肥胖儿童血清脂联素水平与代谢综合征、早期动脉粥样硬化的相关性研究

目的 研究脂联素在肥胖儿童极早期动脉粥样硬化形成过程中所起的保护性作用,评价血清脂联素水平对儿童代谢综合征的诊断价值.方法 选择176例肥胖和88名非肥胖年龄9～12岁的儿童,酶联免疫法(ELISA)检测血清脂联素水平,收集身高、体重、腰围、血压、胰岛素、超敏C反应蛋白(hsCRP)、血脂、血糖等临床资料,计算稳态模型评估的胰岛素抵抗指数(HOMA-IR).超声测量颈动脉内中膜层厚度(IMT)、颈动脉血管顺应性(CAC)、内皮依赖的血管舒张功能(FMD)和最大的腹膜前脂肪厚度(Pmax).结果 (1)脂联素与肥胖指标、血压、低密度脂蛋白胆固醇、空腹胰岛素、HOMA-IR、hsCRP、IMT呈显著负相关(P<0.05或P<0.01),与甘油三酯、空腹血糖、CAC、高密度脂蛋白胆固醇(HDL-C)、FMD无显著相关性(P>0.05).(2)以脂联素水平7.060 mg/L为切点,<7.060 mg/L的儿童发生代谢综合征的危险是>7.060 mg/L的4.43倍.(3)用血清脂联素水平判断代谢综合征诊断的敏感性,曲线下面积为0.769(95%CI0.714～0.816,P<0.01).(4)根据血清脂联素水平将肥胖儿童分为高、中、低3组,重度肥胖、内脏脂肪积聚、高血压、高胰岛素血症、低HDL-C、代谢综合征患病率3组间比较有显著性差异(P<0.05).结论 提高肥胖儿童血清脂联素水平有助于预防极早期动脉粥样硬化的发生.脂联素越低的儿童,患代谢综合征的可能性似越大.

Association of serum adiponectin level with metabolic syndrome and early atherosclerosis in obese children

Objective To evaluate the protective effect of adiponectin in early atherosclerosis and the diagnostic value of adiponectin in metabolic syndrome in obese children. Methods Total 176 obese children and 88 normal weight children aged 9-12 years were included in the present study. All participants underwent hematologic and biochemical tests including serum adiponectin, high sensitivity C-reactive protein (hsCRP),fasting blood glucose, insulin, and plasma lipids. Homeostasis model assessment of insulin resistance (HOMA-IR)was calculated. Noninvasive ultrasound measurement including intima-media thickness of the common carotid artery(IMT), brachial flow-mediated dilatation (FMD), carotid artery compliance (CAC), and the maximum fatthickness ahead of peritoneum (Pmax) were obtained to investigate arterial mechanical properties and endothelial function. Results (1) The level of adiponectin was negatively correlated with obese index, blood pressure,fasting insulin, hsCRP, HOMA-IR, and IMT(P<0.05 or P<0. 01 ); but not with triglyceride, fasting blood glucose, CAC, high-density lipoprotein-cholesterol (HDL-C), and FMD. (2) The risk of metabolic syndrome increased 3.43 times in children with adiponectin level <7. 060 mg/L compared with ＞7. 060 mg/L. (3)Receiver operating characteristic( ROC ) curve was used to choose the optimal cutpoint of adiponectin to identify obese children with the metabolic syndrome. The area under the curve (AUC) for adiponectin to discriminate the sensitivity of metabolic syndrome was 0. 769 (95% CI0. 714-0.816, P< 0. 0 1 ). (4) The obese children were divided into three groups according to the cut-off value for adiponectin (high, middle, low groups). There were significant differences in the prevalences of severe obesity, visceral fat accumulation, hypertension, insulinemia,low HDL-C, metabolic syndrome among three groups (P<0.05). Conclusions High levels of serum adiponectin could prevent early stage of atherosclerosis. The lower the adiponectin level, the higher the incidence of metabolic syndrome.