北京地区超重及肥胖儿童脂代谢异常与血清视黄醇结合蛋白4水平的关系

Association between retinol-binding protein 4 levels and dyslipidemia in overweight and obese children and adolescents

目的分析血清视黄醇结合蛋白4(RBP4)水平与肥胖的相关性,探讨RBP4在儿童肥胖相关高脂血症中的作用。方法招募来自2004年入组北京儿童青少年代谢综合征队列(BCAMS)的1875名6~18岁的超重肥胖儿童青少年。测定RBP4、甘油三酯(TG)、总胆固醇(TC)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)和稳态模型评估胰岛素抵抗指数(HOMA-IR)等指标。脂代谢异常包含以下一项或以上:TC≥5.18 mmol/L;TG≥1.70 mmol/L;LDL-C≥3.37 mmol/L;HDL-C≤l.04 mmol/L。采用偏相关分析法分析RBP4水平与血脂等代谢指标的相关性。采用多因素logistic回归分析法分析RBP4水平与高脂血症的相关性。结果本研究人群中,超重肥胖儿童脂代谢异常的检出率为34.5%(647/1875)。肥胖相关脂代谢异常的患儿血清RBP4水平显著升高[36.65(30.63,44.08)比33.24(28.42,39.98)μg/ml,P<0.01]。RBP4与体质指数(BMI)、TG、TC、LDL-C和HOMA-IR均呈显著正相关(r值分别为0.079、0.216、0.192、0.180、0.135,均P<0.01),与HDL-C无相关性(P>0.05)。相对RBP4水平处于最低四分位的超重肥胖儿童,RBP4处于最高四分位的儿童出现脂代谢异常[比值比(95%可信区间)为2.05(1.53~2.75),P<0.01]、高TG血症[比值比(95%可信区间)为3.22(2.10~4.95),P<0.01]、高TC血症[比值比(95%可信区间)为2.34(1.36~4.02),P<0.01]及高LDL-C[比值比(95%可信区间)为2.51(1.65~3.83),P<0.01]的风险明显增加。进一步校正BMI及HOMA-IR,RBP4与血脂异常仍具有相关性(均P<0.01)。结论RBP4水平增加与肥胖儿童血脂异常密切相关,有望成为血脂异常潜在的早期生物标志物和干预靶点。

Objective To investigate the associations between retinol-binding protein 4 (RBP4) levels and dyslipidemia in Chinese children and adolescents with overweight and obesity.Methods A total of 1 875 overweight and obese children aged 6-18 years were recruited from the Beijing Child and Adolescent Metabolic Syndrome (BCAMS) study in 2004. Levels of RBP4, triglyceride (TG), total cholesterol (TC), high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), and homeostasis model assessment of insulin resistance (HOMA-IR) were measured. Dyslipidemia was defined by the presence of anyone of the following: TC≥5.18 mmol/L;TG≥1.70 mmol/L;LDL-C≥3.37 mmol/L;HDL-C≤1.04 mmol/L. Correlations between RBP4 and metabolic features including lipid profiles were examined by partial correlation analysis. Logistic regression models were used to anaylze the association between RBP4 and dyslipidemia.Results Among children with overweight and obesity, 34.5% (647/1 875) had dyslipidemia. RBP4 levels were elevated in overweight and obese children with dyslipidemia, compared with those without dyslipidemia [36.65(30.63,44.08) vs 33.24(28.42,39.98)μg/ml,P<0.01]. RBP4 levels were positively associated with body mass index (BMI), TG, TC, LDL-C and HOMA-IR levels (r=0.079, 0.216, 0.192, 0.180, 0.135, respectively;all P<0.01), but not with HDL-C levels (P>0.05). In addition, participants in the highest RBP4 quartile were more likely to have dyslipidemia [odds ratios (95% confidence interval) was 2.05 (1.53-2.75), P<0.01], hypertriglyceridemia [3.22 (2.10-4.95), P<0.01], hypercholesteremia [2.34 (1.36-4.02), P<0.01] and elevated LDL-C levels [2.51 (1.65-3.83), P<0.01] than those in the lowest quartile. Further adjustment for BMI and HOMA-IR didn′t modify the associations of RBP4 with lipid disorders (all P<0.01).Conclusion Increment of RBP4 level may be associated with dyslipidemia in obese children and might be a potential early biomarker and therapy target for dyslipidemia.