兰州市儿童肥胖与睡眠障碍的相关性分析

目的 调查兰州市儿童肥胖与睡眠障碍的流行情况及相互关系。方法 采用分层整群随机抽样的方法在甘肃省兰州市4个区选取3 283名小学生,进行体格检查和睡眠问卷调查,选出符合睡眠障碍和符合肥胖标准的两组儿童作为研究对象,同时随机选出既无睡眠障碍也无肥胖的健康儿童200名作为对照组。结果 3 283名儿童中,肥胖检出率为5.76%（189/3 283）,肥胖合并睡眠障碍的儿童占42.3%（80/189）。睡眠障碍检出率为16.24%（533/3 283）,睡眠障碍儿童中肥胖的检出率为24.6%（131/533）。肥胖儿童中,打鼾是最常见的睡眠障碍;肥胖合并睡眠障碍儿童中,阻塞性睡眠呼吸暂停低通气综合征的检出率为45%（36/80）。肥胖儿童睡眠障碍的检出率（42.3%）明显高于体重正常儿童（20.0%,40/200）,差异有统计学意义（P < 0.01）。结论 兰州市儿童肥胖和睡眠障碍之间关系密切,互为影响因素。     

儿童睡眠呼吸暂停的诊断及治疗进展

睡眠呼吸暂停包括阻塞性、中枢性及混合性睡眠呼吸暂停。目前有5.7％的儿童患有阻塞性睡眠呼吸暂停综合征,其危害包括影响生长、发育、认知及行为等方面,同时会增加心脏血管疾病的风险。因此关注阻塞性睡眠呼吸暂停综合征儿童早期的诊断及治疗更有意义。阻塞性睡眠呼吸暂停首选的治疗是扁桃体切除术,其他治疗包括连续的正压通气、抗炎治疗、气道调节器及咽腔矫正器等。中枢性睡眠呼吸紊乱与呼吸中枢不成熟及发育异常有关。中枢性呼吸暂停可能是遗传性的,或者是后天获得性的,因此中枢性呼吸暂停的治疗主要是病因学治疗。     

肥胖儿童阻塞性睡眠呼吸暂停的临床特征

目的 研究肥胖儿童合并阻塞性睡眠呼吸暂停(obstructive sleep apnea,OSA)的临床特征.方法 对在深圳市儿童医院呼吸科行多导睡眠监测的肥胖并诊断为OSA的33例7～15岁儿童的临床资料进行回顾性分析,并选取50例体重正常的、性别及年龄相匹配的OSA患儿作为对照组.结果 33例合并肥胖的OSA儿童中...     

Early cerebrovascular disease in a 2-year-old with extreme obesity and complete metabolic syndrome due to feeding of excessively high amounts of energy

A 2-year-old morbidly obese boy presented with early manifestation of vascular disease associated with several obesity-related features of the metabolic syndrome due to massive overfeeding. Ultrasound of the carotid arteries showed significant thickening of the intima media, perfusion magnetic resonance spectroscopy indicated cerebral microcirculation disturbance, and echocardiography revealed left ventricular hypertrophy. Thorough assessment of morbidly obese children seems to be of importance from early childhood on. Studies evaluating the prevalence of obesity-related metabolic and vascular comorbidities in very young morbidly obese children are warranted.     

Growth hormone and respiratory compromise in Prader-Willi Syndrome

Recombinant human growth hormone (rhGH) therapy in Prader-Willi syndrome (PWS) causes increased basal metabolic rate and oxygen consumption, and hence increased ventilatory load. The case of an adolescent with PWS who experienced respiratory deterioration with an increase in rhGH and improvement with cessation of therapy is reported.     

Liver dysfunction in paediatric obesity: a randomized, controlled trial of metformin

AIM: In a previous study we showed that metformin reduced BMI z-scores and fasting glucose and insulin concentrations, and increased whole body insulin sensitivity in obese adolescents with fasting hyperinsulinemia and a family history of type 2 diabetes. We analyzed the data from this study to determine (a) if metformin reduced serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) concentrations during the 6-month trial, and (b) if the response to pharmacotherapy varied along gender or ethnic lines. METHODS: The 6-month trial was randomized, double blinded and placebo controlled; a total of 14 metformin-treated (500 mg bid) and 15 placebo-treated subjects completed the study. There were no dietary restrictions. RESULTS: In obese adolescents fed ad libitum, metformin (a) prevented the rise in ALT concentrations that were observed in placebo-treated subjects at the 3 to 5 month time-points (p < 0.05); (b) reduced (p < 0.01) the percentage of all ALT values exceeding 40 U/L; and (c) caused a modest (10%) but statistically significant (p < 0.05) reduction in serum ALT in Caucasian subjects. Metformin had no effect on ALT levels or the ALT to AST ratio in the five African American adolescents enrolled in the study but reduced their fasting insulin concentrations from 26.1 to 19.5 muU/mL (p < 0.05). CONCLUSIONS: Our findings suggest that metformin might reduce the rates or severity of liver dysfunction in selected high-risk adolescents.     

Respiratory problems in children with Down syndrome

Down syndrome is associated with a significant health burden, which is particularly apparent in young children who will frequently present with cardiac and respiratory problems. Respiratory presentations include problems related to structural abnormalities of the airways and lungs, glue ears, recurrent lower respiratory tract infections and obstructive sleep apnoea. These conditions are readily identifiable and able to be treated. An awareness of the breadth of respiratory problems and a plan to monitor patients with Down syndrome for their development has the potential to improve outcomes.     

Dramatic impact of morbid obesity on child lung development

ObjectiveTo assess the respiratory function and sleep characteristics of obese adults and children.MethodsAll patients with non-syndromic, severe obesity (BMI ≥ 3 z-scores for children and ≥ 40.00 kg/m² for adults), referred for pulmonary function tests at Lille University Hospital, were retrospectively included.ResultsA total of 69 children (mean ± SD BMI 36.8 ± 6.7 and mean BMI z-score 4.7 ± 1.0) and 70 adults were included (mean BMI 45.7 ± 6.2). Metabolic syndrome was diagnosed in 13 children (26%) and 40 adults (80%). Reduced lung volumes were observed in 34 children (50.0%) and 16 adults (24.0%) and both the mean functional residual capacity (FRC) and the mean residual volume (RV) were lower in children than in adults (FRC: ?1.7 ± 2.1 z-score in children vs. ?1.0 ± 1.1 in adults, P = 0.026; and RV: ?0.8 ± 1.2 z-score in children vs. ?0.1 ± 1.1 in adults, P = 0.002). The prevalence of severe obstructive sleep apnea syndrome was greater in adults (40.7% vs. 18.8%, P = 0.007). Children had a higher average oxygen saturation (median of 96.0% [91.0–98.0] vs. 93.0% [76.0–97.0] in adults, P < 0.0001).ConclusionObesity has consequences for lung volumes in children; however, a longitudinal study is needed to determine the impact on pulmonary expansion and growth.     

The metabolic syndrome in children and adolescents

The metabolic syndrome is a constellation of metabolic abnormalities that result in an increased risk for type 2 diabetes mellitus and cardiovascular disease in adults. It emerges when a person’s predisposition for insulin resistance is worsened by increasing central obesity and is largely confined to the overweight population. The United States National Cholesterol Education Program’s Adult Treatment Panel III report proposed a set of criteria for the clinical diagnosis of metabolic syndrome in the adult population. A uniform definition for the paediatric population is lacking. Despite this, several studies have demonstrated that features of the syndrome develop in childhood and that the syndrome is present in up to 30% of obese children (body mass index at or above the 95th percentile). Ninety per cent of obese children meet at least one of the five criteria. The degree of abnormality is related to the body mass index, waist circumference and fasting insulin levels. There appears to be a genetic predisposition to the development of the syndrome and certain ethnic groups are at increased risk. The intrauterine environment also appears to play a role. Insulin resistance should be targeted for treatment through exercise and dietary intervention. The role of pharmacotherapeutic agents remains unclear. A uniform definition of the metabolic syndrome for paediatric patients needs to be created. Early intervention should be instituted because many of the features of the syndrome track from childhood into adulthood.     

血浆促酰化蛋白水平与儿童青少年肥胖和代谢综合征的关联性分析

目的探讨儿童青少年血浆促酰化蛋白（ASP）水平与肥胖及代谢综合征（MS）的关系。方法以2004年北京市儿童青少年代谢综合征（BCAMS）调查总样本中1 603名6~18岁儿童青少年为研究对象。采用中国肥胖问题工作组推荐的标准诊断超重和肥胖。符合下述5项指标中的3项及以上者诊断为MS：①腹型肥胖（腰围≥P90）;②高血压（≥P90）;③高密度脂蛋白胆固醇≤1.03 mmol·L-1;④三酰甘油≥1.24 mmol·L-1;⑤高空腹血糖（≥5.60 mmol·L-1)。采用ELISA法检测血浆ASP水平,免疫透射比浊法检测补体3（C3）水平。采用方差分析比较超重、肥胖及MS儿童青少年的血浆ASP水平,多因素Logistic回归分析血浆ASP水平与超重、肥胖及MS的关系。结果1 603名研究对象中男性873名（54.5%）、女性730名（45.5％）;超重和肥胖者分别为291名（18.2%）和709名（44.2%）;MS为376名（23.4%）。正常体重、超重和肥胖组MS检出率分别为2.2%(13/603名)、15.5%(45/291名)和44.9%(318/709名)。正常体重组血浆ASP水平男性低于女性,差异有统计学意义（t=2.527,P<0.05）。正常体重、超重和肥胖组血浆ASP的几何均值（P25~P75）,男性分别为37.52(22.36~64.58)、57.88(34.10~95.11)和60.63(35.30~109.72) nmol·L-1;女性分别为44.16(27.27~74.72)、60.25(35.68~113.15)和66.68(44.56~113.97) nmol·L-1,均呈逐渐升高趋势（男性：F=34.329,P<0.001;女性：F=22.246,P<0.001）。C3水平仅在肥胖女性中升高（P<0.01）。血浆ASP水平随MS组分聚集的数目增加而升高（男性：F=16.422,P<0.001;女性：F=9.661,P<0.001）,与高血压、腹型肥胖和高空腹血糖的关系尤为密切。血浆ASP水平升高与儿童青少年超重、肥胖和MS的患病风险密切相关,相对于最低5分位值,位于最高5分位值的ASP水平与超重、肥胖和MS关系的OR值(95%CI)分别为3.90(2.38~6.39)、6.05(4.06~9.01)和2.89(1.93~4.33)。结论超重、肥胖和MS儿童青少年血浆ASP水平明显升高,血浆ASP水平可能对儿童青少年超重、肥胖和MS的发生具有较好的预测价值。     

Craniofacial differences according to AHI scores of children with obstructive sleep apnoea syndrome: cephalometric study in 39 patients

Background Cephalometry is useful as a screening test for anatomical abnormalities in patients with obstructive sleep apnoea syndrome (OSAS).Objective To evaluate comprehensively the cephalo metric features of children with OSAS, with or without adenotonsillar hypertrophy, and to elucidate the relationship between cephalometric variables and apnoea-hypopnoea index (AHI) severity.Materials and methods The study population consisted of 39 children, aged 4–12 years, with OSAS. Cephalometry was analysed using 11 measurements of the bony structures, their relationships and the size of the airways. Additionally, adenoid and tonsillar hypertrophy were graded.Results Cranial base angles (BaSN and BaSPNS) were found to correlate with increasing levels of AHI scores (P<0.001). Protrusion of the maxilla (SNA) and mandible (SNB) did not correlate with AHI scores (P>0.05). The length of the mandibular plane (GnGo) and the minimal posterior airway space (MPAS) were inversely correlated with AHI scores (P<0.001). There was positive correlation between MPAS and GnGo (r=0.740, P<0.001), and negative correlation between MPAS and gonial angle (ArGoGn) (r=–0.541, P<0.001). There was significant correlation between cephalometric data and adenotonsillar hypertrophy concerning BaSN, BaSPNS, ArGoGn, GnGoH, BaN-GnGo, MPAS, GnGO and MPH (P<0.001).Conclusions There is significant correlation between cephalometric data and AHI score severity in children with OSAS. Adenotonsillar hypertrophy affects the cephalometric measurements adversely. The study clearly mandates the institution of early and effective therapy of adenotonsillar hypertrophy in children with OSAS.     

肥胖儿童黑色棘皮病与脂肪因子和代谢综合征的关系

目的 了解肥胖伴黑色棘皮病(AN)患儿代谢特点及血清脂肪因子水平,探讨AN 对代谢综合征的预测价值。方法 将2012 年2 月至2013 年6 月收治的109 名肥胖儿童分为伴AN 组(n=44)和无AN 组(n=65),同期选取年龄、性别相匹配的健康儿童做为对照组(n=47)。采用ELISA 法检测血脂联素、瘦素、肿瘤坏死因子α 和视黄醇结合蛋白4 的水平,并对代谢综合征的危险因素进行多元logistic 回归分析。结果 肥胖伴AN 组腰臀比、收缩压、血甘油三酯、空腹胰岛素、胰岛素抵抗指数均较肥胖无AN 组和对照组升高(P<0.05)。肥胖伴AN 组和肥胖无AN 组脂联素水平均较对照组降低,肥胖伴AN 组瘦素水平较肥胖无AN 组和对照组明显升高(P<0.05)。Logistic 回归提示伴发AN(OR=3.469,95%CI:1.518~7.929)和高BMI(OR=7.108,95%CI:2.359~21.416)是代谢综合征的独立危险因素(P<0.05)。结论 AN 是胰岛素抵抗的皮肤标志,与脂肪因子分泌异常密切相关,降低AN 发生率和BMI 将减少代谢综合征的发生。