儿童肥胖与代谢综合征及胰岛素抵抗的关系

Relationship between obesity,metabolic syndrome and insulin resistance in children

【目的】研究儿童肥胖与代谢综合征(metabolic syndrome,MS)组分及胰岛素抵抗的关系。【方法】选择本院儿科门诊筛选的46例肥胖儿童患者[年龄(12.6±2.1)岁]为研究对象,51例正常体重儿童[年龄(12.5±1.9)岁]作为对照组,比较两组的临床特征及MS组分的差异,并分析胰岛素抵抗的影响因素。【结果】1)肥胖组儿童的体质指数(body mass index,BMI)、腰围(waist circumference,WC)、血糖、血压、血脂水平(包括总胆固醇、甘油三酯、低密度脂蛋白、非高密度脂蛋白)及胰岛素抵抗程度均明显高于对照组,而高密度脂蛋白(high-density lipoprotein cholesterol,HDL-c)明显低于对照组(均P<0.05);2)肥胖组中高血压儿童7例(15.2%),高甘油三酯(TG)血症14例(30.4%),低HDL-c或高非HDL-c血症2例(4.3%),血糖异常3例(6.5%),可诊断为MS的儿童有8例(17.4%),而正常对照组仅2例TG增高(3.9%);3)多元逐步回归显示WC(标准化β=0.432,P<0.01)及TG(标准化β=0.207,P<0.05)为胰岛素抵抗的独立影响因素。【结论】肥胖儿童易存在不同程度的代谢异常,更易患代谢综合征。腰围及甘油三酯为胰岛素抵抗的独立影响因素。

[Objective] To investigate the relationship between obesity,the components of metabolic syndrome（MS）, and insulin resistance in children. [Methods] Forty six obese children aged 12.6±2, 1 years were selected from pediatrics outpatient clinic as subjects,and another 51 children with normal weight aged 12.5±1.9 years were enrolled as controls. Clinical characteristics and the components of MS were compared between the two groups,and the influencing factors of insulin resistance were evaluated. [Results] 1） Compared with normal weight children,obese children had significantly higher body mass index（BMI）, waist circumference（WC）,glucose levels, blood pressure,lipid profile including total cholesterol, triglyceride,low density lipoprotein cholesterol, and non high-density lipoprotein cholesterol, as well as insulin resist ance（ HOMA-IR）, but lower high-density lipoprotein cholesterol （HDL-c） （all P 〈 0.05）. 2） In obese group, 7 children （15.2%） had hypertension, 14（30.4%） had hypertriglyceridemia,2（4.3%） had low HDL-c or high non-HDL-c,3（6.5%） had hyperglycemia, and 8 （ 17.4%） was diagnosed as MS;while only 2 children with normal weight （3.9% ） had hypertriglyc eridemia. 3） Multiple regression analysis showed that WC（standardized β=0. 432, P〈0. 05） and TG（standardized β= 0. 207,P〈0.05） were independently correlated with HOMA-IR. [Conclusions] Obese children are prone to suffer more different metabolic disorders and MS. WC and TG are independently correlated with insulin resistance.