肥胖儿童及青少年脂代谢紊乱与早期血管病变的关系  

Relationship between dyslipidemia and early vascular lesions in obese children and adolescents

作　　者：邹朝春[1] 梁黎[1] 傅君芬[1] 吕兰秋[2] 留佩宁[3] 黄轲[1] 王春林[1] 

机构地区：[1]浙江大学医学院附属儿童医院内分泌科,杭州310003 [2]宁波市妇女儿童医院儿童保健科 [3]温州医学院附属育英儿童医院儿童保健科

出　　处：《中华儿科杂志》2010年第6期413-417,共5页Chinese Journal of Pediatrics

摘　　要：目的 了解肥胖儿童青少年的脂代谢紊乱、血压与血管内膜中层厚度（IMT）变化.方法 2008年1月-2009年9月,从浙江省3家医院共募集580例7～17岁肥胖儿童青少年,按照血脂水平分为2组：血脂正常组中,男100例、女52例,平均年龄10.47岁;血脂紊乱组中,男305例、女123例,平均年龄10.83岁.分别进行相关体格检查,计算体质指数（BMI）,检测血脂、血糖、血胰岛素和肝酶等生化指标,并对其中1家医院的285例研究对象进行颈动脉IMT检测.结果 （1）血脂正常组与血脂紊乱组患儿中,高血压比例分别是12.5%（19/152）和20.1%（86/428）,差异具有统计学意义（x2=4.362,P=0.037）,比值比为1.760,95%可信区间为1.030～3.008.（2）血脂紊乱组的左、右颈总动脉IMT和颈总动脉平均IMT值均较血脂正常组偏高,但差异均无统计学意义（均P〉0.05）.血脂紊乱组的左、右颈内动脉IMT和颈内动脉平均IMT值分别是（0.66±0.15）mm、（0.65±0.15）mm和（0.65±0.15）mm,正常血脂组三者水平分别为（0.62±0.13）mm、（0.60±0.13）mm和（0.61±0.12）mm,组间差异均有统计学意义（均P〈0.05）.（3）双变量相关分析显示收缩压与年龄、BMI、BMI Z值、腰围、臀围、尿酸、丙氨酸转氨酶、甘油三酯、空腹胰岛素和稳态胰岛素抵抗指数呈正相关（均P〈0.05）;其中收缩压与臀围中度相关.颈总动脉和颈内动脉平均IMT也分别与年龄、BMI、腰围、臀围和TG呈正相关（均P〈0.05）.多元线性回归分析显示臀围和稳态模型胰岛素抵抗指数是收缩压的独立相关因素,腰围是颈总动脉和颈内动脉平均IMT的独立相关因素,甘油三酯还是颈内动脉平均IMT的独立相关因素.结论 （1）肥胖儿童青少年存在血脂代谢紊乱、高血压和动脉内膜增厚等血管病变,（2）脂代谢紊乱与血管病变密切相关,其中腰围和高甘油三酯血症是血管病变的高危因素.Obiective Obese children and adolescents are often complicated with the abnormalities of lipid and glucose metabolism.which are often associated with adulthood hypertension,diabetes and cardiovascular disease.In this study,the blood lipids,blood pressure and carotid arterial intima-media thickness（IMT）in obese children and adolescents were measured to investigate the relationship between the dyslipidemia and early vascular lesions.Method A total of 580 obese children and adolescents aged from 7 to 17 years of age were enrolled from 3 hospitals from Jan.2008 to Sept.2009.They were divided into 2 groups according to their blood lipoid levels.Ortholipesis group included 100 males and 52 females with a mean age of 10.47 years and a mean body mass index（BMI）of 28.28 ks/m2.Dyslipidemia group included 305 males and 123 females with a mean age of 10.83 years and a mean BMI of 27.60 kg/m2.Physical examination,and measurement of blood lipid,glucose and liver enzyme were taken.Carotid IMT was measured for 285 subjects.Result（1）Hypertension Was found in 12.5%（19/152）and 20.1% （86/428） patients in ortholiposis and dyslipidemia groups,respectively,with a significant difference （X2=4.362, P=0.037）. The OR was 1.760 with 95% confidence interval of 1.030 - 3.008. Higher prevalence of hypertension was found in patients with dyslipidemia. （2） The left, right and mean common carotid IMTs of dyslipidemia group were higher than those of ortholiposis group without significant difference （all P〉0.05）. The left, right and mean internal carotid IMTs in dyslipidemia group were （0. 66±0. 15）mm, （0. 65±0. 15） mm and （0. 65±0. 15） mm, respectively while these in ortholiposis group were （0. 62±0. 13） mm, （0.60±0. 13） mm and （0.61±0. 12） mm, respectively （P〈0. 05 for all）. （3） Bivariate correlation analysis showed that systolic blood pressure was positively correlated with age, BMI, BMI Z score, waist circumference, hip circumference, uric acid, alanine transarninase, tri

关 键 词：肥胖症 血脂异常 高血压 血管疾病 儿童 

分 类 号：R725.8[医药卫生—儿科]