儿童肥胖症糖代谢状态的再探讨

Reexploration of glucose metabolism in childhood obesity

目的分析肥胖儿童的糖代谢状态。方法266例肥胖儿童为研究对象,检查空腹血糖(FPG)、空腹胰岛素(FINS)、糖化血红蛋白(HbA1c)、口服葡萄糖耐量试验(OGTT)和胰岛素释放试验(IRT),计算胰岛素抵抗指数(HOMA-IR)、量化胰岛素敏感指数(QUICKI)和胰岛素峰值/空腹胰岛素(I p/I 0)。200例非肥胖的健康儿童为对照组,比较两组糖代谢指标。比较不同肥胖程度儿童的糖代谢指标、胰岛素抵抗(IR)发生率。分析肥胖儿童的糖尿病前期风险因素,体质指数(BMI)相关性分析。结果肥胖儿童糖尿病前期及2型糖尿病比例达18.0%(48/266)。肥胖组FINS、HOMA-IR、HbA1c大于对照组,QUICKI低于对照组(P<0.05);两组FPG差异无统计学意义(P=0.423)。重度肥胖组FINS、HOMA-IR大于轻中度肥胖组,I p/I 0小于轻中度肥胖组(P<0.05),FPG、QUICKI、HbA1c、2小时血糖(2hPG)差异无统计学意义。轻中度肥胖、重度肥胖组IR发生率差异无统计学意义(P=0.163)。Logistic回归提示BMI、黑棘皮病等对糖尿病前期的影响差异无统计学意义。相关性分析提示,BMI与FPG无相关性(P=0.160),与FINS、HOMA-IR、2hPG、HbA1c呈正相关(P<0.05),与QUICKI、I p/I 0呈负相关(P<0.05)。结论近20%肥胖儿童已有糖代谢异常。肥胖儿童普遍存在胰岛素抵抗,其发生率不受肥胖程度的影响。

Objective To analyze the status of glucose metabolism in obese children.Methods 266 cases of obese children were included in the study,fasting plasma glucose(FPG),fasting insulin(FINS),glycosylated hemoglobin(HbA1c)were measured,Oral glucose tolerance test(OGTT)and insulin release test(IRT)were carried out,insulin resistance index(HOMA-IR),quantified insulin sensitivity index(QUICKI)and peak insulin/fasting insulin(I p/I 0)were calculated.Two hundred non-obese healthy children were used as control group,and glucose metabolism indexes were compared between the two groups.Glucose metabolism indexes and the incidence of insulin resistance(IR)were compared in children with different degrees of obesity.Prediabetes risk factors and body mass index(BMI)correlation were analyzed in obese children.Results The proportion of prediabetes and type 2 diabetes mellitus in obese children was 18.0%(48/266).FINS,HOMA-IR and HbA1c in obesity group were higher than those in the control group,but QUICKI was lower than that in the control group(P<0.05).There was no significant difference in FPG between the two groups(P=0.423).FINS and HOMA-IR of severe obesity group were higher than those of mild to moderate obesity group,I p/I 0 was lower than that of mild to moderate obesity group(P<0.05),and there was no significant difference in FPG,QUICKI,HbA1c and 2hPG of severe obesity group.There was no significant difference in IR incidence between mild to moderate obesity group and severe obesity group(P=0.163).Logistic regression indicated that BMI and acanthosis nigricans was great influential on prediabetes with no statistical significance(P>0.05).Correlation analysis showed that BMI had no correlation with FPG(P=0.160),but was positively correlated with FINS,HOMA-IR,2hPG and HbA1c(P<0.05),and negatively correlated with QUICKI and I p/I 0(P<0.05).Conclusion Abnormal glucose metabolism is available in nearly 20%of obese children.The prevalence of insulin resistance in obese children is not affected by the degree of obesity.