肥胖代谢综合征儿童游离脂肪酸与血糖代谢分析

目的：探讨口服糖耐量试验（OGTT）和血游离脂肪酸（NEFA）测定在评价和预测儿童代谢综合征（MS）和心血管危险因素中的价值。方法：门诊确诊肥胖儿童109名及31名健康体检儿童，进行人体参数测量并收集临床基本资料，测定血脂，OGTY及胰岛素释放试验，根据腰围、血压、血脂及血糖指标将患儿分为MS组和非MS组。对上述资料进行统计学分析。结果：MS组与非MS组NEFA水平差异无统计学意义；MS组OGTr糖负荷后1h血糖（1hPG）、空腹胰岛素水平（FINS）、稳态模型计算胰岛素抵抗指数（HOMA—IR）高于非MS组（P〈0．05），稳态模型计算胰岛素敏感指数（HOMA—IA）低于非MS组，但两组的空腹及糖负荷后其余时间点血糖（30min、2h、3h）、胰岛素浓度（30min、1h、2h、3h）和胰岛素分泌功能（ISI）、血糖及胰岛素曲线下面积比值（AUCBG／AUCINS）均无统计学差异（P〉0．05）。Sperman相关分析提示1hPG与胰岛素抵抗指标具有相关性。结论：NEFA作为评价肥胖儿童MS及心血管危险因素的可能还有待进一步研究；OGTT比单纯采用空腹及餐后2h血糖能更加有效的评价肥胖儿童MS和心血管危险因素。

The study of serum non-esterified fatty acid and glucose metabolic disturbancein obesity children with metabolic syndrome

Objective： To investigate the availability of oral glucose tolerance test （OGTr） and serum non-esterified fatty aeid（NEFA） in the evaluation and intervene the presence of metabolic syndrome（MS） or cardiovascular risk factors. Methods：109 children diagnosed as obesity were divided into MS group and non-MS group awording to WC, Bp, Serum Lipid and blood glucose.Serum lipid profiles,OGTT and insulin release test were measured following anthropometries measurements. These parameters were calculated. Results： There were no difference of NEFA between groups with or without metabolic syndrome （P 〉0.05）. Post-load lhPG of OGTT, fasting insulin and homeostasis model assessmentinsulin resistance index （HOMA-IR）in children with metabolic syndrome were higher than those in subjects without metabolic syndrome （P〈0.05）, homeostasis model assessmentinsulin action index （HOMA-IA）in children with metabolic syndrome was lower than those in subjects without metabolic syndrome （P 〈0.05）.But there were no difference of fasting glucose, post-load PG at 30min, 2h ＆3h, post-load insulin, insulin sensitivity index （ISI）and AUCBC/AUCINS between groups with or without metabolic syndrome （P 〉0.05）. lh post-load glucose were correlated with the factor of insulin resistance. Conclusion： There is no determination whether serum NEFA can be used as available indicator in diagnosis and prediction of cardiovascular risk factors, while OGTT shown that an elevated lh post-load glucose measurement is seen in obese children who have a clustering of cardiovascular risk factors and MS.