儿童及青少年肥胖症糖脂代谢异常早期诊断和干预的研究  

Research into abnormal glucose and lipid metabolism in early diagnosis and intervention in obese children and adolescents

作　　者：穆亚平[1] 赵方[1] 马洪刚[1] 刘立旻[2] 李娜[1] 王岩[1] 李玢[1] 关丽君[1] 李书琴[3] 韩萍[3] 辛颖[3] 

机构地区：[1]沈阳市儿童医院,沈阳110032 [2]中国医科大学,沈阳110001 [3]中国医科大学附属盛京医院,沈阳110004

出　　处：《中国实用儿科杂志》2011年第8期587-591,共5页Chinese Journal of Practical Pediatrics

摘　　要：目的探寻肥胖与糖脂代谢异常的相关性及相应靶器官肝脏、心脏损害情况,以早期采取干预措施。方法选择2008年7月至2010年10月沈阳市儿童医院儿保门诊就诊的单纯性肥胖儿童516例为肥胖组,100名体检体重正常儿童为对照组。取空腹静脉血检测空腹血糖(FPG)、甘油三酯(TG)、总胆固醇(TC)、谷丙转氨酶(ALT)、空腹胰岛素(FINS)等指标,计算胰岛素抵抗指数(HOMA-IR)及胰岛β细胞功能值(HOMA-β);对肥胖儿童行口服糖耐量试验(OGTT)和胰岛素释放试验。对所有入组者均进行肝脏和心脏超声检查。结果肥胖组收缩压、舒张压均高于对照组(P<0.05),肥胖组高血压检出率为12.0%(62/516)。肥胖组FBG、FINS、HOMA-IR及HOMA-β均高于对照组(P<0.05);TC、TG、LDL-C均高于对照组,而HDL-C低于对照组,差异均有统计学意义(P<0.05)。轻、中、重度肥胖组脂肪肝发生率差异有统计学意义(P<0.001),且随肥胖程度加重,脂肪肝发生率明显增加(χ2=12.97,P<0.001)。肥胖组心包外脂肪增厚268例,平均厚度(3.372±0.098)mm,与对照组比较差异有统计学意义(P<0.001)。97例代谢综合征(MS)患儿进行饮食控制、加强运动,结合口服二甲双胍药物等早期联合干预治疗,FINS和HDL-C改善差异有统计学意义(P<0.001)。结论肥胖儿童高血压发生风险、糖代谢异常均高于非肥胖儿童,轻度肥胖即可发生FPG受损、糖耐量减低、胰岛素抵抗、高胰岛素血症和β细胞功能减低等糖代谢异常。肥胖儿童有明显的血脂代谢紊乱,易并发脂肪肝,脂肪肝发生率与肥胖严重程度相关,10岁后肥胖儿童脂肪肝发生比例明显升高。肥胖儿童左心室肥大和心包外脂肪增厚明显高于正常体重儿童。联合干预治疗肥胖儿童可明显降低FINS和升高HDL-C值,可防止其发展为糖耐量减低和糖尿病。Objective To explore the relationship between obesity and glucose and lipid metabolism , and the damage of the related target organs such as liver and heart in order to take early intervention. Methods Totally 516 children with simple obesity made up obesity group, 100 normal-weight children as a control group. Detect the fasting plasma glucose （FPG）, triglyceride （TG）, total cholesterol （TC）, alanine aminotransferase （ALT）, fasting insulin （FINS） and other projects; calculate the insulin resistance index （HOMA-IR） and insulin value of β-cell function （HOMA-β ） ; oral glucose tolerance test （OGTT） and insulin release test were done in obese children; perform liver and heart uhrasonogra- phy in all children. Results Obese children＇s systolic and diastolic blood pressure were higher than the control group （P 〈 0.05）, hypertension was detected in 12.0% （62/516）of obese children; the FBG, FINS, HOMA-IR and HOMA-B of obese children were higher than the control group （P 〈 0.05） ; the TC, TG, LDL-C were higher than the control group, while HDL-C lower than the control group, the differences being significant （P 〈 0.05 ） ; the incidence of fatty liver of the light moderate and severe groups were significantly different （P 〈 0.001 ）. With the increase of the obesity de- gree, fatty liver was significantly increased （ χ = 12.97, P 〈 0.001 ）. External fat thickness of the pericardium increased in 268 cases of obese group, external fat thickness of the pericardium being 3.372 ±0.098 （ram） ; compared with the control group the difference was significant （P 〈 0.001）. Early joint intervention was done in 97 MS patients, including dieting and increasing physical activity, combined with oral metformin drugs, and the FINS and HDL-C improvement was of significant difference （P 〈 0.001 ） .Conclusion The risk of hypertension in obese children is higher than non-obese children.Abnormal glucose metabolism is more comman in obese children than in non

关 键 词：儿童 青少年 肥胖 代谢综合征 脂肪肝 左心室肥大 心包外脂肪厚度 

分 类 号：R72[医药卫生—儿科]