肥胖儿童青少年胰岛素抵抗的临床特征及其与代谢并发症的关系  

Clinical characteristics of insulin resistance and its relationship with metabolic complications in obese children and adolescents

作　　者：青丽 彭璐婷[1] 刘倩琦[2] 蒋志颖 武苏[2] 黄荣[1] 陈梦莹[1] 李荣[1] 莫宝庆[3] 李晓南[1] Qing Li;Peng Luting;Liu Qianqi;Jiang Zhiying;Wu Su;Huang Rong;Chen Mengying;Li Rong;Mo Baoqing;Li Xiaonan(Department of Children Health Care,Children′s Hospital of Nanjing Medial University,Nanjing 210008,China;Department of Endocrinology,Children′s Hospital of Nanjing Medial University,Nanjing 210008,China;School of Public Health,Nanjing Medial University,Nanjing 211166,China)

机构地区：[1]南京医科大学附属儿童医院儿童保健科,210008 [2]南京医科大学附属儿童医院内分泌科,210008 [3]南京医科大学公共卫生学院,211166

出　　处：《中华实用儿科临床杂志》2020年第11期847-851,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金(81773421);江苏社会发展重点项目(BE2015607)。

摘　　要：目的:研究肥胖并胰岛素抵抗(IR)儿童青少年生长发育和代谢紊乱的临床特征。方法:选取2015年9月至2018年4月在南京医科大学附属儿童医院儿童保健科就诊的正常体质量或肥胖的儿童青少年。测量儿童身高、体质量、腰围,计算腰围身高比(WHtR)、体质量指数(BMI)。根据Tanner标准进行青春发育分期。空腹测定血糖、血脂及胰岛素,根据空腹血糖和胰岛素水平,计算IR指数稳态模型(HOMA-IR),HOMA-IR≥2.69为IR。通过腹部超声诊断非酒精性脂肪肝(NAFLD)。结果:1.共纳入研究对象691例,其中正常体质量组(正常组)183例,年龄(9.73±2.38)岁;肥胖组508例,年龄(10.24±2.05)岁。肥胖组IR检出率高于正常组(55.71%比10.38%),差异有统计学意义(P<0.001)。2.HOMA-IR与年龄(r=0.256,P<0.001)、BMI(r=0.426,P<0.001)、腰围(r=0.454,P<0.001)、WHtR(r=0.321,P<0.001)呈正相关;校正年龄、性别、青春发育分期后,HOMA-IR与BMI(r=0.418,P<0.001)、腰围(r=0.419,P<0.001)、WHtR(r=0.375,P<0.001)仍呈正相关。3.青春发育期,2组儿童HOMA-IR指数上升,但肥胖组HOMA-IR升高较正常组更为明显[TannerⅠ:2.60(1.49,3.94)比1.28(0.80,1.90);TannerⅡ:3.07(1.75,5.17)比1.80(1.16,2.96);TannerⅢ:4.33(2.80,6.57)比2.47(1.41,3.68);TannerⅣ~Ⅴ:3.49(1.04,5.78)比1.91(0.54,2.60)],差异均有统计学意义(均P<0.05)。4.与肥胖无IR的儿童青少年相比,肥胖并IR的儿童青少年的收缩压[112(104,124)mmHg比109(98,121)mmHg,1 mmHg=0.133 kPa]、三酰甘油[1.27(0.95,1.81)mmol/L比1.09(0.79,1.61)mmol/L]、空腹血糖[4.80(4.46,5.01)mmol/L比4.48(4.16,4.76)mmol/L]、空腹胰岛素[21.27(16.21,28.56)mmol/L比7.62(4.43,10.83)mmol/L]均升高,差异均有统计学意义(均P<0.05)。IR是肥胖儿童青少年NAFLD的危险因素(OR=1.536,95%CI:1.049~2.247,P<0.05)。结论:严重、腹型肥胖是影响儿童和青少年IR发展的主要危险因素,青春发育期肥胖儿童IR程度更为严重。肥胖儿童并IR者更易出现血糖、血脂、血压代Objective To study the clinical characteristics of growth development and metabolic disorders in obese children and adolescents with insulin resistance(IR).Methods Normal weight or obese children and adolescents who hospitalized at the Department of Children′s Health Care of Children′s Hospital Affiliated to Nanjing Medical University from September 2015 to April 2018 were recruited.Children′s height,body weight and waist circumference were measured,and waist-to-height ratio(WHtR)and body mass index(BMI)were calculated.Puberty process was determined by Tanner stage.Blood glucose,blood lipid and insulin were measured in fasting state,and homeostasis model assessment of insulin resistance(HOMA-IR)was calculated based on fasting blood glucose and insulin levels.IR was considered when HOMA-IR was over 2.69.Non-alcoholic fatty liver(NAFLD)was diagnosed by abdominal ultrasound.Results(1)A total of 691 subjects were included,including 183 cases with the age of(9.73±2.38)years in the normal weight group/normal group,and 508 cases with the age of(10.24±2.05)years old in the obese group.The rate of IR was higher in obese group than that in normal group(55.71%vs.10.38%),and the difference was statistically significant(P<0.001).(2)HOMA-IR was positively correlated with age(r=0.256,P<0.001),BMI(r=0.426,P<0.001),waist circumference(r=0.454,P<0.001),and WHtR(r=0.321,P<0.001).After the adjustment for age,sex,and puberty stage,HOMA-IR was also positively correlated with BMI(r=0.418,P<0.001),waist circumference(r=0.419,P<0.001)and WHtR(r=0.375,P<0.001).(3)During puberty,HOMA-IR in both of obese group and normal group was increased,and HOMA-IR in obese group was more particularly serious compared to normal group[TannerⅠ:2.60(1.49,3.94)vs.1.28(0.80,1.90);TannerⅡ:3.07(1.75,5.17)vs.1.80(1.16,2.96);TannerⅢ:4.33(2.80,6.57)vs.2.47(1.41,3.68);TannerⅣ-Ⅴ:3.49(1.04,5.78)vs.1.91(0.54,2.60)],and the differences were all statistically significant(all P<0.05).(4)Compared with the obese objects without IR,obese children and adol

关 键 词：肥胖儿童青少年 胰岛素抵抗 临床特征 青春期发育 代谢紊乱 

分 类 号：R723.14[医药卫生—儿科]