肥胖儿童青少年出生体重与体块指数及胰岛素抵抗关系的研究

目的 探讨肥胖儿童青少年出生体重（birth weight，BW）与其体块指数（bodymassindex，BMI）及胰岛素抵抗（insulin resistance，IR）之同的关系，以了解宫内营养状况对生后肥胖的影响。方法将500例7～15岁单纯性肥胖青少年按出生体重分成四组：BW≥4000g、3500g≤BW〈4000g、3000g≤BW〈3500g、BW〈3000g，对他们的体块指数、空腹血糖（freeblood glucose，FBG）、空腹胰岛素（freeinsulin，FINS）进行监测，用稳态模式（homeostasis model assessment，HOMA）计算胰岛索抵抗指数（IR=FBG×FINS／22．5），胰岛B细胞分泌指数IS=20×FINS／（FBG-3．5）]，胰岛索敏感指数（IAI=1／（FINX×FBG）]和空腹血糖／空腹胰岛索的比值。结果低出生体重者（BW〈3000g）BMI显著低于其他三组（P〈0．05），出生体重和BMI呈正相关（r=0．127，P〈0．01），男孩出生体重与BMI呈正相关（r=0．136，P〈0．05），女孩出生体重与BMI无相关性（r=0．069，P〉0．05）。BMI与FINS（r=0．270）、HOMA（r=0．259）、HOMB（r=0．108）呈正相关（P〈0．05），与FBG／FINS（r=-0．218）、IAI（r=-0．212）呈负相关（P〈0．05）。结论肥胖儿童青少年的出生体重与其体块指数有相关性，在一定范围内，出生体重大者（BW≥4000g、3500g≤BW〈4000＞g、3000g≤BW〈3500g）较出生体重小者（BW〈3000g）长大后体块指数要大，发生肥胖的风险要高；儿童青少年时期的BMI与胰岛素抵抗密切相关。

Relationship between Body Mass Index, Insulin Resistance and Birth Weight of Obese Children and Adolescents

Objective To explore the relationship between body mass index （ BMI）, insulin resistance （In） and birth weight （BW） of obese children and adolescents so as to know the influence of intrauterine nutrition on postnatal obesity. Methods 500 children and adolescents aged from 7 to 15 with simple obesity were collected and divided into four groups ： BW I〉4000g, 3500g ≤ BW 〈 4000g, 3000g≤BW 〈 3500g and BW 〈 3000g. Body mass index, free blood glucose （FBG） and free insulin （FINS） were monitored. Homeostasis model assessment were applied to computed insulin resistance index （ IR = FBG× FINS/22.5 ） , echylosis of pancreatic β - cell index ｜IS = 20 × FINS/ （FBG-3.5）} , insulin sensitivity index {IAI=I/ （FINX ×FBG） ] and the value of FBG/FINS. Results BMI of low birth weight group （ BW 〈 3000g） was significantly lower than the other three groups （ p 〈 0. 05 ） and BW was positively associated with BMI （ r =0. 127, p 〈0.01）. Boys＇ BW was positively associated with BMI （r=0. 136, p 〈0.05）, however, girls＇ BW was uneorrelated （r= 0. 069, p 〉 0. 05）. Additionally, BMI was positively correlated with FINS （r = 0. 270, P 〈 0. 05 ）, HOMA （ r = 0. 259, P 〈 0. 05 ） and HOMB （r =0. 108, P 〈0. 05） respectively, but negatively correlated with FBG/FINS （r = -0. 218, p 〈0. 05） and IAI （r = -0. 212, p 〉 0. 05）. Conclusion BW of obese children and adolescents is correlated with their BMI. In certain range, BMI with high BW is larger than that with low birth weight （ BW 〈 3000g）. Besides, BMI is closely related to insulin resistance.