甘油三酯与高密度脂蛋白-胆固醇比值在预测儿童代谢综合征中的意义

Significance of triglyceride to high-density lipoprotein ratio in predicting childhood metabolic syndrome

目的:探讨甘油三酯与高密度脂蛋白-胆固醇比值(TG/HDL-C)和稳态模型评估-胰岛素抵抗指数(HOMA-IR)在儿童代谢综合征(MS)中的预测价值。方法:收集自2015年1月—2019年12月在天津医科大学总医院儿科诊断为肥胖的儿童203例,测量血压、腰围,于次日空腹行口服葡萄糖耐量试验(OGTT)并检测HbA1c、血脂等。按照儿童青少年肥胖MS的诊断标准,分为MS组67例,对照组(非MS组)136例。根据OGTT计算HOMA-IR、松田指数、稳态模型评估-胰岛β细胞功能指数(HOMA-β)、早期胰岛素分泌指数(ΔI30/ΔG30)、血糖曲线下面积(血糖-AUC)、胰岛素曲线下面积(胰岛素-AUC),利用受试者工作特征(ROC)曲线评价TG/HDL-C和HOMA-IR的特异性和灵敏性,以及两项指标联合预测与单独预测之间是否存在统计学差异。结果:与非MS组相比,MS组TG/HDL-C比值(Z=-8.441,P=0.000)、HOMA-IR(Z=-4.476,P=0.000)升高。当TG/HDL-C>1.31时,其预测MS的敏感性为86.6%,特异性为84.6%。当HOMA-IR>7.08时,预测MS的敏感性为53.7%,特异性为77.9%。相较于单独应用HOMA-IR诊断MS,TG/HDL-C单独诊断MS(Z=3.425,P=0.0006),以及TG/HDL-C联合HOMA-IR诊断MS(Z=4.481,P<0.0001)更具敏感性。而单独应用TG/HDL-C与TG/HDL-C联合HOMA-IR诊断MS相比时,两者间差异无显著统计学意义。结论:TG/HDL-C单独或者TG/HDL-C联合HOMA-IR,可作为MS的一个良好预测指标。

Objective:To investigate the predictive value of triglyceride to high density lipoprotein-cholesterol ratio(TG/HDL-C)and homeostasis model assessment of insulin resistance index(HOMA-IR)in children with metabolic syndrome(MS).Methods:A total of 203 children with obesity diagnosed in the Pediatrics of Tianjin Medical University General Hospital from January 2015 to December 2019 were collected.Blood pressure and waist circumference were measured.Oral glucose tolerance test(OGTT),glycated hemoglobin(HbA1c),and blood lipids were tested.According to the diagnostic criteria for obesity and metabolic syndrome in children and adolescents,all patients were divided into metabolic syndrome group(MS group,n=6)and control group(non-MS group,n=136).According to OGTT,HOMA-IR,Matsuda index,islet cell function index(HOMA-β),early insulin secretion index(ΔI30/ΔG30),area under the blood glucose curve(Glycemic-AUC),area under the insulin curve(insulin-AUC)were calculated.The ROC curve was used to evaluate the specificity and sensitivity of TG/HDL-C and HOMA-IR,and whether there was statistical difference between the two indicators′combined prediction and individual prediction.Results:Compared with non-MS group,TG/HDL-C ratio(Z=-8.441,P=0.000)and HOMA-IR(Z=-4.476,P=0.000)increased in the MS goup.When TG/HDL-C>1.31,the predicted sensitivity of MS was 86.6%,specificity was 84.6%.When HOMA-IR>7.08,the sensitivity of predicting MS was 53.7%,and the specificity was 77.9%.Compared with using HOMA-IR alone to diagnose MS,TG/HDL-C alone to diagnose MS(Z=3.425,P=0.0006)and TG/HDL-C combined with HOMA-IR to diagnose MS(Z=4.481,P<0.0001)were more sensitive.There was no significant statistical difference between TG/HDL-C alone and TG/HDL-C combined with HOMA-IR in the diagnosis of MS.Conclusion:TG/HDL-C alone or TG/HDL-C combined with HOMA-IR can be used as a good predictor for MS.