瘦素脂联素比值在儿童青少年代谢综合征中的诊断价值

Diagnostic significance of leptin/adiponectin ratio in metabolic syndrome of Chinese children and adolescents

目的探讨血清瘦素（LEP）／）脂联素（APN）（L／A）比值对儿童代谢综合征（MS）的诊断价值。方法回顾性分析2004年北京市儿童青少年MS（BcAMs）调查总样本中3520例6—18岁Ms患儿资料。MS采用2007年国际糖尿病联盟（IDF）制定的变量标准为参照，根据自行的工作定义进行诊断。酶联免疫吸附法（ELISA）测定血清LEP和APN水平，采用受试者工作特征曲线（ROC）下面积来探讨L／A对儿童MS的诊断价值。多组间比较采用方差分析和卡方检验，Pearson相关分析L／A与MS各组分之间的相关性。结果（1）随着L／A值逐渐增大，儿童青少年体质指数、血压、中心性肥胖及胰岛素抵抗的比例呈进行性升高，Ms检出率越高（x^2值：男：108．63；女：94．30，均P〈0．01）；（2）男童中UA值ROC曲线下面积（AUC=0．803）大于LEP（AUC=0．771）及APN曲线下面积（AUC=0．703，均P〈0．05）；女童中uA值ROC曲线下面积（huc=0．838）略高于LEP曲线下面积（AUC=0．817，P=0．0785），但两者均大于APN曲线下面积（AUC=0．717，均P〈O．05）。结论LJ／A值较单独LEP、APN更能反映儿童代谢情况。可作为一项辅助诊断儿童青少年MS的新指标。

Objective To investigate the correlation between serum leptin （LEP）/adiponectin （APN） （L/A） ratio and metabolic syndrome （MS） in children and adolescents. Methods Total of 3 520 children and adolescents between 6 and 18 years of age were selected from the subjects that had been recruited for 2004 survey conducted by Beijing Children and Adolescent MS （BCAMS） study. Adjusted criteria issued by International Diabetes Federation （IDF） in 2007 were used to establish a diagnosis of MS. Enzyme-linked immunosorbent assay （ELISA） was used to determine serum leptin and adiponectin levels. Areas under the receiver operating characteristi c curve （ROC） were also examined to determine the diagnostic value of L/A in the diagnosis of MS in children.Multiple comparisons were made between groups using analysis of variance （ANOVA） and the chi-square test. Pearson correlation analysis was performed to determine the correlation between L/A values and various components of MS. Results （1） As the L/A value increased, body mass index （BMI）, blood pressure （BP）, central obesity （C0%） and insulin resistance （IR%） increased progressively, as did, MS detection rate （MS%） increased （x^2 =male： 108.63;female：94.30） （all P〈 0.01）. （2） L/A ratio area under curve （AUC） of ROC （AUC=0.803） in boys was higher than leption （AUC= 0.771） and adiponectin （AUC=0.703, all P〈0.05）.L/A ratio AUC of ROC （AUC=0.838） in girls was higher than leptin （AUC=0.817, P=0.0785）. L/A ratio and leptin AUC of ROC are higher than adiponectin （AUC= 0.717, all P〈0.05）. Conclusions L/A is a better marker for the diagnosis of MS in Children better than leptin and adiponectin alone. L/A could be used as an indicator for MS in children and adolescents, and played an auxiliary role in the diagnosis of obesity-related MS in children.