory cytokines, growth factors and adipokines in adipogenesis and insulin resistance[J]. Inflammation, 2022,45(1): 31-44.
[17] Sharma A, Sharma A, Chauhan R. Spirometric lung functions in type 2 diabetes mellitus: A hospital-based study[J]. Cureus,2023,15(5): e38919.
[18] Mohamad IL, Saad K, Abdel-Azeem A, et al. Evaluation of pulmonary function changes in children with type 1 diabetes mellitus in upper Egypt[J]. Ther Adv Endocrinol Metab,2015,6(3): 87-91.
[19] Mameli C, Ghezzi M, Mari A, et al. The diabetic lung: Insights into pulmonary changes in children and adolescents with type 1 diabetes[J]. Metabolites, 2021,11(2): 69.
[20] Zhang RH, Zhou JB, Cai YH, et al. Non-linear association between diabetes mellitus and pulmonary function: A population-based study[J]. Respir Res, 2020,21(1): 292.
基金
北京市医院管理局儿科学科协同发展中心儿科专项重点项目(XTZD20180401)
PDF(754 KB)
