儿童代谢综合征与早期动脉粥样硬化的关系  

Association of metabolic syndrome with early atherosclerosis in obese children

作　　者：张金华 阴东亮 刘蕴玲[3] 王蓓[3] 刘好田[4] 程慧玲[5] 周聊生[6] 

机构地区：[1]济南市立四院保健科,250014 [2]济南市立三院内二科 [3]山东省千佛山医院保健内分泌科 [4]山东省千佛山医院特检科 [5]山东省千佛山医院检验科 [6]山东省千佛山医院保健心血管科

出　　处：《中华临床医师杂志（电子版）》2012年第23期7536-7539,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：山东省科技厅攻关项目(2006GG3202024)

摘　　要：目的研究代谢综合征儿童动脉粥样硬化危险因素及动脉结构和功能的变化;观察降低体重对血管危险因素及血管结构的影响。方法选择10～12岁36例代谢综合征儿童,104例肥胖的非代谢综合征儿童和44例体重正常儿童组分别进行身体测量,实验室检查生化指标和高敏C反应蛋白(hs-CRP)、可溶性细胞间黏附分子(sICAM)、IL-6,超声检测颈动脉内中膜层厚度(IMT),其中36例代谢综合征儿童进行强化生活方式干预,比较干预前后指标变化。结果 (1)三组间比较,动脉粥样硬化危险因素(体重指数、血脂、血压、空腹胰岛素、胰岛素抵抗指数HOMA-IR等)和慢性炎症指标(hs-CRP、IL-6、sICAM)具有统计学差异(P≤0.01),IMT差异无统计学意义(P=0.042)。(2)随着代谢综合征组分的增加,动脉粥样硬化的危险因素增多,慢性炎症指标增高,IMT增厚。(3)代谢综合征儿童生活干预3个月后,体重下降,动脉粥样硬化危险因素改善,但IMT差异无统计学意义。(4)多元逐步回归分析得回归方程:IMT=-0.32+0.002腰围+0.003平均血压-0.058HDL-C+0.001HOMA-IR。结论代谢综合征儿童早期动脉粥样硬化血管改变已经发生。合理有效的生活方式的干预,可减少MS儿童血管的危险因素。Objective To investigate the changes of the risk factors in early stage of arteriosclerosis and vascular structure and function in children with metabolic syndrome(MS) and the changes after weight-lowing.Methods The study comprised 36 MS children and 104 obese children with non-MS and 44 normal weight children aged 10-12 years.All participants underwent physical examination,routine hematologic and biochemical tests including high sensitive C-reactive protein(hs-CRP),intercellular adhesion molecule-1(ICAM-1),interleukin 6(IL6).Homeostasis model of assessment of insulin resistance(HOMA-IR) were calculated.Ultrasound measurement was performed to investigate intima-media thickness of the common carotid artery(IMT),and the maximum fat thickness ahead of peritoneum(Pmax).36 MS children were underwent intensifying lifestyle intervention for three months with weight lowing.Results(1) The level of risk factors of atherosclerosis including BMI,waist circumustance(WC),Pmax,blood pressure,fasting insulin,hs-CRP,HOMA-IR,ICAM,IL-6 were significantly difference in three groups(P ≤0.01),IMT had no difference(P = 0.042).(2) The more the metabolic compositions were,the higher the risk factors of atherosclerosis,the markers of chronic inflammations,IMT value.(3) The risk factors of atherosclerosis were improved after weight-lowing.(4) Stepwise regressive analysis come to regressive equation IMT =-0.32 + 0.002 WC + 0.003 MAP-0.058 HDL-C + 0.001 HOMA-IR.Conclusions The change of vascular construction in early atherosclerosis occur in obese children with MS.Intensive lifestyle intervention is important to improve cardiovascular risk factors in MS children.

关 键 词：儿童 肥胖症 动脉粥样硬化 代谢综合征 

分 类 号：R725.8[医药卫生—儿科]