肥胖儿童伴黑棘皮病糖代谢特征及二甲双胍干预治疗58例

Characteristics of glycometabolism in 58 corpulent children with acanthosis nigricans and interfering treatment with metformin

目的 :观察中、重度肥胖伴黑棘皮病病儿的糖代谢特征 ,二甲双胍干预治疗对糖、脂代谢的影响。方法 :选择中、重度肥胖病儿 5 8例 ,分为伴有黑棘皮病 (32例 )和不伴黑棘皮病 (2 6例 ) 2组 ,均予二甲双胍 5 0 0mg ,po ,bid× 8wk。结果 :(1)伴有黑棘皮病组治疗前空腹胰岛素 (FINS)为 (43±s 13)mU·L- 1、餐后 2h胰岛素 (PINS)为 (12 8± 2 3)mU·L- 1明显高于不伴黑棘皮病组 (30± 11)mU·L- 1,(5 8± 9)mU·L- 1(P <0 .0 1) ;(2 )二甲双胍干预治疗 8wk ,2组FINS ,PINS ,总胆固醇 (TC) ,三酰甘油 (TG) ,均有非常明显下降 (P <0 .0 1) ,胰岛素敏感指数 (IAI)上升 (P <0 .0 1) ,2组不良反应轻微。结论 :肥胖伴黑棘皮病病儿多存在高胰岛素血症、胰岛素抵抗 ,二甲双胍干预治疗能减轻胰岛素抵抗 ,增加机体对胰岛素的敏感性。

AIM: To observe the characteristics of glycometabolism in moderate to severe corpulent children with acanthosis nigricans and the effects of metformin in interfering treatment of glycometabolism and lipometabolism. METHODS: Fifty-eight patients with moderate to severe adiposis were divided into two groups. Acanhthosis nigricans (AN) group (32 patients) and without AN group (26 patients). All patients were treated with metformin 500 mg, po, bid for 8 wk. RESULTS: (1) Fasting insulin(FINS) in AN group was (43±s 13) mU·L -1 and 2 post-meal insulin (PINS) was (128±23) mU·L -1 before the treatment, those were significantly higher than those in without AN group (FINS(30±11) mU·L -1 and PINS(58±9)mU·L -1)(P<0.01); (2)Two groups FINS, PINS, TC, and TG significantly decreased (P<0.01) and the insulin-sensitivily index (IAI) increased (P<0.01) after 8 wk interfering treatment with metformin. The adverse reactions of two groups were mild. CONCLUSION: There are hyperinsulinism and insulin-resistant in corpulent children with AN. The interfering treatment with metformin can decrease insulin-resisatant and increase insulin-sensitivity to body.