儿童和青少年胰岛素抵抗影响因素的研究

A study on the factors influencing insulin resistance in children and adolescents

目的 探讨不同营养状况儿童青春期发育中胰岛素抵抗的影响因素。方法 筛选7～ 17岁单纯性肥胖儿童和青少年 30 0人 ,男女各半 ,并根据性别、身高 (± 2cm)和年龄 (± 3个月 )进行配比 ,选择正常组和营养不良组各 30 0人 ,测定空腹血清瘦素、胰岛素、血糖、胆固醇、甘油三酯、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇水平。结果 两性肥胖组各期 (男性TannerⅠ期和女性TannerⅡ期除外 )胰岛素水平均显著高于正常组和营养不良组 ,两性肥胖组各期瘦素水平均高于正常组 ,正常组均高于营养不良组。肥胖组甘油三酯水平为 (1 5 3± 0 13)mmol/L ,显著高于正常组的 (1 12±0 10 )mmol/L和营养不良组的 (1 0 3± 0 0 9)mmol/L。 3组的血糖和其他血脂水平的差异无显著性。伴随青春期发育胰岛素敏感性下降 ,胰岛素敏感指数与Tanner分期和瘦素均呈负相关。结论 在 7～ 17岁人群中 ,肥胖、血清瘦素水平和青春期发育是胰岛素抵抗的独立影响因素。

Objective To explore the factors influencing insulin resistance in children with different nutritional status during pubertal development. Methods Three hundred children with simple obese aged 7 to 17 years,and 300 normal healthy children and 300 children with malnutrition,matched for age (±3 months) and height (±2 cm),were selected. Fasting serum levels of leptin,insulin,glucose,total cholesterol (TC),triglycerides (TG),low density lipoprotein-cholesterol (LDL-C) and high density lipoprotein-cholesterol (HDL-C) were measured for them. Results Levels of fasting serum insulin in obese children,except for boys at Tanner stage I and girls at Tanner stage II,were higher than those in normal and malnutrition children( P <0.01). Average serum level of leptin in obese boys and girls at varied Tanner stages was higher than that in normal children,and higher in normal children than that in children with malnutrution ( P <0.01). Serum level of TG in obese children [(1.53±0.13) mmol/L] was higher than that in normal ones [(1.12±0.10) mmol/L] and in children with malnutrition [(1.03±0.09) mmol/L]. There was no significant difference in levels of fasting blood glucose and other blood lipids between the three groups of children. Insulin sensitivity decreased with pubertal development and its index reversely correlated with Tanner stage and serum level of leptin ( r =-0.27 and -0.36,respectively,P <0.01). Conclusion Obesity (BMI),serum level of leptin and pubertal development were independent risk factors for insulin resistance in children aged 7 to 17 years.