肥胖儿童血浆脂联素与肿瘤坏死因子-α的变化及意义

目的儿童肥胖症与血浆脂联素（ADPN）和肿瘤坏死因子-α（TNF-α）水平的变化密切相关。该文通过分析肥胖儿童血浆ADPN和TNF-α的变化及其相互关系，探讨儿童肥胖症的发病原因，为儿童肥胖症的预防提供科学依据。方法265名儿童随机分为肥胖组（147人）和正常对照组（118人），分别测定腰围（WC），臀围，腰臀比（WHR），体脂百分比（%BF），收缩压（SBP），舒张压（DBP），甘油三酯（TG），总胆固醇（TC），高密度脂蛋白胆固醇（HDL-C），低密度脂蛋白胆固醇（LDL-C），空腹血糖（FBG），空腹胰岛素（FINS），ADPN，TNF-α，计算稳态模型胰岛素抵抗指数（HOMA-IR），并分析ADPN，TNF-α与体质量指标、糖脂代谢指标及二者的相关关系。结果①肥胖组儿童ADPN水平低于正常组儿童（P<0.05），且与TNF-α，BMI，WHR，HOMA-IR，%BF，FINS，SBP，TG呈显著负相关（均P<0.05）；②肥胖组儿童TNF-α水平高于正常组儿童(P<0.01)，且与BMI，WHR，%BF，FINS，HOMA-IR，TG，SBP呈显著正相关（P<0.01），与HDL（P<0.05）呈负相关；③多元逐步回归分析显示ADPN，BMI和TNF-α是影响BF%的主要因素（R2=0.926），且ADPN和TNF-α的交互作用有统计学意义。结论 肥胖儿童ADPN水平显著下降、TNF-α水平显著升高，且均是影响儿童体脂的主要因素。ADPN与TNF-α的交互作用提示二者在机体内可相互影响，共同参与儿童肥胖的形成。［中国当代儿科杂志，2009，11（1）：47-50］

Plasma levels of adiponectin and tumor necrosis factor-alpha in children with obesity

Objective To examine plasma adiponectin (ADPN) and tumor necrosis factor-alpha (TNF-α) levels and their correlation in children with obesity in order to investigate the roles of both in the development of childhood obesity.Methods One hundred and forty-seven children with obesity and 118 normal children who were randomly sampled from five primary schools from the Kaifu District in Changsha were enrolled. Physical shape indexes,including height, weight, waist circumference, hip circumference, and waist to hip ratio (WHR) were measured. Body mass index (BMI) was calculated. Blood pressure was measured. Percentage of body fat (%BF) was measured with dual energy X-ray absorptiometry. Plasmal levels of ADPN and TNF-α were detected using ABC-ELISA. Blood concentrations of triglycerides (TG), total cholesterol (TC), high density lipoprotein-cholesterol (HDL-C) and low density lipoprotein-cholesterol (LDL-C) were measured by automatic biochemistry analyzer. Fasting blood glucose level was measured by glucose oxidase method. Fasting blood insulin level was assayed by radioimmunity. Homeostasis model assessment for insulin resistance (HOMA-IR) was performed.Results Plasma ADPN levels in obese children significantly decreased compared with those in normal children (8.12±2.54 mg/L vs 12.22±4.68 mg/L; P<0.05), and had a negative correlation with plasma TNF-α levels, BMI, WHR and HOMA-IR (P<0.01), and with %BF, fasting insulin, systolic blood pressure and TG (P<0.05). Plasma TNF-α levels in obese children significantly increased compared to normal children (171.38±34.33 ng/L vs 91.07±21.60 ng/L; P<0.01) and positively correlated with BMI, WHR, %BF, fasting insulin, HOMA-IR, TG and systolic blood pressure (P<0.01), and negatively with HDL (P<0.05). Multiple stepwise regression analysis showed that ADPN, BMI and TNF-α were main influential factors for %BF (R2=0.926, P<0.01). There was a significant interaction between ADPN and TNF-α (P<0.05).Conclusions Plasma ADPN levels decreased and plasma TNF-α levels increased in children with obesity and both were main influential factors for %BF in children. There was an interaction between ADPN and TNF-α, suggesting that they both participate in the development of childhood obesity.