广州地区单中心Turner综合征患者代谢综合征发生率及其相关危险因素的研究  

Prevalence and clinical characteristics of metabolic syndrome in Turner syndrome： A single center study in Guangzhou

作　　者：郭松[1] 杜敏联[1] 陈红珊[1] 李燕虹[1] 苏喆[1] 马华梅[1] 陈秋莉[1] 古玉芬[1] 

机构地区：[1]中山大学附属第一医院儿科,广州510080

出　　处：《中华内分泌代谢杂志》2014年第12期1074-1079,共6页Chinese Journal of Endocrinology and Metabolism

基　　金：广东省2012年高科技发展专项资金资助项目（2012B061700067）

摘　　要：目的 研究Turner综合征（Turner syndrome,TS）患儿代谢综合征的发生率及其相关危险因素和临床特征,并探讨TS患儿代谢异常发生过程中的早期改变.方法 由临床和核型分析确诊TS患儿47例.测量体重、身高、腰围及血压,检测空腹血糖、胰岛素、总胆固醇、高密度脂蛋白胆固醇（HDL-C）、甘油三酯,并计算体重指数（BMI）、BMI-SDS、腰围身高比（WHtR）、非HDL-C及稳态模型评估的胰岛素抵抗指数（HOMA-IR）.根据我国2012年6月最新提出的代谢综合征定义及诊断建议统计各代谢异常成分的发生率及其特征,并将≥10岁的38例患儿分为代谢综合征组、1项指标组、2项指标组、3项指标组及对照组,并进行组间比较分析.对6≤年龄＜10（岁）的9例患儿进行发病特征描述.结果 所有47例患儿中总胆固醇、非HDL-C及甘油三酯均与年龄呈正相关.在年龄≥10岁的38例患儿中,代谢综合征者发生率为13.15％,中央型肥胖者18.42％,高血压28.9％,低HDL-C或高非HDL-C者26.32％,高甘油三酯者23.68％,高血糖者15.79％,高胰岛素血症者5.26％,胰岛素抵抗者10.53％,糖尿病者2.63％.代谢综合征组的BMI、BMI-SDS、腰围、WHtR及甘油三酯均较对照组高[（21.50±0.78对16.89 ±0.61）kg/m2,1.08±0.39对-0.76±0.29,73.90±0.93对60.75±1.44）cm,0.54±0.01对0.45±0.01,1.65（0.61 ～ 2.69）对0.75（0.30～ 1.20） mmol/L,均P＜0.016 7].一项指标组WHtR较对照组高（P＜0.016 7）.6≤年龄＜10（岁）的9例患儿中符合1项心血管疾病高危因素的患儿4例,符合2项的患儿1例.结论 TS患儿代谢综合征危险因素及代谢综合征的发生率高,并可早期出现代谢异常.高血压和血脂异常发生率最高,可能与TS自身的先天异常有关;与胰岛素分泌反应延迟及血糖不耐受相关的胰岛素抵抗可能是TS患者早期代谢异常改变的原因之一,中央型肥胖是TS患者代谢综合征发展过程中的早期改变.人体Objective To investigate the prevalence and clinical characteristics of metabolic syndrome （MetS） in Turner＇s syndrome （TS）,and to analyze the possible early risk factors of MetS in TS girls.Methods The study comprised 47 TS patients confirmed by clinical manifestations and karyotype analysis carried out in First Affiliated Hospital of Sun Yat-sen University during 2010 to 2013.Height,weight,waist circumstance,and resting blood pressure were measured,and plasma fasting glucose,insulin,total cholesterol,high density lipoproteincholesterol （HDL-C）,and triglycerides were determined before any treatment.Body mass index （B MI）,BMI Z-Score （BMI-SDS）,waist-to-height ratio （WHtR）,and homeostasis model assessment for insulin resistance （HOMA-IR） were calculated.All data were analyzed and described according to the guideline on children and adolescents metabolic syndrome from Chinese Medical Association of pediatrics published in June 2012,38 patients older than or equal to 10 years of age were recruited in group Ⅰ,and 9 patients within 6 to 10 years old formed group Ⅱ.Group Ⅰ was further divided into 5 subgroups based on their metabolic components according to guideline,viz.MetS group,group with 1 variable,group with 2 variables,group with 3 variables,and control group.Statistical analysis was conducted in group Ⅰ,and the metabolic characteristics was described in group Ⅱ.Results Positive correlations existed in total cholesterol,non-HDL-C,and triglycerides with age （r =0.409,P＜0.01 ; r =0.35,P＜0.05 ; r =0.356,P＜0.05） while negative correlation existed in BMI-SDS（r =-0.35,P＜0.05） in all 47 TS patients.In group Ⅰ,the prevalence of MetS,insulin resistance,hypertension,low HDL-C or high non-HDL-C,hypertriglyceridemia,hyperglycemia,hyperinsulinism,diabetes,and central obesity was 13.15％,10.53％,28.9％,26.32％,23.68％,15.79％,5.26％,2.63％,and 18.42％ respectively.TS patients of MetS group had wasit circumference [（73.90±0.93vs60.75±1.44）cm,P＜0.0167],W

关 键 词：代谢综合征 胰岛素抵抗 肥胖症 TURNER综合征 

分 类 号：R725.9[医药卫生—儿科]