温州超重肥胖少年儿童临床表型分析

Clinical phenotypic analysis of overweight and obese adolesents in Wenzhou

目的分析温州市超重肥胖少年儿童的临床特征。方法本研究为病例对照横断面研究。入组对象来源于2012年1月—2014年12月在温州医科大学附属第二医院暨育英儿童医院体检中心体检的6—16岁的中小学生，研究对象分为肥胖组、超重组、正常组，分别记录性别、年龄、身高、体重，计算BMI，并检测肝脏B超、空腹血糖、空腹胰岛素、肝功能、肾功能、血脂，计算HOMA—IR、HOMA—B。结果共有312例少年儿童纳入研究，其中肥胖组109例，超重组89例，正常组114例。超重及肥胖少儿的谷丙转氨酶（AUF）、谷草转氨酶（AST）、谷氨酰转肽酶（GGT）高于体重正常少儿（P〈0．01及P〈0．05）；超重及肥胖少儿总胆固醇（TC）、甘油三酯（TO）、低密度脂蛋白胆固醇（LDL—C）均高于而高密度脂蛋白胆固醇（HDL—C）低于体重正常少儿（P均〈0．05）；肥胖少儿脂肪肝的患病状态高于超重和体重正常少儿（49％vs．0％，8％vs．0％，P均〈0．01）；超重及肥胖少儿的空腹胰岛素及胰岛素抵抗指数高于体重正常少儿（P均〈0．01）。结论超重肥胖少年儿童已经表现出明显的胰岛素抵抗特征，如转氨酶的升高，血脂异常，脂肪肝患病率明显升高。

Objective To analyze the clinical manifestations of overweight and obese children in Wenzhou. Methods Cross section and case-control study were conducted in this study. Total 312 students in primary and high schools who received physieal examination in our hospital between Jan. ,2012 and Dec. ,2014 were recrited and were divided into obesity group（ 109 cases） ,overweight group（ 89 caes）and normal weight group（ 114 cases）. The anthropometric data（ gender, age, height, weight）, BMI, B-scan liver images, fasting blood glucose, fasting insulin, liver function, renal function, blood lipids profile, HOMA-IR and HOMA-B were recorded and analyzed. Results As compared with normal weight group,the levels of glutamic-pyruvictransamiuase （ GPT）, glutamic-oxalacetictransaminease （GOT） and glutamyltranspeptidase （GGT） were significantly increased in overweight and obese group（ P ＇all 〈0.05 ）. The levels of total cholesterol（TC） ,triglyceride（TG） and low density lipoprotein cholesterin （LDL-C）were higher but high density lipoprotein cholestenn （HDL-C） were lower in overweight and obese group when compared with those in normal weight group（ P all 〈 0.05 ）. At＇cording to the uhtasoundresults ,the prevalence of non-alcoholic fatty liver（NAFLD） were 45% in obese group, which was higher than those in overweight（ 8% ）and notmal weight group （0%） ,P 〈 0.01, respectively. HOMA-IR was significantly higher in overweight and obese group when compared with those in normal weight group（ P 〈 0.01, respectively ）. Conclusion The overweight and obesity children have the characteristics of insulin resistance,include theincreased levels of transaminase, dyslipidemia, and increased prevalence of nonalcoholic fatty liver disease （NAFLD）.