肥胖儿童糖化血红蛋白与心血管危险因素和代谢综合征发病的关系

Relationship between HbA1c and cardiovascular disease risk factors and morbidity of metabolic syndrome in obese children

目的探讨肥胖儿童糖化血红蛋白（HbA1c）水平与心血管疾病危险因素和代谢综合征（MS）发病的关系。方法根据HbA1c水平将209例肥胖儿童分为Ⅰ组（HbA1c≥5.7%）122例,Ⅱ组（HbA1c〈5.7%）87例;选取89名正常体质量儿童为Ⅲ组（对照组）。比较三组儿童的各项代谢和心血管指标及两组肥胖儿童间MS检出率。观察HbA1c水平与各心血管疾病危险因素的相关程度。采用受试者工作特征曲线（ROC）观察以HbA1c为筛查标准诊断MS的最佳切点。结果Ⅰ组体质指数（BMI）、腰围（WC）高于Ⅱ组、Ⅲ组,高密度脂蛋白胆固醇（HDL-C）浓度低于Ⅱ组、Ⅲ组,差异均有统计学意义（P均〈0.05）;I组空腹胰岛素（FINS）、口服糖耐量试验（OGTT）0.5 h及1 h血糖浓度、胰岛素抵抗指数（HOMA-IR）高于Ⅱ组,胰岛素敏感指数（HOMA-IS）低于Ⅱ组,差异有统计学意义（P均〈0.05）。I组收缩压（SBP）、舒张压（DBP）、胆固醇（TC）和低密度脂蛋白胆固醇（LDL-C）浓度高于Ⅲ组,差异均有统计学意义（P均〈0.01）。Ⅱ组BMI、WC、SBP、DBP、TC和LDL-C浓度高于Ⅲ组,HDL-C浓度低于Ⅲ组,差异均有统计学意义（P均〈0.01）。Spearman相关分析提示,HbA1c水平与BMI、WC、FINS、FPG、OGTT 0.5 h、1 h、2 h血糖、TC、LDL-C、SBP、DBP、HOMA-IR呈正相关;与HDL-C水平呈负相关。Ⅰ组、Ⅱ组检出MS分别为47.54%、29.88%,差异有统计学意义（P=0.010）。HbA1c≥5.7作为筛查标准诊断MS的敏感性为56.71%,特异性为76.44%,ROC曲线下面积为0.69（95%CI 0.61~0.76,P〈0.000）。结论肥胖患儿HbA1c水平与心血管危险因素密切相关,需注意HbA1c监测调控。

Objective To study the relationship between HbA1c and cardiovascular disease（CVD） risk factors and morbidity of metabolic syndrome（MS） in obese children.Methods According to the HbA1c level,209 obese children were divided into two groups： group I（n=122,HbA1c≥5.7） and group II（n=87,HbA1c5.7%）.89 normal weight subjects were selected as group III（control group）.The metabolism and cardiovascular index were compared among three groups.The prevalence of MS was compared between group I and II.The correlation between HbA1c and other known CVD risk factors were analyzed.Receiver-operating characteristic（ROC） curves were constructed to identify the cut point of HbA1c with maximum accuracy for determining MS.Results Body mass index（BMI） and waist circumference（WC） were higher and high density lipoprotein-cholesterol（HDL-C） level was lower in group I than in the other groups（P0.05）.FINS,0.5 h and 1 h glucose during OGTT and HOMA-IR were higher and HOMA-IS was lower in group I than in group II（P0.05）.Systolic blood pressure（SBP）,diastolic blood pressure（DBP）,total cholesterol（TC） and low density lipoprotein-cholesterol（LDL-C） were higher in group I than in group III（P0.01）.BMI,WC,SBP,DBP,TC and LDL-C were higher and HDL-C lower in group II than in group III（P0.01）.The HbA1c concentration was positively correlated with BMI,WC,FINS,FPG,0.5 h,1 h,2 h glucose during OGTT,TC,LDL-C,SBP,DBP and HOMA-IR（P0.01）,and negatively correlated with HDL-C（P0.01）.The prevalence of MS in group I and II were respectively 47.54% and 29.88%（P=0.010）.ROC analysis revealed that an HbA1c cut point of 5.7% had maximum accuracy in determining metabolic syndrome.Conclusions It suggests that obese children with increased HbA1c levels had more serious cardiovascular disease（CVD） risk.HbA1c in obese children may be used as an indicator of metabolic alterations that could develop into CVDs.More attention should be paid to manage HbA1c appropriately.