肥胖儿童的动脉粥样硬化危险因素

目的通过比较肥胖和非肥胖儿童动脉粥样硬化的危险因素,探讨肥胖对儿童发生动脉粥样硬化的影响。方法对51例肥胖儿童和32例非肥胖儿童常规进行24h动态血压测定,检测胰岛素、高敏C反应蛋白、游离脂肪酸、甘油三酯、总胆固醇、空腹血糖、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇水平,采用B超检测颈动脉内膜中膜厚度、内皮依赖性血管舒张功能、最大的腹膜前脂肪厚度和最小的皮下脂肪厚度,酶联免疫吸附法检验血清抵抗素、脂联素,并计算稳态模型胰岛素抵抗指数。结果肥胖儿童组高敏C反应蛋白、胰岛素抵抗指数高于非肥胖儿童组(分别为1.57±0.06mg/L、4.567±2.621和1.38±0.05mg/L、1.70±0.712),空腹胰岛素、最小皮下脂肪厚度、最大腹膜前脂肪厚度、24h平均收缩压、甘油三酯、低密度脂蛋白胆固醇、游离脂肪酸也明显增高(P<0.05);肥胖组高密度脂蛋白胆固醇、脂联素低于非肥胖组(分别为0.27±0.22mmol/L、1.477±0.609mg/L和1.14±0.25mmol/L、2.795±1.124mg/L;P<0.05)。但两组颈动脉内膜中膜厚度、24h平均舒张压、内皮依赖性血管舒张功能无明显差异。体质指数与24h平均收缩压(r=0.43,P=0.006)、高敏C反应蛋白(r=0.461,P=0.018)、胰岛素抵抗指数(r=0.463,P=0.007)、游离脂肪酸(r=0.358,P=0.029)呈正相关,而与脂联素(r=-0.356,P=0.031)呈负相关。结论肥胖儿童导致动脉粥样硬化的危险因素水平明显增高,肥胖儿童已经存在动脉粥样硬化慢性炎症的早期改变,但是还未出现动脉内膜粥样斑块形态学上的改变。

A Study of Risk Factors for Arteriosclerosis in Obese Children

Aim To investigate the effect of obesity on the arteriosclerosis development in children by comparing the risk factors for arteriosclerosis in obese children with those in non-obese children.Methods Fifty-one obese children and thirty-two non-obese children were evaluated for endothelium-dependent arterial dilation,intima-media thickness(IMT)of the common carotid artery,the maximum preperitioneal fat thickness(Pmax)and minimum subcutaneous fat thickness(Smin)by B ultra sonograthy;24 h average systolic blood pressure(SBP)and diastolic blood pressure(DBP)were detected;the serum levels of triglyceride(TG),total cholesterol(TC),blood glucose and free fatty acids(FFA),low density lipoprotein cholesterol(LDLC),high density lipoprotein cholesterol(HDLC)were deteced by chemistry;insulin(FIns),by RIA;adiponectin(AD),resistin by ELISA,and high-sensitivity c-reactive protein(hs-CRP),by scatter nephelomete method.Results The values of Hs-CRP,HOMA-IR,INS,Smin,Pmax,SBP,TG,LDLC,and FFA were higher in the obese children than in the non-obese children(P<0.05),while HDL-C and adiponectin in the obese children were lower than those in the non-obese children(P<0.05).However,no statistical difference was found between the levels of IMT,DBP,and Endothelium-dependent arterial dilation in the obese children and those in the non-obese children(P>0.05).The BMI was correlated with SBP(r=0.43,P=0.006),hs-CRP(r=0.461,P=0.018),HOMA-IR(r=0.463,P=0.007),FIns(r=0.404,P=0.013),FFA(r=0.358,P=0.018),while it was negatively correlated with AD(r=-0.356,P=0.031).However,there was no statistically different relationship between ITM and other biochemical indicators.Conclusions The levels of the risk factors for arteriosclerosis were much higher in obese children than those in non-obese children.The results showed that the chronic inflammation situation of arteriosclerosis has already existed in the obese children,but no morphological change in the endarterium was found.