6～14岁超重/肥胖患儿的血25-羟维生素D_3水平与代谢综合征组分分析

Analysis of serum 25-hydroxyvitamin D_3 levels and metabolic syndrome components in overweight/obese children aged 6～14 years

目的探讨6～14岁超重/肥胖患儿的血清25-羟维生素D_3[25(OH)D_3]水平与代谢综合征及其各组分之间的相互关系。方法收集6～14岁超重/肥胖患儿共204例为肥胖组,同期正常对照141例为对照组,分别测量身高、体重、腰围、血压,抽取外周血检测空腹血糖(FPG)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL)、低密度脂蛋白胆固醇(LDL)、25(OH)D_3。并对其中126例肥胖患儿进一步查糖化血红蛋白,行口服葡萄糖耐量试验(OGTT),计算OGTT时间-血糖曲线下面积(AUC)。比较肥胖与对照两组间25(OH)D_3水平差异,寻找25(OH)D_3水平与各代谢指标间的关系。结果肥胖组的25(OH)D_3低于对照组,差异有统计学意义(t=-3.19,P<0.05)。血25(OH)D_3水平和年龄存在明显负相关(r=-0.19,P<0.05)。矫正性别年龄因素后,血25(OH)D_3水平和BMI标准差评分(BMI SDS)、腰围身高比(WHt)、AUC存在明显负相关(r分别=-0.16、-0.14、-0.19,P均<0.05),与HDL存在明显正相关(r=0.10,P<0.05)。矫正性别年龄BMI SDS后,25(OH)D_3水平和AUC值保持明显负相关(r=-0.19,P<0.05)。以25(OH)D_3高三分之一组为参照,25(OH)D_3低三分之一、中三分之一组患儿发生超重/肥胖的风险递减(OR分别=2.39、1.72,P均<0.05);发生血糖异常的风险递减(OR分别=3.91、1.59,P均<0.05);患代谢综合征的风险递减(OR分别=4.95、2.62,P均<0.05)。结论超重/肥胖患儿的血清25(OH)D_3水平与超重/肥胖程度呈负相关。维生素D水平偏低是机体糖代谢紊乱的一个危险因素。低维生素D水平儿童患代谢综合征风险明显升高,代谢综合征各组分综合分析的意义大于单个组分。

Objective To investigate the relationship between serum 25-hydroxyvitamin D3〔25(OH)D3〕level and metabolic syndrome(MS)as well as its components in overweight/obese children aged 6~14 years.Methods A total of 204 cases of overweight/obese children aged 6~14 years were collected as obese group,141 cases of normal weight in the same period were collected as control group.The height,weight,waist circumference and blood pressure were measured.The fasting blood glucose(FPG),triglyceride(TG),high density lipoprotein cholesterol(HDL),low density lipoprotein cholesterol(LDL)and 25(OH)D3 were detected in the peripheral blood.In addition,126 cases of obese children were further examined with glycosylated hemoglobin(HbA1c),and the oral glucose tolerance test(OGTT)was performed to calculate the area under the OGTT time-glucose curve(AUC).The differences of 25(OH)D3 levels between the two groups were compared,and the relationship between the 25(OH)D3 level and the metabolic parameters was analyzed.Results The 25(OH)D3 in obese group was lower than that in the control group(t=-3.19,P<0.05).The serum 25(OH)D3 level was negatively related to the age(r=-0.19,P<0.05).After adjusting for sex and age,the serum 25(OH)D3 level was negatively correlated with BMI SDS,WHt and AUC(r=-0.16,-0.14,-0.19,P<0.05),and positively correlated with HDL(r=0.10,P<0.05).After adjusting for sex,age and BMI SDS,there was a significant negative correlation between 25(OH)D3 level and AUC(r=-0.19,P<0.05).Referred to the higher tertile 25(OH)D3 group,the risk of overweight/obesity decreased from the lower tertile 25(OH)D3 group to the middle tertile 25(OH)D3 group(OR=2.39,1.72,P<0.05),as well as the risk of abnormal blood glucose(OR=3.91,1.59,P<0.05)and the risk of MS(OR=4.95,2.62,1.00,P<0.05).Conclusion The level of serum 25(OH)D3 is negatively correlated with the degree of overweight/obesity.Low vitamin D level is an independent risk factor for impaired glucose metabolism in the body.The risk of MS was significantly higher in children with low vitamin D level,and the significance of comprehensive analysis of MS components was greater than that of a single component.