儿童肥胖代谢综合征血促肾上腺皮质激素及皮质醇变化分析

Analysis of serum ACTH and cortisol levels in children with metabolic syndrome

目的通过观察代谢综合征(MS)患儿血促肾上腺皮质激素(ACTH)、皮质醇(COR)变化及其与MS相关指标的相关性,探讨垂体及肾上腺皮质功能在儿童MS发病机制中的意义。方法选取门诊确诊肥胖儿童263例,根据腰围、血压、血脂及血糖等指标将患儿分为MS组101例及非MS组162例,进行人体参数测量并收集临床基本资料,测定身高、体质量、腰围、血压、血ACTH、COR、空腹血糖(FPG)、空腹胰岛素(FINS)、血脂等指标,计算体质指数(BMI)、胰岛素抵抗指数(HOMA-IR)等,对上述资料进行统计学分析。结果 MS组患儿的体质量、腰围、收缩压、舒张压、血FINS、HOMA-IR、三酰甘油(TG)、ACTH、COR高于非MS组,差异具有统计学意义(P均<0.05);MS组患儿血高密度脂蛋白胆固酮(HDL-C)低于非MS组,差异具有统计学意义(P均<0.05);MS组患儿血ACTH与腰围、收缩压、舒张压、HOMA-IR和MS组分数(nMSc)呈正相关(P均<0.01),血COR与腰围、收缩压、舒张压和nMSc呈正相关(P均<0.05),与血HDL-C呈负相关(P<0.05)。结论 MS儿童血ACTH及COR增高,血ACTH及COR与腰围、血压、血HDL-C、HOMA-IR和nMSc等相关,下丘脑—垂体—肾上腺皮质功能改变可能是儿童MS的发病机制之一。

Objective To observe changes of serum adrenocorticotropic hormone（ACTH）and cortisol（COR）in children with metabolic syndrome（MS）,to analyze the relationship between these serum levels and metabolic syndrome,and to explore the significance of pituitary and adrenal functions in the pathogenesis of MS in children.Methods Two hundred and sixty-three obese children were recruited in the study.They were divided into MS group（n = 101）and non-MS group（n = 162）according to waist circumference,blood pressure,blood lipid,blood glucose and other indexes.The body parameters were measured and clinical data were collected.The height,weight,waist circumference,blood pressure,serum ACTH,COR,fasting plasma glucose（FPG）,fasting insulin（FINS）levels,blood lipids were measured,body mass index（BMI）,insulin resistance index（HOMA-IR）were calculated,and statistical analyses were made.Results Weight,waist circumference,systolic and diastolic blood pressure,blood FINS,HOMA-IR,TG,ACTH,COR levels were significantly higher in MS group than those in non-MS group.In MS group,serum ACTH concentration was positively correlated with waist circumference,systolic and diastolic blood pressure,HOMA-IR,and nMSc.Serum COR concentration was positively correlated with waist circumference,blood systolic and diastolic blood pressure,and nMSc,while it was negatively correlated with blood HDL-C level.Conclusions Serum ACTH and COR levels were elevated in MS children.Serum ACTH and COR levels correlated with waist circumference,blood pressure,blood HDL-C level,HOMA-IR,and nMSc.Change of hypothalamus-pituitary-adrenal function may be one of the mechanisms of MS in children.