单纯性肥胖儿童血清25-(OH)D3水平与BMI的关系研究

Relationship between serum 25-(OH)D level and BMI in children with simple obesity

目的探讨单纯性肥胖儿童血清25-羟维生素D3[25-(OH)D3]水平与体质量指数(BMI)的关系。方法选取2018年2月至2020年2月连云港市第一人民医院收治的单纯性肥胖患儿150例,根据BMI超过同性别、同年龄及同身高健康儿童标准体重的20%~29%为轻度肥胖,超过30%~49%为中度肥胖,≥50%为重度肥胖,将患儿分为轻度肥胖组(n=60)、中度肥胖组(n=48)和重度肥胖组(n=42)。另选择同期在门诊体检的年龄、性别相匹配的正常儿童(BMI在同性别及同年龄的标准范围内)40例为对照组。比较各组临床基本资料及血清25-(OH)D3水平、血脂[总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)]、T淋巴细胞亚群水平,分析血清25-(OH)D3水平与BMI、血脂及T淋巴细胞亚群的关系。结果 (1)体重及血脂水平:轻度肥胖组、中度肥胖组和重度肥胖组的体重、BMI、TC、TG、LDL-C水平均显著高于对照组(t=3.729~31.336,P<0.05),轻度肥胖组上述指标均显著低于中度、重度肥胖组(t=2.397~19.924,P<0.05),中度肥胖组上述指标均显著低于重度肥胖组(t=2.012~7.428,P<0.05);(2)25-(OH)D3水平:轻度肥胖组、中度肥胖组和重度肥胖组血清25-(OH)D3水平均明显低于对照组(t值分别为4.756、5.977、7.089,P<0.05),轻度肥胖组血清25-(OH)D3水平分别高于中度、重度肥胖组,中度肥胖组高于重度肥胖组(t值分别为2.612、4.813、2.224,P<0.05);(3)T淋巴细胞亚群水平:轻度肥胖组、中度肥胖组和重度肥胖组血清CD3+、CD4^(+)、CD4^(+)/CD8^(+)水平均低于对照组(t=2.665~11.456,P<0.05),轻度肥胖组上述指标均显著高于中度、重度肥胖组(t=2.234~7.407,P<0.05),中度肥胖组上述指标显著高于重度肥胖组(t值分别为2.860、2.865、4.259,P<0.05);(4)相关性分析:单纯性肥胖患儿血清25-(OH)D3水平与BMI、TG均呈负相关(相关系数r值分别为-0.405、-0.311,P<0.05),与CD3+、CD4^(+)、CD4^(+)/CD8^(+)均呈正相关(相关系数r值分别为0.346、0.319、0.324,P<0.05)。结论单纯性肥胖儿童血清25-(OH)D3水平随着肥胖程度的增加而逐渐降低,且与BMI、TG水平及T淋巴细胞亚群密切相关。

Objective To explore relationship between serum 25-hydroxyvitamin D3[25-(OH)D3] level and body mass index(BMI) in children with simple obesity.Methods A total of 150 children with simple obesity who admitted to The First People′s Hospital of Lianyungang City from February 2018 to February 2020 were selected.According to the standard body weight of healthy children of same gender, same age and same height, the children′s body weight beyond 20%~29% of the standard body weight were considered as mild obesity, 30%~49% as moderate obesity and ≥50% as severe obesity.60 obese children were divided into mild obesity group, 48 obese children were divided into moderate obesity group and 42 obese children were divided into severe obesity group.Another 40 children with normal body weight of matched age and sex who received physical examination in pediatric clinic of the hospital at the same period were selected as the control group.Clinical basic data of all children were collected.And their serum 25-(OH)D3 level, blood lipid [total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C)] and T lymphocyte subsets were detected and compared among the four groups.The relationships of serum 25-(OH)D3 level with BMI,blood lipid level and T lymphocyte subsets levels were analyzed.Results(1)Body weight and blood lipid levels: The body weight, BMI,serum levels of TC,TG and LDL-C of these obese children in the mild obesity group, the moderate obesity group and the severe obesity group were all significantly higher than those in the control group(t=3.729~31.336,all P<0.05);the serum levels of above indexes of the obese children in the mild obesity group were significantly lower than those in the moderate obesity group and the severe obesity group(t=2.397~19.924,all P<0.05);and the serum levels of above indexes of the obese children in the moderate obesity group were significantly lower than those in the severe obesity group(t=2.012~7.428,all P<0.05).(2)Serum 25-(OH)D3 level: The serum 25-(OH)D3 levels of the obese children in the mild obesity group, the moderate obesity group and the severe obesity group were all significantly lower than those in the control group(t=4.756,5.977 and 7.089 respectively, all P<0.05).The serum 25-(OH)D3 level of the obese children in the mild obesity group was higher than that in the moderate obesity group and the severe obesity group, and the serum 25-(OH)D3 level of the obese children in the moderate obesity group was higher than that in the severe obesity group(t=2.612,4.813 and 2.224 respectively, all P<0.05).(3)T lymphocyte subsets: The serum levels of CD3+,CD4^(+),CD4^(+)/CD8^(+) of the obese children in the mild obesity group, the moderate obesity group and the severe obesity group were all lower than those in the control group(t=2.665~11.456,all P<0.05),and the serum levels of above indexes of the obese children in the mild obesity group were significantly higher than those in the moderate obesity group and the severe obesity group(t=2.234~7.407,all P<0.05),in turn, the serum levels of above indexes of the obese children in the the moderate obesity group were significantly higher than those in severe obesity group(t=2.860,2.865 and 4.259 respectively, all P<0.05).(4) Correlation analysis: The serum 25-(OH)D3 level of the children with simple obesity was negatively correlated with BMI and TG(r=-0.405 and-0.311 respectively, both P<0.05),and was positively correlated with serum levels of CD3+,CD4^(+) and CD4^(+)/CD8^(+)(r=0.346,0.319 and 0.324 respectively, P<0.05).Conclusion The level of serum 25-(OH)D3 of the children with simple obesity gradually decreases with increase in obesity severity, and is closely related to BMI and serum levels of blood lipid and T lymphocyte subsets.