北京市超重和肥胖学龄儿童中代谢综合征的流行特征  

Metabolic syndrome in overweight and obese schoolchildren in Beijing

作　　者：万乃君[1] 米杰[1] 王天有[1] 段佳丽 黎明[3] 巩纯秀[4] 杜军保[5] 赵小元[1] 程红[1] 侯冬青[1] 王俐[1] 

机构地区：[1]首都儿科研究所附属儿童医院内科,北京100020 [2]北京市疾病预防中心 [3]中国医学科学院中国协和医科大学北京协和医院卫生部内分泌重点实验室 [4]首都医科大学附属北京儿童医院 [5]北京大学第一医院

出　　处：《中华儿科杂志》2007年第6期417-421,共5页Chinese Journal of Pediatrics

基　　金：北京市科技计划重点项目(H030930030130);国家自然科学基金(30671804);北京市自然科学基金(7072011)

摘　　要：目的了解北京市6～18岁超重、肥胖儿童青少年中代谢综合征(MS)的流行现状和临床表型特征;比较美国国家胆固醇教育计划和国际糖尿病联盟定义的标准诊断儿童青少年 MS 的差异。方法以2004年北京儿童青少年 MS 调查中筛查出的超重和肥胖儿童为研究对象,并选取一组正常体重儿童为对照组,检测空腹血浆葡萄糖和胰岛素、血清甘油三酯和高密度脂蛋白胆固醇水平,采用稳态模式评估法计算胰岛素抵抗指数。符合以下5项指标中3项及以上者为 MS:腹型肥胖(腰围≥P_(90))、高血压(≥P_(90))、低高密度脂蛋白胆固醇[<1.03 mmol/L(40 mg/dl)]、高甘油三酯[≥1.24 mmol/L(110 mg/dl)]和空腹血糖升高[>15.6 mmol/L(100 mg/dl)]。结果 (1)采用美国国家胆固醇教育计划定义,MS 检出率分别为,对照组0.9%,超重组7.6%,肥胖组29.8%,高于国际糖尿病联盟定义的检出率(0.1%,5.2%,28.6%);两定义标准诊断的 MS 检出率均呈现随体重指数升高而增加的趋势(趋势检验,P<0.001);(2)肥胖儿童中 MS 单项异常检出率依次为:腹型肥胖81.6%,高血压47.7%,高甘油三酯35.6%,低高密度脂蛋白胆固醇16.9%,高空腹血糖13.4%;超过四分之一的超重儿童具有高血压(29.8%)、腹型肥胖(27.4%)和高甘油三酯(26.0%);随体重指数增加,MS 指标多项异常者和胰岛素抵抗者呈增加趋势(P<0.001)。结论北京市肥胖儿童青少年中 MS已呈现严重流行趋势;腹型肥胖、高血压、高甘油三酯是超重肥胖儿童最常见的代谢异常。采用美国国家胆固醇教育计划定义的儿童 MS 检出率高于国际糖尿病联盟定义的检出率。Objective To determine the prevalence and clinical phenotype of metabolic syndrome among overweight and obese schoolchildren in Beijing, and to compare the rates of diagnosis made according to the criteria of the National Cholesterol Education Program （NCEP） of the United States and International Diabetes Federation （IDF）. Methods Based on Beijing Child and Adolescent Metabolic Syndrome （BCAMS） study with body mass index （BMI）, waist circumference （WC） and blood pressure measured, the overweight and obese children were screened among nearly 20 000 children 6 - 18 years of age in Beijing by Chinese BMI cutoffs for schoolchildren （7 - 18 years） and the US 2000 CDC Growth Charts the 85th and 95th percentile （6 years） and were enrolled as the study population. Simultaneously a group of children with normal BMI were selected as the control group and based on the international method of age grouping, each of the above groups was divided further into 4 sub-groups in terms of age： 6 -9, 10 - 12, 13 - 15 and 16-18 years old, respectively. Fasting plasma glucose （FPG） and insulin （FINS）, serum high-density lipoprotein cholesterol （HDL-C） and triglyceride （TG） were examined. HOMA-IR index was calculated for estimating individual insulin resistance. A child who met any three or more of the following five criteria, according to NCEP definition, was diagnosed as MS. A diagnosis of MS using IDF definition required abdominal obesity plus any two or more of the other four criteria：①abnormal obesity：WC ≥ P90 ;②elevated BPs ：SBP/DBP≥P90 ; ③low HDL-C： HDL-C 〈 1.03 mmol/L （40 mg/dl） ; ④high TG： TG≥1. 24 mmol/ L （110 mg/dl）; ⑤impaired fasting glucose （IFG）： FPG≥5.6 mmol/L （100 mg/dl）. Results The prevalence rates of MS by NCEP definition were： 0. 9%, 7.6% and 29. 8% in the normal weight （ control group）, overweight and obese children, respectively, which were higher than the rates diagnosed by IDF definition with 0. 1%, 5.2% and 28.6% i

关 键 词：儿童 肥胖症 代谢综合征X 

分 类 号：R725.8[医药卫生—儿科]