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目的探讨血清脂联素水平与高胰岛素血症和(或)胰岛素抵抗的联系。方法采用酶联免疫法测定2004-02—2004-12在天津医科大学总院就诊的34例肥胖儿童和31例正常对照的血清脂联素水平。分析血清脂联素与人体参数、体脂分布及糖代谢中各指标的相关关系。结果(1)肥胖组脂联素水平低于对照组(P<0.001)。(2)脂联素与性别、年龄无相关关系;与收缩压、舒张压呈负相关(相关系数分别为r=-0.369,r=-0.405,P<0.01);与BMI、腰臀比和SF呈负相关(相关系数分别为r=-0.330,r=-0.282和r=-0.350,P<0.01);与空腹血糖、空腹胰岛素水平呈负相关(相关系数r=-0.264和r=-0.357,P<0.01);与HOMA-R呈负相关(P<0.01),与HOMA-β无相关关系。(3)多元回归分析表明,HOMA-R是影响脂联素最为显著的因素,R2=0.122;标准化偏回归系数-0.369(P<0.01)。结论肥胖症儿童血清脂联素水平较正常儿童降低。血清脂联素水平的变化,是影响空腹血糖、空腹胰岛素水平、HOMA-R的重要因素。低脂联素血症可能参与胰岛素抵抗的发生。     

肥胖儿童血清抵抗素与胰岛素抵抗、β细胞功能的关系

目的研究不同程度肥胖儿童血清抵抗素与胰岛素抵抗(IR)、胰岛β细胞功能的关系。方法根据体质量指数(BMI)将研究对象分为正常对照组(BMI<22,n=30)、肥胖1组(23≤BMI<30,n=82)和肥胖2组(BMI≥30,n=31)。对3组患儿进行葡萄糖耐量试验,测量空腹血清抵抗素,分别采用稳态模型的胰岛素抵抗指数(HOMAIR)、胰岛β细胞功能指数(HOMAβ)和总体胰岛素敏感指数(WBISI)、30min胰岛素增量与葡萄糖增量比值(△I30/△G30)作为基础和糖负荷后胰岛素敏感性和胰岛β细胞功能的评价指标。结果肥胖儿童糖耐量减低6例(5.3%),2型糖尿病2例(1.8%)。随BMI增加,糖负荷后2h血糖(2hPG)、血糖曲线下面积(AUCg)、空腹胰岛素(FINS)、胰岛素曲线下面积(AUCi)和HOMAIR逐步增高(P均<0.05),WBISI逐步降低(P<0.001);肥胖组HOMAβ和△I30/△G30较对照组明显上升(P均<0.05);肥胖组间无显著差异(P均>0.05);空腹血清抵抗素3组间差异无显著性意义(P>0.05);8例糖耐量异常儿童抵抗素较对照组略高,但无显著差异(P>0.05)。BMI与2hPG、FINS、HOMAIR、HOMAβ、△I30/△G30呈明显正相关(P均<0.05),与WBISI呈高度负相关(P<0.001),抵抗素与上述指标及BMI无明显相关(P均>0.05)。结论肥胖儿童存在IR、糖负荷后血糖水平升高和胰岛β细胞分泌功能上调,随肥胖程度加重,胰岛素敏感性进一步降低,而胰岛β细胞分泌功能无相应增强。循环抵抗素水平可能不是介导儿童肥胖及IR的关键因素,抵抗素的确切作用尚待进一步研究。     

单纯性肥胖症儿童血清内脂素、促酰化蛋白水平测定及其临床意义

目的 探讨血清内脂素(visfatin)和促酰化蛋白(ASP)与单纯性肥胖症儿童发病的关系及其对肥胖症防治的意义.方法 研究对象共86例,男57例,女29例;年龄7～15岁.其中单纯性肥胖儿童40例;超重儿童22例;健康对照儿童24例.采用酶联免疫吸附法检测各组儿童血清visfatin、ASP水平.结果 1.肥胖组血清visfatin与健康对照组和超重组相比,分别增加了49.80％(P＜0.05)、35.88％ (P ＜0.05).肥胖组血清ASP与健康对照组和超重组相比,分别增加了7.34％ (P ＜0.01)和5.57％(P＜0.05).超重组和健康对照组血清visfatin及ASP比较差异均无统计学意义.2.肥胖组体质量指数(BMI)、总胆固醇、三酰甘油、低密度脂蛋白、空腹血糖、空腹胰岛素、胰岛素抵抗指数均高于健康对照组,差异均有统计学意义(P均＜0.05);肥胖组高密度脂蛋白和胰岛素敏感指数明显低于健康对照组,差异均有统计学意义(P均＜0.05);肥胖组BMI、空腹胰岛素、胰岛素抵抗指数均高于超重组,差异均有统计学意义(P均＜0.01).3.相关性分析:血清visfatin与BMI、三酰甘油均呈正相关(r =0.218,P＜0.05;r =0.500,P＜0.01).血清ASP与BMI、总胆固醇和三酰甘油均呈正相关(r=0.268,P＜0.05;r =0.250,P＜0.05;r =0.427,P＜0.01).结论 Visfatin和ASP与肥胖关系密切,均参与肥胖儿童体内脂质代谢紊乱的发生.检测血清visfatin和ASP水平将有助于判断儿童肥胖症的发展趋势,有助于评价肥胖儿童未来发生糖尿病、心血管疾病的危险程度.     

单纯性肥胖儿童血浆内脂素水平与相关因素分析

目的 探讨单纯性肥胖儿童血浆内脂素水平与相关因素的关系.方法 2006年2月至2007年2月在天津医科大学总医院儿科内分泌门诊采用酶联免疫法测定50例单纯性肥胖儿童和30名正常对照的血浆内脂素.并分析血浆内脂素与收缩压、舒张压、体质量指数、体脂百分比、腰围、腰臀比及空腹血糖、空腹胰岛素水平、胰岛素抵抗指数、胰岛素敏感性指数及血脂的相关关系.结果 (1)肥胖组血浆内脂素质量浓度为(32.26±6.83)μg/L,对照组为(25.69±8.05)μg/L,肥胖组明显高于对照组(P<0.01).(2)内脂素与年龄、性别无相关关系;与体质量指数、体脂百分比、空腹血糖和胰岛素抵抗指数呈显著的正相关(相关系数r分别为0.333、0.301、0.486、0.290,P<0.01);与收缩压、舒张压、腰围、腰臀比、空腹胰岛素水平呈正相关(相关系数r分别为0.280、0.278、0.242、0.273、0.221.P<0.05);与胰岛素敏感性指数、高密度脂蛋白呈负相关(相关系数r分别为-0.269、-0.222.P<0.05);与总胆固醇、三酰甘油(甘油三酯)、低密度脂蛋白无相关关系.(3)多元逐步回归分析表明空腹血糖为影响内脂素最为显著的因素,标准化偏回归系数为0.486(P<0.01),R2=0.236.结论 血浆内脂素水平与肥胖程度、脂肪分布、糖、脂代谢密切相关.初步提示内脂素可能与儿童肥胖的发生发展密切相关.     

肥胖儿童血清胰岛素水平对体脂分布及胰岛素抵抗和血脂的影响

目的　探讨肥胖儿童血清胰岛素水平与体脂分布、胰岛素抵抗及血脂的关系。方法　对 6 8例单纯性肥胖儿童依据空腹血胰岛素 (FINS)及空腹血糖 (FBG)水平分为高胰岛素血症组 (HIG) 4 3例和正常胰岛素组 (NIG)2 5例 ,测量FBG、胰岛素 (INS)、血脂 ,计算体重指数 (BMI)、腰臀比、稳态模型胰岛素抵抗指数 (HOMA IR)、敏感指数 (HOMA IAI)、胰岛细胞分泌功能 (HOMA IS)及葡萄糖、胰岛素曲线下面积 (AUCBG、AUCINS)。结果　 (1)HIG组BMI、腰围、腰臀比、HOMA IR、HOMA IS、AUCINS明显高于NIG组 (P <0 0 5、0 0 1、0 0 0 1) ,HOMA IAI低于NIG组 (P <0 0 0 1) ;(2 )HIG组FINS与BMI、腰围、腰臀比、HOMA IR、HOMA IS、AUCINS成正相关 (r =0 316 ,0 32 4 ,0 4 6 4 ,0 835 ,0 5 99,0 5 2 5 ,P <0 0 5 ,0 0 5 ,0 0 1,0 0 0 1,0 0 0 1,0 0 0 1) ,与HOMA IAI成负相关(r =- 0 812 ,P <0 0 0 1) ;(3)两组FBG、AUCBG、血脂差异无显著性 (P >0 0 5 )。结论　高胰岛素血症肥胖患儿体内脂质沉积严重且脂肪分布异常 ,胰岛素抵抗更为严重 ,高胰岛素血症可能为肥胖产生的原因之一。     

单纯性肥胖儿童血浆卡尼汀、游离脂肪酸水平与胰岛素抵抗的相关性

目的了解单纯性肥胖儿童血浆卡尼汀(CT)、游离脂肪酸(FFA)水平与胰岛素抵抗相关参数的关系。方法选择56例确诊为单纯性肥胖的儿童作为研究对象(肥胖组),36例健康体检儿童为健康对照组。采用放射免疫法(RIA)测定二组血浆胰岛素,高效液相色谱法(HPLC)测定血浆CT水平,酶比色法测定血浆FFA及三酰甘油(TG)。计算体质量指数(BMI)及腰臀比(WHR),按稳态模式胰岛素(HOMA-IR)计算其胰岛素抵抗指数(InRI)和胰岛素敏感指数(InSI),应用SPSS13.0软件进行统计学分析。结果肥胖组血浆CT水平为(43.67±12.75)μmol/L,健康对照组为(58.31±21.25)μmol/L,二组比较差异有统计学意义(t=2.566P<0.05)。肥胖组血浆FFA水平为(785.32±284.91)μmol/L,健康对照组为(604.87±136.52)μmol/L,二组比较差异有统计学意义(t=2.143P<0.05)。肥胖组WHR、TG、胰岛素(Ins)水平、InRI与健康对照组比较差异均有统计学意义(Pa<0.05)。血浆FFA与BMI、WHR、TG均呈正相关(r=0.403,0.320,0.406Pa<0.05),与InSI呈负相关(r=-0.364P<0.01);血浆CT与空腹胰岛素(FINS)、InSI呈正相关(r=0.365,0.364Pa<0.01),与WHR呈负相关(r=-0.614P<0.01);肥胖组血浆CT水平与FFA水平呈负相关(r=-0.592P<0.01)。结论肥胖患儿存在明显的脂肪代谢紊乱,血浆FFA及CT水平的变化与胰岛素抵抗密切相关,这些变化可能参与肥胖及肥胖相关并发症的发生。     

罗格列酮对肥胖大鼠外周血瘦素抵抗的影响

目的观察高脂喂养的肥胖大鼠模型瘦素抵抗出现的时间、程度、在肥胖形成过程中的动态变化及与胰岛素抵抗的关系;探讨罗格列酮对商脂肥胖大鼠瘦素抵抗的影响。方法清洁级雄性Wistar大鼠30只按体质量随机分成正常对照组、肥胖组和治疗组。肥胖组和治疗组以高脂饮食喂养20周,制备肥胖模型。治疗组于20周后予以罗格列酮2 mg/(kg·d)灌胃。于实验过程第10、20、24周分别取血检测空腹血糖、空腹胰岛素和血清瘦素。结果肥胖组大鼠血清瘦素水平明显高于正常组、治疗组(P均<0.05);正常组与治疗组无显著差异。肥胖组血清瘦紊水平逐渐升高,第20周显著高于第10周(P<0.01)。血清瘦素与血清胰岛素水平(r=0.427 P<0.05)、三酰甘油(r=0.515 P<0.01)呈显著正相关。结论肥胖存在瘦素抵抗。瘦素抵抗与胰岛素抵抗密切相关,血清瘦素水平是代谢综合征和心血管疾病发展的预报器。罗格列酮治疗在改善胰岛素抵抗的同时,也降低瘦素抵抗的水平。     

单纯性肥胖儿童胰岛素抵抗与肿瘤坏死因子-α的关系

目的探讨单纯性肥胖儿童胰岛素抵抗与肿瘤坏死因子-α(TNF-α)的关系。方法单纯性肥胖患儿50例作为观察组(男23例,女27例);选取同期健康儿童30例为对照组(男14例,女16例)。采用发光免疫法、放射免疫法、快速测血糖法分别对两组儿童的血糖、血胰岛素、血脂和TNF-α进行检测。并作对比分析。结果观察组稳态模型胰岛素抵抗指数(HOMA-IR)、TNF-α及舒张血压(DBP),与对照组比较均明显升高(t=3.939,4.938,3.278 P均<0.01);收缩血压(SBP)、空腹三酰甘油(TC)与对照组比较均明显升高(t=2.536,2.573 P均<0.05);胰岛素敏感指数(HOMA-ISI)观察组明显低于对照组(t=-4.75 P<0.01)。观察组TNF-α与体质量指数(BMI)、TC、HOMA-IR均呈显著正相关(r=0.284,0.328,0.361 P均<0.05)。TNF-α与HOMA-ISI呈显著负相关(r=-0.36 P<0.01)。BMI与HOMA-IR呈显著正相关性(r=0.294 P<0.05)。结论单纯性肥胖儿童存在胰岛素抵抗,血清TNF-α与肥胖儿童的BMI、TC、BP、胰岛素抵抗密切相关,TNF-α可能参与胰岛素抵抗病理生理机制。     

肥胖儿童血清抵抗素变化及其临床意义

目的 探讨饮食控制和运动疗法对肥胖儿章血清抵抗素水平的影响及其临床意义。方法 测定36例肥胖儿童饮食控制和运动治疗前后血清抵抗素、胆固醇（CHO）、甘油三脂（TG）、低密度脂蛋白胆固醇（LDL-C）、空腹和葡萄糖耐量试验（OGTT）2小时血糖、胰岛素,计算胰岛素抵抗指数（HOMA-IR）。结果 肥胖儿童血清抵抗素水平显著高于对照组（P〈0．05）,并与OGTT2小时血糖、胰岛素呈正相关（P〈0．05）;经饮食控制和运动治疗后肥胖儿童血清抵抗素、体重、BMI、血清CHO、TG、LDL-C、空腹和OGTT2小时胰岛素、HOMA-IR显著低于治疗前（P〈0．05）,治疗前后空腹和OGTT2小时血糖差异无显著性（P〉0．05）。结论 肥胖儿童血清抵抗素水平升高,并与OGTT2小时血糖、胰岛素呈正相关,推测将来有可能以检测血清抵抗素水平来了解肥胖儿童有否存在糖耐量受损;饮食控制和运动疗法可使肥胖儿童血清抵抗素降低,胰岛素抵抗减轻。     

单纯性肥胖症儿童糖耐量及胰岛素分泌功能测定

目的　了解单纯性肥胖症儿童胰岛素分泌功能与糖耐量减低 (IGT)的发生。方法　测定单纯性肥胖症儿童 3 0例空腹及餐后血糖、胰岛素水平。如空腹血糖 (FPG) <6.1mmol/L ,服糖后 2h血糖≥ 7.8mmol/L并 <11mmol/L即为IGT ,若服糖后 2h血糖 <7.8mmol/L为糖耐量正常 (NGT)。计算胰岛素敏感性指数。结果　葡萄糖耐量 (OGTT)结果显示 ,单纯性肥胖症例 3 0中 ,IGT 14例 ( 48% ) ;肥胖儿童FPG( 4.92±1.2 3mmol/L)和正常儿童 ( 4.5 1± 0 .5 8mmol/L)无差异 (P >0 .0 5 ) ;空腹胰岛素 (FINS) ( 3 0 .99± 2 7.71) μIU/L水平明显高于正常儿童 ( 10 .2 3± 2 .3 5 ) (P <0 .0 1)。胰岛素敏感性指数 (IAI) ( - 5 .0 2± 0 .2 3 )明显低于正常儿童 ( - 3 .83± 0 .19) (P <0 .0 1)。肥胖儿童IGT组BMI、FINS、FPG较NGT组高 ,无显著性差异 (P >0 .0 5 ) ;服糖 2h胰岛素 (INS 2 )及 2h血糖明显高于NGT组 (P <0 .0 1) ;IGT组ISI(由OGTT计算 )明显低于NGT组 (P<0 .0 0 1)。 3 0例肥胖儿童BMI与FINS、INS2、2h血糖明显正相关 (分别为r =0 .69　P <0 .0 1;r =0 .41　P <0 .0 5 ;r =0 .3 9　P <0 .0 5 ) ,与ISI明显负相关 (r =- 0 .3 8　P <0 .0 5 )。结论　肥胖儿童存在明显的胰岛素抵抗现象 ,且肥胖程度越重 ,机体对胰岛素     

Relationship between insulin resistance and serum levels of adiponectin and resistin with childhood obesity

OBJECTIVE: The aim is to study the relationship between insulin resistance and serum adiponectin and resistin in obese children. METHODS: A total 113 obese and 37 nonobese children were enrolled and serum adiponectin and resistin were measured. RESULTS: Compared with controls, higher insulin resistance by homeostasis model (HOMA-IR) and lower whole body insulin resistance index (WBISI)were found in obese children (all P <0.05). The adiponectin levels in obese children and controls were 3.63 and 5.79 microg/L with a significant difference (P<0.001) while the difference of resistin levels was not significant (P = 0.948). Significant correlations between insulin resistance parameter and age,sexual development, BMI, serum triglyceride, ApoB, LDL-cholesterol, HDL-cholesterol, alanine aminotransferase, uric acid, or adiponectin levels (all P <0.05) were noted. Stepwise multiple regression analysis showed that BMI and adiponectin levels were independent determinants of WBISI. CONCLUSIONS: These results suggest that adiponectin may play a protective role in obese children through decreasing insulin resistance.     

单纯性肥胖儿童黑色棘皮症与胰岛素抵抗性及细胞因子的关系

目的 探讨单纯性肥胖儿童的黑色棘皮症(AN)和体质量指数、胰岛素抵抗性、瘦素、血浆酶原纤维蛋白溶解原活化抑制剂(PAI-1)的关系。方法 单纯性肥胖儿童38例,其中AN阳性17例,测量身高、体质量、腹围、臀围,同时测血胰岛素、瘦素、空腹血糖、PAI-1。结果 AN阳性者肥胖度、腹围、空腹胰岛素、自动动态平衡标准评价胰岛素抵抗指数(HOMA-R)关系有显著差异,AN与体脂肪率间无关。AN阳性肥胖儿中均升高,PAI-1 40μg／L以上,瘦素30 μg／L以上者均为AN阳性。结论　单纯性肥胖儿童,特别是伴AN阳性肥胖儿,要特别注意随访观察2型糖尿病和冠状动脉疾病的发生和发展。     

Insulin resistance and beta cell function in chronically transfused patients of thalassemia major

OBJECTIVE: To assess the glycometabolic function in chronically transfused patients of beta- thalassemia major in terms of glucose tolerance, insulin secretion, insulin resistance index, and beta cell function index and to determine their relationship with clinical and biochemical profile. METHODS: 30 homozygous thalassemia major children (aged 8-15 years) receiving regular blood transfusion and 10 age and sex matched normal children attending a tertiary level hospital were subjected to glucose tolerance test, estimation of fasting plasma insulin level, insulin resistance index and beta cell function index. Liver enzymes, liver size and indicators of iron overload (serum ferritin, total units of blood transfused, splenic size) were recorded. RESULTS: There was no diabetes mellitus or impaired glucose tolerance test in either the cases or the controls. Fasting plasma insulin levels were significantly higher in cases than controls (P = 0.004), and correlated well with indicators of iron overload like total units of blood transfused (r = 0.41, P = 0.03), serum ferritin (r = 0.38, P = 0.038) and splenic size (r = 0.43, P = 0.03). Insulin resistance was higher in cases compared to controls (P = 0.01). It correlated well with age (r = 0.56, P = 0.006), fasting blood glucose (r = 0.8, P = 0.003), fasting plasma insulin (r = 0.95, P = 0.00001), total units of blood transfused (r = 0.52, P = 0.005), serum ferritin (r = 0.4, P = 0.02) and splenomegaly (r = 0.51, P = 0.004). Insulin resistance was higher in patients not on chelation therapy compared with those on chelation therapy (P = 0.003). The beta cell function index was higher in cases compared to the controls, but not of statistic significance (P = 0.077). It did not correlate well with total amount of blood transfused (r = -0.32, P = 0.08), serum ferritin (r = -0.138, P = 0.46), spleen size (r = 0.16, P = 0.36), or chelation therapy (P = 0.98). CONCLUSION: Diabetes mellitus or impaired glucose was not seen in chronically transfused patients of thalassemia major (between 8 and 15 years of age), in our study. Insulin resistance, compensated by hyperinsulinemia, sets in early even before the onset of frank diabetes mellitus and correlated well with age, chelation therapy and indicators of iron overload like total units of blood transfused, splenomegaly and serum ferritin.     

Relationship between resistin and aPAI‐1 levels with insulin resistance in Saudi children

Background: Association of resistin with insulin resistance (IR) in humans is still controversial and few studies have investigated the association of plasminogen activator inhibitor‐1 (PAI‐1) with IR in children. The purpose of the present study was therefore to evaluate serum levels of resistin and active PAI‐1 (aPAI‐1) in Saudi children and their association with the various obesity‐related complications. Methods: In this cross‐sectional study, 73 boys and 77 girls with varying body mass index (BMI) were recruited. They were assessed for anthropometric measures and fasting serum levels of glucose, insulin, lipid profile, resistin, angiotensin II (ANG II) and aPAI‐1. Results: Resistin was positively correlated with hips (r = 0.33, P < 0.01), waist (r = 0.23, P < 0.05) and BMI (r = 0.33, P < 0.01). The association of resistin with the markers of obesity was also significant in girls but lost significance in boys. aPAI‐1 was positively correlated with total cholesterol (r = 0.24; P < 0.01), triglycerides (r = 0.2, P < 0.05), HOMA‐IR (r = 0.26, P < 0.01) and insulin (r = 0.26, P < 0.01). The significant association of aPAI‐1 with IR was also true in girls but lost significance in boys. Conclusion: Resistin is not correlated with IR and further studies are needed to explore the role of resistin especially in childhood obesity. In contrast, increased levels of PAI‐1 may contribute to the risk of cardiovascular diseases related to obesity and insulin resistance in children. The observed gender‐related differences in the association between resistin, aPAI‐1 with obesity markers and IR could be attributed to sexual dimorphism in body fat distribution.     

肥胖儿童伴良性黑棘皮病与胰岛素抵抗19例分析

目的　探讨肥胖儿童伴良性黑棘皮病与胰岛素抵抗及 2型糖尿病的关系。方法2 0 0 3年 6月～ 2 0 0 3年 9月 ,在我院内分泌门诊及病房就诊的体重指数 (BMI)≥ 2 5的肥胖儿童共 76例 ,对其中伴黑棘皮病皮肤改变的 19例 ( 2 5 % )均行皮肤病理活检以明确诊断 ,同时对这些患儿行空腹血糖、空腹血胰岛素水平、空腹血糖 /胰岛素比值 (FGIR)及人体测量学参数 [腰围 /臀围比值(WHR) ,全身体脂含量 (FM)、体脂百分数 (BF % )、体重指数 (BMI) ]等的检测 ,并行葡萄糖耐量试验(OGTT试验 ) ,以探讨肥胖儿童伴良性黑棘皮病与胰岛素抵抗及 2型糖尿病的关系。结果　 19例良性黑棘皮病患儿人体测量学参数包括腰围 /臀围比值 ,全身体脂含量 (FM)、体脂百分数 (BF % )、体重指数 (BMI)及空腹血胰岛素水平明显高于正常对照组 (P <0 0 1) ,空腹血糖 /胰岛素比值 (FGIR) ( 4 2 7± 0 5 3)小于 7,存在明显的胰岛素抵抗 ,其中 1例诊断为 2型糖尿病 ,10例有糖耐量异常。结论　儿童良性黑棘皮病与肥胖、高胰岛素血症 ,胰岛素抵抗及 2型糖尿病密切相关 ,是临床胰岛素抵抗的皮肤标志     

Insulin Resistance during Puberty in Non-obese Japanese Children

We examined whether non-obese Japanese children without diabetes exhibited insulin resistance during puberty. The study subjects were 201 Japanese school students, consisting 95 males and 106 females, aged 11.5 ± 2.6 yr. None of the subjects were obese, with the mean percent of overweight being 0.7 ± 10.5%, or had diabetes at the time of the study. Overnight fasting plasma values of insulin (FIRI) and HOMA-R were measured, with concomitant measurement of the plasma glucose (FPG) levels. The mean FPG, FIRI and HOMA-R values were 89.6 ± 7.3 (70–109) mg/dl, 9.0 ± 3.6 (1.7–24.4) µU/ml and 2.0 ± 0.9 (0.3–5.2), respectively. The mean FIRI value was significantly higher in females than in males (8.3 ± 3.4 vs. 9.6 ± 3.7 µU/ml, p=0.0060). The FIRI and HOMA-R values of the pubertal students were significantly higher compared with those of the prepubertal students (FIRI, 10.0 ± 3.4 vs. 6.5 ± 2.8 µU/ml; HOMA-R, 2.3 ± 0.8 vs. 1.4 ± 0.7; p<0.0001 for both). Similar trends were observed between the two genders. The mean FIRI levels and HOMA-R values were positively correlated with age (FIRI, r=0.280, p<0.0001; HOMA-R, r=0.300, p<0.0001). In conclusion, we demonstrated that the FIRI and HOMA-R values were significantly associated with pubertal development in non-obese Japanese children without diabetes, consistent with the results of studies in white and black children.     

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目的观察二甲双胍治疗对高胰岛素血症肥胖患儿血清脂源性激素脂联素、抵抗素、瘦素水平的影响。方法2004-01—2005-02将武汉市儿童医院和同济医院54例高胰岛素血症肥胖患儿分为轻、中度肥胖组及重度肥胖组,均以二甲双胍治疗12周,测量治疗前后体重、空腹血糖、空腹胰岛素及脂源性激素脂联素、瘦素、抵抗素的变化。结果治疗前轻、中度肥胖组和重度肥胖组高胰岛素血症患儿空腹血糖水平与健康对照组比较差异无显著性(P>0.05),血清胰岛素、瘦素、抵抗素及胰岛素抵抗指数(HOMA-IR)均高于健康对照组(P<0.01),脂联素水平明显低于健康对照组(P<0.01)。二甲双胍治疗12周后与治疗前相比,血清胰岛素水平、胰岛素抵抗指数明显降低(P<0.01),轻、中度肥胖组及重度肥胖组血清瘦素水平分别由治疗前的(24.3±1.8)μg/L、(30.2±5.1)μg/L降低为治疗后的(19.6±6.3)μg/L、(24.7±5.3)μg/L,差异有统计学意义;抵抗素水平分别由治疗前的(16.5±6.0)μg/L、(22.3±5.2)μg/L升高为(22.0±5.1)μg/L、(30.6±11.7)μg/L,差异有统计学意义;轻、中度肥胖组和重度肥胖组血清脂联素水平治疗前分别为(8.4±3.2)mg/L、(6.5±1.2)mg/L,治疗后分别为(8.9±2.3)mg/L、(7.03±3.0)mg/L,治疗前后相比,P>0.05。体重指数(BMI)下降,但差异无显著性。结论二甲双胍能显著改善肥胖患儿胰岛素抵抗。降低血清瘦素水平可能是其改善胰岛素抵抗机制之一,但在对脂源性激素脂联素、抵抗素水平的改善上,有其局限性。     

Alterations of glucoregulation in childhood obesity--association with insulin resistance and hyperinsulinemia

AIM: To study the prevalence of alterations of glucoregulation in childhood obesity. PARTICIPANTS: 250 obese children. Oral glucose tolerance test was performed, serum glucose and insulin were determined, and HOMA-IR was calculated. RESULTS: Impaired fasting glucose (IFG) was found in 1.2% according to World Health Organisation criteria and 4.4% according to the criteria of the International Diabetes Federation. Impaired glucose tolerance (IGT) was found in 13.6%, type 2 diabetes mellitus (DM2) in 2.4%. Frequency of fasting glucose (FG) above 7.0 mmol/l was 1.2%. Basal hyperinsulinemia was increased in 70%, reactive hyperinsulinemia in 88%, frequency of elevated HOMA-IR was 78%. 120' insulin was increased in all cases with abnormal FG, IGT and DM2, HOMA-IR was elevated in 79% of patients with IGT and all patients with abnormal FG and DM2. Significant positive correlations were demonstrated between body mass index and insulin levels. CONCLUSION: Our data show that hyperinsulinemia can successfully compensate for insulin resistance in the majority of the obese children. Since IFG is less frequent than IGT there is a need for performing OGTT to demonstrate abnormality of glucoregulation in obese children.