肥胖类型与儿童脂肪细胞因子的关系

Relationship between Obesity Phenotypes and Adipocytokines in Children

目的探讨肥胖类型与儿童脂肪细胞因子水平的关系。方法以2004年北京市儿童青少年代谢综合征（BCAMS）调查总样本中3508例（男1788例,女1720例）6-18岁儿童为研究对象。结合体质量指数（BMI）和腰围（WC）将研究对象分为4组：外周型肥胖组226例,腹型肥胖组192例,复合型肥胖组1004例,非肥胖组2086例。采用酶联免疫吸附法（ELISA）检测研究对象空腹血浆胰岛素、血清瘦素、血清抵抗素和血清脂联素水平。采用协方差分析比较不同类型肥胖与非肥胖组间脂肪因子的差异;不同肥胖评价指标对脂肪因子的影响采用多元回归分析,不同类型肥胖预测脂肪因子异常的作用采用多因素Logistic回归分析。结果复合型肥胖组胰岛素、瘦素水平高于非肥胖组和其他肥胖类型,脂联素水平相反,抵抗素水平腹型肥胖组最高;在所有依据BMI诊断为肥胖的儿童中进行多元回归分析,标准偏回归系数（β）显示,空腹胰岛素[β（WC）=0.158 P〈0.001;β（BMI）=0.137 P〈0.01]、瘦素[β（WC）=0.243 P〈0.001;β（BMI）=0.109 P〈0.05]和脂联素[β（WC）=-0.106 P〈0.05;β（BMI）=0.023 P〉0.05],WC均比BMI作用大;而WC[β（WC）=-0.004 P〉0.05）和BMI[β（BMI）=0.075 P〉0.05]与抵抗素的关联均无统计学意义。按非肥胖、外周型肥胖、腹型肥胖和复合型肥胖组的顺序,胰岛素、瘦素和脂联素异常率呈现逐渐升高的趋势[趋势检验,χ2（胰岛素）=640.065 P〈0.001;χ^2（瘦素）=932.667 P〈0.001;χ^2（脂联素）=131.174 P〈0.001]。采用Logistic回归模型调整性别、年龄和青春发育期,以非肥胖组为参照,外周型肥胖、腹型肥胖和复合型肥胖预测高胰岛素血症的OR（95%CI）分别为3.46（2.44-4.91）、5.41（3.87-7.57）和10.10（8.26-12.35）;高瘦素血症OR（95%CI）为5.83（4.02-8.45）、7.07（4.97-10.05）和20.82（16.49-26.28）;低脂联素血症OR（95%CI）为1.47（1.05-2.07）、2.0（1.42-2.80）和2.66（2.23-3.18）。血清抵抗素则是腹型肥胖危险性最高,复合型肥胖次之。结论儿童脂肪细胞因子水平与肥胖类型相关,与腹型肥胖关系尤为密切。腹部内脏脂肪堆积可能是造成脂肪因子改变的主要原因之一。

Objective To explore the relationship between obesity phenotypes and adipocytokines in children. Methods Based on the Beijing child and adolescent metabolic syndrome （BCAMS） study,3 508 children （1 788 boys and 1 720 girls） aged 6 -18 were recruited. In this study,participants were categorized into four groups ：226 cases in general obese group, 192 cases in abdominal obese group, 1 004 cases in combined obese group and 2 086 cases in non -obese group, according to the sex, age, specific body mass index（BMI） , and waist circumference （WC） equal to or greater than the 90^th percentile for age and gender of school children in Beijing in 2004. The levels of plasma insulin, serum leptin, resistin and adiponectin were measured by sensitive, specific double -antibody sandwich enzyme -linked immunosorbent assays （ELISA）. Analysis of covarianee, multivariate linear regression and binary logistic regression analysis were performed. Results There were highest plasma insulin and serum leptin, and lowest adiponectin levels in combined obese group than those in other obese groups and non - obese group and resistin level in abdominal obese group was highest than those in other obese groups or non - obese group. Among subjects with general obesity and conbined obesity,WC was more important factor than BMI for plasma insulin[β（WC） = 0. 158 P 〈 0. 001; β（BMI） =0. 137 P 〈0.011 ,serum leptin[β（WC） =0. 243 P 〈0. 001 ;β（BMI） =0. 109 P 〈0.051 and serum adiponectin[β（WC） = -0. 106 P〈0.05;β（BMI） =0.023 P 〉0.051. With covaxiates adjusted,the odds ratios（OR）and 95% confidence intervals of general obesity, abdominal obesity and combined obesity were 3.46 （2.44 - 4.91 ）, 5.41 （ 3.87 - 7.57 ） and 10.10 （ 8.26 - 12.35 ） for predicting by_ perinsulinemia,respectively ,5.83 （4.02 - 8.45 ） ,7.07 （4.97 - 10.05 ） and 20.82 （ 16.49 - 26.28 ） for hyperleptinaemia, respectively, 1.47 （ 1.05 - 2.07 ） ,2.0 （ 1.42 - 2.80 ） and 2.66 （2.23 - 3.18 ） for hypoadiponectinaemia, respectively. Serum resistin was highest in abdominal obesity. Conclusion The levels of adipocytokines in children were correlated with the phenotypes of obesity, especially for abdominal obesity.