北京地区儿童青少年胰岛素抵抗分布及其与瘦素／脂联素比值的关系

Distribution of homeostasis model assessment of insulin resistance and its correlation with leptin/ adiponectin ratio among children and adolescents in Beijing

目的研究北京儿童青少年胰岛素抵抗指数的分布，探讨血液瘦素／月旨联素比值（LEP／APN）对儿童胰岛素抵抗状态的诊断价值。方法选取北京地区6—18岁儿童青少年代谢综合征研究队列的3506名儿童青少年，以中国肥胖问题工作组2004年制定的中国学龄儿童青少年超重、肥胖筛查体质指数（BMI）分类标准将研究对象分为正常体重人群（1628人）、超重人群（659人）和肥胖人群（1219人），进行体量指标和青春发育程度的评价以及测定空腹血糖、血脂、真胰岛素、LEP和APN等。以稳态模型胰岛素抵抗指数（HOMA—IR）评价胰岛素抵抗状态。在健康儿童青少年中，按HOMA—IR百分位分布确定评价儿童青少年胰岛素抵抗界值。采用相关和回归分析评价LEP／APN与HOMA—IR的相关性，受试者工作特征曲线（ROC曲线）探讨LEP／APN对儿童胰岛素抵抗状态的诊断价值。结果尝试建立北京地区健康儿童青少年胰岛素抵抗界值：青春发育前期HOMA—IR≥2．6；青春发育期HOMA—IR≥3．4。超重和肥胖儿童胰岛素抵抗检出率分别为22．2％和42．9％。相关分析显示LEP／APN与HOMA—IR相关（相关系数为0．51，偏相关系数为0．40，P〈0．01）。多元线性回归分析提示LEP／APN独立于其他因素对HOMA—IR的影响最大（偏回归系数0．273，标准化偏回归系数为0．467，P〈0．01）。ROC曲线分析显示LEP／APN对胰岛素抵抗预测能力高于LEP、APN和评价肥胖的体量指标（如腰围、BMI和体脂率）。结论评价儿童青少年胰岛素抵抗需考虑青春发育状况，超重和肥胖儿童存在明显胰岛素抵抗。LEP／APN可作为一项反映儿童青少年胰岛素抵抗的新指标，对肥胖相关代谢紊乱的预测具有参考价值。

Objective To analysis the distribution of HOMA-IR, and explore the diagnostic value of leptin/adiponectin ratio （LEP/APN） on insulin sensitivity in Beijing children and adolescents. Methods A total of 3506 schoolchildren, selected from the Beijing Child and Adolescent Metabolic Syndrome Study （ BCAM study） ,were included in the current study, among them 659 were overweight and 1219 were obese. Age- and sex-specific body mass index （BMI） percentiles, developed by the Working Group for Obesity in China, were used to classify participants as normal weight （BMI 〈 85% ）, overweight （BMI i〉85% but 〈 95% ）, or obese （BMI I〉 95% ）. Examination included anthropometry, pubertal development, and levels of fasting lipid profile, insulin, LEP and APN. Insulin resistance （IR） was evaluated by HOMA-IR. Correlation analysis and receiver operating characteristic curve （ROC） were used in the statistical analysis. Results According to the distribution of HOMA-IR in healthy children and adolescents, the cutoff value for IR was I〉2.6 in pre-pubertal stage and 1〉3.4 in pubertal phase, respectively. The prevalence of IR was 22. 2% and 42. 9% respectively in overweight and obese children and adolescences. The LEP/APN ratio was progressively increased from normal group to overweight group and to obesity group, and correlated with HOMA-IR significantly （ Pearson correlation coefficient was 0. 51 and partial correlation coefficient was 0. 40）. After adjusting for age, sex, puberty and other confounding factors, the LEP/APN ratio is an independent predicator for HOMA-IR by multivariate linear regression analysis （ unstandardized coefficient was 0. 273 and standardized coefficient was 0. 467, P 〈 0. 01 ）. Area under the ROC curve of LEP/APN ratio for diagnosing of IR was larger than those of LEP, APN, BMI, waist circumference and FAT%. Conclusions Evaluation of IR needs to consider puberty status and prevalence of IR is obvious in overweight and obese children and adolescents. The LEP/APN ratio is expected to be early biomarker of IR state, and an early potent predicator of metabolic disorders.