肥胖及伴非酒精性脂肪肝病儿童血清脂联素与代谢综合征的相关性

Association of Serum Adiponectin and Metabolic Syndrome in Children with Obesity and Nonalcoholic Fatty Liver Disease

目的研究肥胖及伴非酒精性脂肪肝病(NAFLD)儿童、青少年的血脂代谢特征及血清脂联素水平与代谢综合征(MS)的关系。方法采用典型整群抽样方法选取北京市海淀区中等水平的4所小学和4所中学的7～18岁儿童及青少年,在知情同意的前提下,进行问卷、身体测量、腹部B超脂肪肝检查及血生化检测。从中选取各项调查资料完整的609例作为研究对象,其中单纯肥胖儿童280例,肥胖伴NAFLD儿童65例(肥胖伴NAFLD组),正常体质量儿童264例作为健康对照组。经统计分析,正态分布测量数据以x-±s表示;血清三酰甘油(TG)、脂联素、ALT和AST生化指标呈偏态分布,以几何均数和四分位间距(P25～P75)表示,经自然对数转化为正态分布后进行分析。采用方差分析、Logistic回归分析等。结果肥胖组及肥胖伴NAFLD组体质量指数(BMI)及腰围(WC)显著高于健康对照组,3组间差异有统计学意义(P<0.001);3组儿童的空腹血浆葡萄糖、血脂、脂联素及转氨酶水平比较差异均有显著统计学意义;肥胖伴NAFLD组儿童的ALT、AST明显升高;控制可能的影响因素年龄、性别后进行多因素Logistic回归分析显示,与单纯肥胖组比较,肥胖伴NAFLD组MS及组分高TG、高血压的检出率明显增加,罹患MS的相对风险增加尤为显著(P<0.001)。结论肥胖及肥胖伴NAFLD对儿童、青少年的肝功能和血脂代谢均造成危害,其血清脂联素水平随肥胖程度的增加而降低,脂联素作为胰岛素的增敏激素,连接脂肪组织和整体糖代谢,脂联素可作为MS的评估指标之一。

Objective To investigate the relationship between serum adiponectin and metabolic syndrome（MS） in children and adolescents with obesity and nonalcoholic fatty liver disease （NAFLD）. Methods Four elementary schools and 4 middle schools were selected from Haidian district in Beijing with representative cluster sampling. Two hundred and eighty obese children（ obese group） ,65 obese children with NAFLD（ NAFLD group） and 264 normal weight children （healthy control group） aged 7 to 18 years were recruited from the 8 schools with uncompletely randomized sampling. Data including questionnaire, anthropometric measurements, B type uhrasonographic examination for liver were collected and fasting blood laboratory assay were determined. Variables including triglyceride（ TG）, adiponectin, alanine aminotransferase （ALT） and aspartate aminotransferase（AST） were skewed distribution and natural logarithmical transformations were performed. Chi-square test for category and multiple binary Logistic regression analysis were used to statistical analysis. Results Body mass index （BMI） and waist circumference（WC） in obese group and NAFLD group were higher than those in healthy control group. All the chi -square tests for trend among the 3 groups were statistically significant （P 〈 0. 001 ）. As the degree of obesity increasing, children had more adverse lipid profiles, higher fasting plasma glucose, higher aminotransferase and lower adiponectin in the 2 obese groups than controls. All the chi - square tests for trend among the 3 groups were statistically significant. All the prevalence rates of MS, high TG and high blood pressure were higher in NAFLD group than those in obese group after adjustment for sex, age in multiple binary Logistic regression analysis. The relative risk of MS was especially significant（ P 〈 0. 001 ）. Conclusions Dyslipidmias and liver fuction disturbance are more serious in obese and obese with NAFLD schoolchildren than those in schoolchildren with normal weight. As the degree of obesity increasing,children have lower serum adiponectin level. Adiponectin is as similarity as increased factor of insulin. It is linked to fatty organization and whole glucose regulation. Adiponectin may be as a target of evaluating MS.