儿童肥胖与脂质代谢紊乱

Relationship between Obesity and Dyslipidemia in Children

目的探讨儿童肥胖与脂质代谢紊乱的关系。方法回顾性分析我院肥胖病门诊7～18岁患儿283例,其中男性179例、女性104例。测量体重、身高、腰围及臀围,酶比色法测定空腹血清总甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)和低密度脂蛋白胆固醇(LDL-C)水平。结果283例患儿超重15例、肥胖268例。147例血脂水平异常,其中1项异常100例、2项异常34例、3项异常和4项全部异常分别为11和2例。TG升高131例、TC升高42例、HDL-C降低和LDL-C升高分别为20和17例。校正年龄和性别后,体质指数(BMI)仅与血清TG水平呈显著正相关(r=0.13,P<0.05)。腰围不仅与血清TG水平呈显著正相关(r=0.21,P<0.01),也与血清HDL-C呈显著负相关(r=-0.14,P<0.05)。腰围与血脂紊乱的程度呈正相关(r=0.17,P<0.01)。以同龄同性别腰围95th百分位值为标准,将283例患儿分为腰围正常组和腰围异常组,则腰围异常组患儿血清TG显著增高(P<0.01),而HDL-C水平显著降低(P<0.05)。结论肥胖儿童脂质代谢紊乱以血清TG和TC升高为主。与BMI相比,腰围与脂质代谢紊乱的关系更密切。同龄同性别腰围95th百分位值可作为诊断儿童腰围正常与否的临界点。

Objective To evaluate the relationship between obesity and dyslipidemia in children. Methods Totally 283 overweight or obese children aged 7 - 18 years （ 179 boys and 104 girls） were recruited from our obesity out-patient service. Body weight, height, and waist and hip circumference were measured. Serum fast total triglyceride （TG）, total cholesterol （TC）, high-density lipoprotein cholesterol （HDL-C）, and low-density lipoprotein cholesterol （LDL-C） were measured. Results Among these 283 children, 15 children were overweight and 268 children were obese. Also 147 of 283 children were diagnosed with dyslipidemia. The numbers of children with one, two, three, or four abnormal lipid index were 100, 34, 11, and 2, respectively. TG elevated in 131 children and TC elevated in 42 children. In addition, LDL-C increased in 17 children, while HDL-C decreased in 20 children. After having been adjusted for age and gender, a positive correlation between body mass index and serum TG （ r = 0. 13, P 〈 0.05 ） was observed. Waist circumference had not only a positive correlation with serum TG （r =0. 21, P 〈0. 01 ）, but also a negative correlation with serum HDL-C （r = - 0. 14, P 〈0.05 ）. Waist circumference also showed a positive correlation with the level of dsylipidemia （r = 0. 17, P 〈 0. 01 ）. According to 95^th percentile of age and gender-specific waist circumference, 283 children were divided into two groups： normal waist circumference group and abnormal waist circumference group. Serum TG was higher （ P 〈 0.01 ） while HDL-C was lower （ P 〈 0. 05 ） in abnormal waist circumference children compared with children with normal waist circumference. Conclusions Dyslipidemia is common in obese children. Increase of serum TG and TC accounts for the majority of dyslipidemia among this population. Waist circumference is a better predictor index for dyslipidemia than body mass index. The 95^th percentile of age and gender-specific waist circumference can be a cutoff point.