补体C5a及肿瘤坏死因子α与肥胖儿童胰岛素抵抗的相关性分析

Analysis on the association of C5a and TNF-α with insulin resistance in obese children

目的通过观察儿童肥胖伴或不伴胰岛素抵抗临床指标及炎症因子的变化,探讨补体C5a及TNF-α与胰岛素抵抗的相关性。方法收集2014年9月-2016年9月在西安交通大学第二附属医院小儿内分泌门诊就诊的7~14岁未成年人,分为肥胖伴胰岛素抵抗组(n=60),肥胖不伴胰岛素抵抗组(n=46)和正常对照组(n=40)。测量体格数据、血脂、血糖、胰岛素、TNF-α和补体C5a,并分析临床指标与胰岛素抵抗指数HOMA-IR相关性。结果 BMI及腰围在肥胖两组均高于正常对照组(P<0.001);胰岛素抵抗组高于非胰岛素抵抗组(P<0.001)。甘油三酯、空腹血糖、胰岛素在胰岛素抵抗组高于无胰岛素抵抗组,HDL-C在胰岛素抵抗组低于无胰岛素抵抗组(P<0.001),而总胆固醇在三组间差异无统计学意义(P>0.05);肥胖组TNF-α、C5a均高于正常对照组(P<0.001),TNF-α在肥胖两组间差异无统计学意义(P=0.456)。C5a在肥胖伴胰岛素抵抗组高于肥胖不伴胰岛素抵抗组(P=0.034)。多元线性回归显示BMI(β=0.413)、腰围(β=0.234)、空腹血糖(β=0.268)、TNF-α(β=0.318)和C5a(β=0.400)与胰岛素抵抗显著正相关(P<0.05或<0.01)。结论炎性指标TNF-α、C5a与胰岛素抵抗指数密切相关。BMI、甘油三酯、空腹血糖、TNF-α和C5a是胰岛素抵抗的独立危险因素。

Objective To investigate the correlations of complement C5 a and tumor necrosis factor alpha(TNF-α) with insulin resistance by observing changes in clinical indicators of obese children with or without insulin resistance. Methods Children aged 7-14 years were enrolled in this study from the pediatric endocrine clinic of the Second Affiliated Hospital of Xi′an Jiaotong University from September 2014 to September 2016.All participants were divided into obesity with insulin resistance group(n=60),obesity with non-insulin resistance group(n=46) and control group(n=40).Physical data,levels of blood lipid,fasting blood glucose(FBG),insulin,TNF-α and complement C5 a were tested.And the correlation of HOMA-IR and clinical indicators were analyzed. Results Body mass index(BMI) and waist circumference were significantly higher in the obese group and the insulin resistance group compared with normal control group and non-insulin resistance group(P<0.001).Tri-glyceride(TG),FBG and insulin levels were significantly higher in insulin resistance group than those in non-insulin resistance group(P<0.001),and HDL-C level was lower in insulin resistance group(P<0.001).However,there was no significant difference on the level of total cholesterol(TC) among three groups(P>0.05).The levels of TNF-α and C5 a in the obesity group were significantly higher than those in the normal control group(P<0.001).Difference on TNF-α level between the two groups were not significant,while C5 a level was significantly higher in obesity with insulin resistance group than that in obesity without insulin resistance group(P=0.456).Multivariate regression analysis showed that BMI,waist circumference,FBG,TNF-α and C5 a levels were positively correlated with insulin resistance(β=0.413,0.234,0.268,0.318,0.400,P<0.05). Conclusions The inflammatory indicators like TNF-and C5 a levels are closely related to insulin resistance index.BMI,TG,FBG,TNF-α and C5 a levels may be independent risk factors for insulin resistance.