丙戊酸对癫疒间患儿血浆肉毒碱浓度的影响

目的探讨丙戊酸治疗是否影响癫疒间患儿血浆肉毒碱浓度.方法 2003年4月至2004年2月在山东大学齐鲁医院儿科癫疒间治疗中心就诊且服用丙戊酸的癫疒间患儿32例,测定其血浆游离的和总的肉毒碱浓度,与对照组进行比较,并对丙戊酸治疗组患儿肉毒碱浓度与年龄、丙戊酸的剂量、疗程、联合用药、合并智力障碍、体重指数等因素作相关性分析.结果丙戊酸治疗组血浆游离的和总的肉毒碱浓度明显低于对照组,但肉毒碱浓度与年龄、丙戊酸剂量、疗程、合并智力障碍、联合用药等因素无显著相关性.丙戊酸治疗后治疗组的体重指数明显高于对照组,肉毒碱浓度与体重指数无显著相关性.结论丙戊酸治疗可引起肉毒碱减少和肥胖程度增加,年幼、丙戊酸剂量增大、疗程延长、合并智力障碍及联合用药并非是肉毒碱减少的危险因素,未发现肉毒碱减少与肥胖程度有关.     

丙戊酸对癫患儿血浆肉毒碱浓度的影响

目的探讨丙戊酸治疗是否影响癫疒间患儿血浆肉毒碱浓度。方法2003年4月至2004年2月在山东大学齐鲁医院儿科癫疒间治疗中心就诊且服用丙戊酸的癫疒间患儿32例,测定其血浆游离的和总的肉毒碱浓度,与对照组进行比较,并对丙戊酸治疗组患儿肉毒碱浓度与年龄、丙戊酸的剂量、疗程、联合用药、合并智力障碍、体重指数等因素作相关性分析。结果丙戊酸治疗组血浆游离的和总的肉毒碱浓度明显低于对照组,但肉毒碱浓度与年龄、丙戊酸剂量、疗程、合并智力障碍、联合用药等因素无显著相关性。丙戊酸治疗后治疗组的体重指数明显高于对照组,肉毒碱浓度与体重指数无显著相关性。结论丙戊酸治疗可引起肉毒碱减少和肥胖程度增加,年幼、丙戊酸剂量增大、疗程延长、合并智力障碍及联合用药并非是肉毒碱减少的危险因素,未发现肉毒碱减少与肥胖程度有关。     

丙戊酸对癫(癎)患儿血浆氨水平的影响

目的研究丙戊酸(VPA)治疗对癫癎患儿血浆氨水平的影响。方法测定2003-04—2004-02在山东大学齐鲁医院儿科癫癎治疗中心就诊且服用VPA的32例癫癎患儿和33例与之年龄匹配的对照儿(儿外科患儿)的血浆氨和游离肉毒碱的浓度,并测定32例癫癎患儿的VPA的血药质量浓度。对服用VPA的癫癎患儿血氨与VPA的剂量、质量浓度、肉毒碱浓度进行相关分析。结果VPA治疗组血氨浓度高于对照组,差异具显著性意义。血氨与VPA剂量、VPA血药质量浓度显著正相关;与游离肉毒碱浓度相关性无统计学意义。联合用药组血氨浓度高于单一用药组。结论VPA治疗可引起血氨浓度增加,且血氨与VPA剂量、VPA血药质量浓度显著正相关,与游离肉毒碱浓度相关性无统计学意义,联合用药可能是血氨增高的危险因素。     

癫癎患儿丙戊酸钠治疗后体重指数和血浆甘丙肽的变化

癫癎是小儿神经系统的常见病,当前抗癫癎治疗的主要目标不只局限于控制发作,而是要全面提高癫癎患儿的生活质量.因此,抗癫癎药物副作用的研究受到了高度关注.丙戊酸钠是一线抗癫癎药,具有疗效高、适应证广的优点,在临床上得到广泛的应用,体重增加是其常见副作用,影响癫癎患者的生活质量.甘丙肽是一个具有广泛生物学活性的多肽,是体内增进食欲的主要调节因子之一[1].丙戊酸钠是否通过调节甘丙肽的浓度影响食欲和增加体重,目前尚未见研究报道.本研究观察了51例癫癎患儿服用丙戊酸钠后体重指数和血浆甘丙肽浓度的变化,探讨丙戊酸钠引起体重变化的可能机制.     

利培酮治疗精神分裂症致肥胖患儿血浆瘦素水平的变化

目的探讨瘦素在经利培酮治疗致肥胖儿童精神分裂症患者血浆中的变化。方法 60例精神分裂症患儿经利培酮单药治疗10周,分别于治疗前、治疗10周进行血糖、血脂、胰岛素、血浆瘦素检测与身高、体质量测量,并对瘦素与上述其他指标进行相关性分析。同时选择在本院行体检的健康儿童60例作为健康对照组。结果治疗前精神分裂症患儿体质量指数(BMI)、血浆瘦素与健康对照组比较差异均无统计学意义(Pa>0.05)。治疗后BMI、血糖、胰岛素、血浆瘦素、胆固醇、低密度脂蛋白胆固醇、极低密度脂蛋白胆固醇均较治疗前显著升高(Pa<0.05)。瘦素与BMI、空腹血糖、胰岛素、胆固醇、三酰甘油、低密度脂蛋白胆固醇、极低密度脂蛋白胆固醇、高密度脂蛋白胆固醇水平均呈显著正相关。结论利培酮治疗精神分裂症患儿致肥胖与瘦素抵抗密切相关,瘦素在利培酮致肥胖中起重要作用。     

瘦体合剂治疗单纯性肥胖并高胰岛素血症

目的探讨瘦体合剂对单纯性肥胖并高胰岛素血症患儿的疗效和对相关指标的影响。方法单纯性肥胖并高胰岛素血症患儿43例随机分成瘦体合剂治疗组、二甲双胍治疗对照组。观测治疗前后体脂、血脂、胰岛索抵抗指数等指标。结果治疗后两组体质量、体质量指数、体脂含量、血脂、瘦素、肿瘤坏死因子-α(TNF-α)、空腹血胰岛素、胰岛素抵抗指数均明显降低;近期疗效治疗组显效、有效及总有效率分别为22.7%、59.1%、81.8%,对照组分别为9.5%、52.4%、61.9%,治疗组显著优于对照组;瘦体合剂短期服用未出现明显不良反应。结论瘦体合剂治疗单纯性肥胖并高胰岛素血症总体疗效明显优于对照组,其机制是通过调节脂质代谢、降低TNF-α瘦素水平以改善胰岛素抵抗实现。     

丙戊酸钠对中性粒细胞氧化代谢与机体氧化应激的影响

目的 探讨长期丙戊酸钠(VPA)口服抗癫(癎)治疗对癫(癎)患儿中性粒细胞氧化代谢及机体氧化应激的影响.方法 选择健康体检儿童30名与癫(癎)患儿26例.观察对照组与癫(癎)组患儿用药前、VPA治疗6个月、12个月后中性粒细胞活化率、刺激指数和血浆中性粒细胞髓过氧化物酶(MPO)活性,并检测血浆抗氧化酶系统超氧化物歧化酶(SOD)、过氧化氢酶(CAT)、谷胱甘肽过氧化物酶(GSH-Px)活性以及脂质过氧化代谢产物丙二醛(MDA)含量等氧化应激指标的变化.结果 VPA治疗后6个月与12个月患儿中性粒细胞活化率分别为(11.50 ±6.52)％与(14.31±5.76)％,均高于对照组(5.90±3.77)％与癫(癎)尚未服药时(7.42±3.15)％(P＜0.01);刺激指数VPA治疗6个月(474.88±118.98)、治疗12个月(416.31±110.00)均低于对照组(544.83±140.83)与癫(癎)尚未服药时(535.23±111.55)(P＜0.05);VPA治疗后血浆MPO活性、MDA含量均较正常对照组与癫(癎)尚未服药时高(P＜0.05或0.01);SOD、CAT活性均较对照组与尚未服药时低(p＜0.05或0.01);GSH-Px活性在各阶段患儿间差异无统计学意义.多元逐步回归分析显示服药疗程、中性粒细胞活化率与血浆MDA含量呈正相关(P＜0.05),血浆SOD活性与MDA含量呈负相关(P＜0.05).结论 VPA治疗致患儿中性粒细胞的活化与机体氧化应激之间具有相关性,而且治疗疗程可能是影响癫(癎)患儿氧化应激损伤的关键因素之一.     

不同抗癫癎药物治疗对癫癎患儿血脂的影响

目的 探讨癫癎患儿血脂水平的改变及应用抗癫癎药物对血脂水平的影响.方法 采用酶测定法分别测定2009年1月-2011年1月在小儿癫癎专科门诊随访治疗的55例癫癎患儿(全面性发作30例,单纯局限性发作18例,不能分类的发作7例)和30例健康体检儿童(健康对照组)血清总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白( HDL-C)、低密度脂蛋白(LDL-C)水平,分析癫癎患儿在单药或联合用药至少0.5a后与健康对照组比较血脂水平的变化.结果 癫癎患儿服用抗癫癎药物后引起其血脂水平的改变,与健康对照组血脂水平相比,血清TG、LDL-C显著升高(Pa＜0.01),HDL-C水平显著下降(P＜0.01);丙戊酸钠( VPA)单药治疗的癫癎患儿与健康对照组相比,TG、LDL-C升高及HDL-C降低,其差异有统计学意义(Pa＜0.05,0.01),而单用VPA与联合用药组之间及两个联合用药组间血脂水平改变的差异均无统计学意义(Pa＞0.05);联合用药组与健康对照组比较,其改变幅度VPA＞ VPA+拉莫三嗪＞VPA+左乙拉西坦,但差异均无统计学意义(Pa＞0.05).结论 癫癎患儿服用抗癫癎药物后存在血脂水平的改变,以单用VPA的改变最大.     

丙戊酸钠对癫(癎)患者体质量、体质量指数、血糖、血清胰岛素水平的影响

目的 探讨丙戊酸钠(VPA)对癫(癎)患儿体质量、体质量指数(BMI)、血糖、血清胰岛素水平的影响.方法 以VPA治疗3个月的30例癫(癎)患者作为研究对象,进行治疗前后自身对比研究,检测患者治疗前及治疗后3个月时体质量、BMI、身高、血糖、血清胰岛素水平,比较治疗前后体质量、BMI、血糖、血清胰岛素、胰岛素抵抗指数变化.利用放射免疫分析法检测其血胰岛素水平.采用SPSS 10.0软件进行统计学分析.结果 癫(癎)患儿治疗后体质量[(15.68±3.82) kg vs (19.64±4.75) kg,t=3.56 P＜0.01]、BMI[(18.29±2.91) kg/m2 vs (20.16±2.71) kg/m2,t=2.13 P＜0.05]、胰岛素(4.42±0.39) mU /L vs (6.89±0.41) mU /L,t=24.7 P＜0.01)、胰岛素抵抗指数(0.96±0.19 vs 1.45±0.21,t=9.4 P＜0.01)均较VPA治疗前明显增高.而血糖水平较治疗前无明显增高[(4.42±0.23) mmol/L vs (4.39±0.35) mmol/L,t=0.39 P＜0.05].结论 VPA治疗可引起癫(癎)患儿体质量、BMI、血清胰岛素水平增高,并导致胰岛素抵抗;诱导胰岛素抵抗可能是VPA患儿体质量增加的原因之一.但对其血糖无直接影响.     

丙戊酸钠对癫癎患儿血小板数量及功能影响研究

目的探讨丙戊酸钠(VPA)对癫癎患儿血小板数量及功能的影响.方法对38例服用不同剂量VPA的癫癎患儿分别于服药前、服药3个月和6个月时检测其血小板数量、血小板聚集率、血栓素B2(TXB2)和6-酮-前列腺素-F1α(6-Keto-PGF1α)的水平.结果服用VPA 3个月与服药前比较,血小板计数明显减少(t=2.824,P<0.01),且与VPA剂量呈负相关;胶原和二磷酸腺苷(ADP)诱导的血小板聚集率显著下降( t =2.153和2.263,P均<0.05),与VPA剂量呈负相关;TXB2显著下降(t =2.373,P<0.05),与VPA剂量不相关;6-Keto-PGF1α无明显变化.服药6个月与3个月比较,上述各指标差异无显著性.全身性发作组与部分性发作组比较,上述各指标无显著性差异.结论 VPA能影响癫癎患儿的血小板数量及功能,影响的程度与VPA剂量相关,与癫癎患儿的发作类型无关.     

Leptin levels in children with insulin dependent diabetes mellitus

Leptin, a product of the ob gene, is a polypeptide hormone produced in adipose tissue that informs the brain about the amount of energy storage of body fat. It has very important effects on neuroendocrine functions and energy expenditure. The aim of our study was to determine leptin levels of children with insulin dependent diabetes mellitus (IDDM), which is known to affect body metabolism, and to investigate the relationship between duration of the disease, insulin dosage, HbA1c levels, body mass index (BMI), serum lipids and IGF-1 levels. Sixteen patients with IDDM (chronological age 13.8 +/- 2.6 years) whose HbAlc levels were 10.2 +/- 1.9 %, BMI 21.2. +/- 2.7 kg/m2, insulin dosage 0.9 +/- 0.4 U/kg/day and duration of the disease 6.7 +/- 2.6 years, and 12 healthy controls (13.4 +/- 2.6 years) were included in the study. Fasting plasma leptin levels were measured by radioimmunoassay method. The mean plasma leptin levels of the patient and the control groups were 19.1 +/- 7.6 ng/ml and 6.1 +/- 2.9 ng/ml, respectively, and significant difference was found between the two groups (p < 0.05). No correlation was found between leptin values and IGF-1, cholesterol, HDL-cholesterol, LDL-cholesterol, triglyceride levels, atherogenic index, insulin dosage or HbA1c levels in the patient group. A weak statistical correlation was determined between BMI and leptin levels in the IDDM group (r = 0.28, p < 0.05). A positive correlation was also found between leptin levels and the duration of the disease (r = 49, p < 0.05). As a result, it seems that leptin levels of children with IDDM differed from the levels of the control group significantly, and that the duration of insulin therapy was responsible for this difference.     

The effects of co-therapy with recombinant human insulin-like growth factor I and insulin on serum leptin levels in adolescents with type 1 diabetes mellitus

We previously demonstrated that in patients with type 1 diabetes mellitus (DM), co-therapy with subcutaneous (s.c.) recombinant human insulin-like growth factor I (rhIGF-I) and insulin improves glycemic control and reduces daily insulin requirements without inducing a significant change in body weight. However, it has been postulated that treatment with IGF-I may promote beneficial changes in body composition. Consequently, we assayed serum leptin, a peptide highly correlated with total fat mass, before and during chronic rhIGF-I administration. We studied 14 adolescents with type 1 DM (age range 12-19 yr). All patients were treated for 12 weeks with twice daily (BID) sc rhIGF-I in combination with standard BID split-mix insulin. At baseline, leptin concentrations were positively correlated with body mass index (BMI) (r(2) = 0.52, p = 0.004), as previously described for non-diabetic individuals. Leptin levels in diabetic females were higher than in diabetic males, and more than two times higher than in non-diabetic female controls. Baseline leptin levels did not correlate with patient age, duration of DM or hemoglobin A1c (HbA1c) measurements. The relationship between leptin concentrations and gender was maintained throughout treatment; however, average leptin levels did not change during 12 weeks of IGF-I + insulin co-therapy. These data suggest that despite treatment-induced improvements in HbA1c and serum IGF-I levels, serum leptin concentrations are unchanged by co-therapy with IGF-I + insulin. Moreover, these results suggest that improved metabolic control with IGF-I therapy is not obtained at the expense of increasing adiposity, a complication seen frequently with intensive insulin therapy.     

瘦素和脂联素在儿童肥胖相关性高血压发病中的作用

目的探讨瘦素和脂联素在儿童肥胖相关性高血压发病中的作用。方法基于北京市儿童青少年代谢综合征研究项目的现况调查结果，非随机选择3 502名6~18岁学龄儿童（其中男1 784名，女1 718名）为研究对象，按照超重（包括肥胖）和高血压状态将研究对象分为4组，正常体重正常血压组（对照组，1 497名）、正常体重高血压组（HBP组，125名）、超重但血压正常组（OB组，1 349名）和超重合并高血压组（OB+HBP组，531名）。通过比较4组人群血清瘦素和脂联素水平，以及瘦素和脂联素与血压之间的相关回归分析，探讨其与肥胖和血压之间的关系。结果超重肥胖人群BMI、血压、胰岛素和瘦素水平显著升高，脂联素水平降低。HBP组与对照组BMI、瘦素、脂联素水平差异无统计学意义。OB组和OB+HBP组与对照组比较，BMI、SBP、DBP、胰岛素和瘦素水平升高，脂联素水平降低，与HBP组比较仍可见BMI、胰岛素和瘦素水平升高，脂联素水平降低。与OB组比较，OB+HBP组BMI和胰岛素水平及男性的瘦素水平明显升高。血压与年龄、BMI、胰岛素、瘦素均呈显著正相关（r=0.260~0.643,P<0.01），与脂联素呈显著负相关（r=-0.171~-0.332, P<0.01）。但在调整胰岛素或BMI后，瘦素、脂联素与血压的相关性减弱或消失。结论 超重人群血压、胰岛素及瘦素水平均高于对照人群，脂联素水平低于对照人群。瘦素、脂联素可能通过肥胖或胰岛素抵抗与血压相关。     

瘦素/脂联素值与肥胖儿童体质量指数及糖脂代谢的关系

目的 探讨瘦素/脂联素(L/A)值与单纯性肥胖儿童体质量指数(BMI)、糖脂代谢及肥胖症发病的关系.方法 单纯性肥胖60例和57例健康儿童,采用放射免疫分析(RIA)法测定其血清瘦素水平;ELISA法测定其血清脂联素、空腹胰岛素(FINS)水平;免疫比浊法测定其血脂各成分.分析并比较血清瘦素、脂联素及L/A值与肥胖儿童BMI、糖脂代谢的相关性.结果 1.肥胖儿童血清瘦素、FINS和三酰甘油(TG)水平与健康对照组相比明显增加;脂联素水平降低,差异均有显著性(Pa＜0.05,0.01).2.单纯性肥胖儿童瘦素与BMI、FINS、TG水平均呈显著正相关(r=0.408,0.301,0.301 Pa＜0.05,＜0.01);脂联素水平与BMI、FINS、TG均呈显著负相关(r=-0.360,-0.413,-0.258 Pa＜0.01,＜0.05).3.L/A值与BMI、FINS、TG呈显著正相关(r=0.780,0.764,0.601 Pa＜0.001).结论 血清瘦素和脂联素与肥胖儿童的发病有关,可作为儿童肥胖的监控指标;L/A值较单独瘦素、脂联素更能反映肥胖症儿童的代谢状况,可为肥胖症儿童糖脂代谢提供更为有效的监测指标.     

No relationship between leptin and cortisol in obese children and adolescents

Recent findings have shown that leptin downregulates the steroid producing system in the adrenal. We studied the interactions of leptin, insulin and cortisol in obese children and adolescents at different stages of maturation. In 44 boys (age 11+/-3.1 yr, body mass index [BMI] 29+/-5.3 [mean +/- SD]) and 35 girls (age 11.4+/-2.6 yr, BMI 29+/-4.3), blood levels of leptin, insulin, cortisol, and glucose were determined. Fat mass (FM) was calculated by bioelectrical impedance. No significant differences were found between boys and girls with respect to humoral and anthropometric characteristics. When children were divided according to maturation stage (prepubertal, pubertal, and late/postpubertal) insulin was higher in the more mature groups (p<0.01) and leptin was higher in the pubertal group (p=0.03). In the prepubertal and pubertal groups, the expected positive relationship between adiposity and leptin was found although the magnitude of this association decreased with maturity. In none of the groups studied was cortisol significantly correlated to leptin. Insulin (p=0.03) and glucose (p=0.01) were positively associated with cortisol in the prepubertal group after adjustment for adiposity. However, in the pubertal group an inverse correlation was found between insulin and cortisol (p=0.03), and between insulin and glucose after control for adiposity. In the late/ postpubertal group, no significant correlations were found between estimates of adiposity and humoral parameters even after adjustment for gender. Stepwise multiple regression failed to detect a significant influence of cortisol to explain the variation in leptin, and vice versa. BMI contributed to the variation in leptin (adj. R2 =0.275, p<0.0001), and glucose added 5% to the variation in cortisol (p=0.03). The results do not confirm the inverse association between leptin and cortisol found in adults. Although BMI reflects levels of leptin, it is likely that several other factors in conjunction with fatness modulate the relationship with leptin. Whether leptin per se exerts an influence on the hypothalamic-adrenal-adipo axis remains to be investigated in longitudinal studies.     

儿童肥胖与C-反应蛋白瘦素胰岛素敏感指数的相关性研究

目的：探讨儿童肥胖与超敏C反应蛋白(hsCRP)、瘦素(LP)、胰岛素敏感指数(ISI)的相关性。方法：抽样调查湘潭市13702名2～18岁儿童及青少年，将69名肥胖自愿者及30名年龄、性别相匹配的自愿受试者分为两组，分别测体重指数(BMI)、hsCRP，LP，空腹血糖(FPG)、空腹胰岛素(INS)，计算ISI，比较两组差异及各指标的相关性。结果：肥胖组hsCRP，INS，LP显著高于对照组(P<0.01)，ISI显著低于对照组(P<0.01)；BMI与hsCRP，LP，INS呈显著正相关(P<0.05～0.01)，与ISI呈显著负相关(P<0.01)，hsCRP与FPG，INS呈显著正相关(P<0.05～0.01)，与ISI呈显著负相关(P<0.01)；LP与INS，BMI呈显著正相关(P<0.01)，与ISI呈显著负相关(P<0.01)。结论：肥胖儿童存在胰岛素抵抗(IR)及瘦素抵抗(LR)，同时CRP，LP等炎症因子在肥胖发病过程中起重要作用。     

The relationship between different subcutaneous adipose tissue layers, fat mass and leptin in obese children and adolescents

We studied the relationships of subcutaneous adipose tissue layers (SAT-layers), body fat mass (FM) and waist-to-hip ratio (WHR) with leptin in obese children and adolescents. Twenty-nine obese children and adolescents (12 boys: age: 11.3 +/- 3.7 yr; body mass index [BMI]: 28.5 +/- 4) and 17 girls (age: 12.2 +/- 2.2 yr; BMI: 29.8 +/- 4.7) (mean +/- SD) were studied. FM was estimated by bioelectrical impedance. SAT-layers were determined at 15 different body sites from 1-neck to 15-calf by the Lipometer optical device. Leptin and insulin were determined by RIA. Maturity was associated with a greater thickness of certain SAT-layers from the upper body and with a lower thickness of SAT-layers from the abdominal region and lower extremities. Significant correlations were found for all estimates of adiposity and leptin (all p<0.001). Waist and hip circumferences were not correlated to leptin after adjustment for FM. SAT-layers from the upper body were significantly and positively correlated to leptin. Multiple regression analysis revealed FM as a main contributor to the variation in leptin (R2=0.53, p<0.0001). FM together with SAT-layers 5-front chest and 13-rear thigh explained 72% of the variation in leptin (p<0.0001). In a body fat distribution model, hip circumference together with SAT-layers 4-upper back and 2-triceps explained 75% of the variation in leptin (p< 0.0001). The results suggest that SAT-layers and their topography are main determinants for leptin in obese children and adolescents. Maturity in obese children is associated with higher values of upper body SAT-layers and lower values of abdominal and lower extremities SAT-layers. Whether leptin is under the control of certain subcutaneous adipose tissue depots from the upper body remains to be elucidated by longitudinal studies.     

Insulin resistance and ferritin as major determinants of abnormal serum aminotransferase in severely obese children.

OBJECTIVES: Liver involvement is a common complication of obesity related in part to insulin resistance. The role of ferritin has not been investigated in children. The aim was to determine the prevalence of liver enzyme abnormalities in severely obese children and to look for relationships between fat mass distribution, insulin resistance, and plasma ferritin. METHODS: 197 children with severe obesity (defined as a body mass index Z-score (BMI-Z) > 3.0) were studied prospectively from 2001 to 2004. Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) values were measured, as well as anthropometric characteristics: blood pressure; body composition by dual energy X-ray absorptiometry, and plasma fasting glucose, insulin, leptin, lipid, and ferritin concentrations. RESULTS: Serum ALT and AST values were abnormal in 23 (11.7%) and 13 (6.6%) children, respectively. By univariate analysis, serum ALT and AST values were positively correlated with android fat mass distribution (P < 0.0001 and P = 0.005, respectively) after adjustment for age, sex, ethnicity, and Tanner stage. Using the same model, a positive correlation and a positive trend linked plasma ferritin to serum AST (P = 0.02) and serum ALT (P = 0.06), respectively. Serum ALTwas positively correlated to insulin resistance (P = 0.03). Using a multivariate model, with the android/gynoid fat mass ratio as an additional independent variable, ferritin remained correlated with serum AST and ALT (P = 0.001 and P = 0.008, respectively). CONCLUSIONS: Abnormal serum aminotransferase values are uncommon in severely obese children in France. Android fat mass distribution, insulin resistance, and higher ferritin concentrations are significantly associated with liver abnormalities in our cohort.     

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。     

Changes in circulating levels of adiponectin and leptin in children during the first two years of life

AIM: Adiponectin, leptin and insulin play an important role in the control of growth and glyco-metabolic homeostasis both during pre- and post-natal life. In order to find out markers indicative of post-natal growth, we evaluated circulating levels of these growth factors in full term small for gestational age (SGA) children, during the first 2 years of life, correlating them with the auxological parameters. METHODS: Fourteen SGA (8 males and 6 females) and 16 AGA (appropriate for gestional age) infants (7 males and 9 females) have been included in this study, recording length, weight, body mass index (BMI), adiponectin, leptin and insulin levels at birth. In SGA subjects, these biochemical and clinical parameters have also been evaluated at the first and at the second year of age. RESULTS: AGA and SGA adiponectin and insulin levels at birth did not show statistically significant differences, while leptin concentrations were significantly (P=0.011) lower in SGA children (median 418.49, range 157.68-903.67 pg/mL) in comparison with AGA ones (median 811.71, range 312.50-3085.95 pg/mL). CONCLUSIONS: In conclusion, at birth adiponectin and insulin levels do not differ between AGA and SGA subjects while leptin concentrations are significantly lower in SGA infants and positively correlated to the birthweight.