肥胖儿童黑棘皮病严重程度与胰岛素抵抗的相关性研究

The relationship between the severity of acanthosis nigricans and insulin resistance in obese children

目的探究肥胖儿童的各项指标尤其是胰岛素抵抗随着黑棘皮病(AN)程度加重的变化情况,分析黑棘皮病严重程度预测胰岛素抵抗的能力。方法回顾性分析2018年3月到2020年1月在天津医科大学总医院儿科就诊的88例肥胖儿童的临床资料,收集一般资料:身高、体重、腰围、收缩压及舒张压,检测儿童的葡萄糖、胰岛素、谷丙转氨酶、谷草转氨酶、尿酸、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、糖化血红蛋白和25羟维生素D等指标,分析肥胖儿童黑棘皮病严重程度与一般资料、生化指标的关系以及其预测胰岛素抵抗的能力。结果4组肥胖儿童中中度AN组的BMI、腰围、收缩压和生化指标UA的值最高,并未随着黑棘皮病的加重而逐步升高;肥胖儿童非AN组的HOMA-IR随着黑棘皮病的加重而升高,IAI随着黑棘皮病的加重而降低,非AN组的HOMA-IR、IAI与任何程度的AN组均存在统计学意义;肥胖儿童黑棘皮病严重程度预测胰岛素抵抗的曲线下面积为0.791,当黑棘皮病严重程度大于1分(即存在AN)时,敏感性为61.43%,特异性为94.44%。结论肥胖儿童的胰岛素抵抗程度随着黑棘皮病的加重而加重,黑棘皮病可作为筛查胰岛素抵抗的临床表型特征。

Objective To explore the changes of various indexes in obese children,especially insulin resistance with the severity of acanthosis nigricans(AN),and analyze the ability of the severity of acanthosis nigricans to predict insulin resistance.Methods The clinical data of 88 obese children in the Department of Pediatrics of Tianjin Medical University General Hospital from March 2018 to January 2020 were retrospectively analyzed.The general data were collected,including height,weight,waist circumference,systolic blood pressure and diastolic blood pressure.Glucose,insulin,alanine aminotransferase,aspartate aminotransferase,uric acid,total cholesterol,triglycerides,high-density lipoprotein,low-density lipoprotein were collected.The relationship between the severity of acanthosis nigricans in obese children and the general data,biochemical indexes and its ability to predict insulin resistance was analyzed.Results The BMI,waist circumference,systolic blood pressure and biochemical index UA of moderate AN group were the highest,which did not gradually increase with the aggravation of acanthosis nigricans.HOMA-IR increased with the aggravation of acanthosis nigricans and IAI decreased with the aggravation of acanthosis nigricans in obese children.HOMA-IR,IAI of non AN group were statistically significant with any degree of AN group.The area under the curve of predicting insulin resistance of acanthosis nigricans in obese children was 0.791,the sensitivity was 61.43%and the specificity was 94.44%when the severity of acanthosis nigricans was more than 1 point(equivalent to the existence of AN).Conclusions Insulin resistance in obese children increases with the aggravation of acanthosis nigricans.Acanthosis nigricans can be used as a clinical phenotype for screening insulin resistance.