单纯性超重、肥胖青少年血清脂联素、瘦素、游离脂肪酸及炎症因子水平变化及相关性分析

目的探讨单纯性超重、肥胖青少年血清脂联素、瘦素、游离脂肪酸（FFA）、超敏C-反应蛋白的水平变化及其与糖、脂代谢的相互关系。方法按中国肥胖问题工作组发布的中国学龄儿童青少年超重、肥胖筛查体重指数值分类标准，随机选择15岁青少年单纯性肥胖组（组1）77例、超重组（组2）120例和正常对照组（组3）109例，测定空腹血清脂联素、瘦素、游离脂肪酸（FFA）、超敏C-反应蛋白（hs—CRP）、胰岛素（Fins）、血糖（FBG）血脂谱及临床基本资料。结果空腹血糖在3组间无显著性差异（P=0．152）。组3至组1的甘油三酯（TG）呈梯度升高，高密度脂蛋白胆固醇（HDL—C）呈梯度下降，各组间差异显著（P〈0．001）。组3至组1的FFA、hs—CRP、Fins、胰岛素抵抗指数（HOMA—IR）呈梯度升高，脂联素呈梯度下降，各组间差异显著（P〈0．001）。瘦素在组1中明显升高，组2、组3间无统计学显著性差异（P〉0．05）。306例受试者经多元逐步线性回归分析显示：脂联素的独立影响因素是体重指数（BMI）、HDL—C、hs—CRP（R=0．429，R^2=0．184）；瘦素的独立影响因素是BMI、Fins、低密度脂蛋白胆固醇（LDL—C）（R=0．364，R^2=0．133）；FFA的独立影响因素是BMI、TG（R=0．661，R^2=0．437）；hs—CRP的独立影响因素是脂联素、BMI、HDL—C、HOMA—IR（R=0．445，R^2=0．198）；HOMA—IR的独立影响因素是瘦素、BMI、FBG、FFA（R=0．574，R^2=0．330）。结论单纯性超重、肥胖青少年血游离脂肪酸、瘦素、hs—CRP明显升高，脂连素明显降低；体重指数是瘦素、脂联素、胰岛素抵抗、hs—CRP共同的独立决定因素；脂肪细胞因子在调节糖、脂代谢及炎症方面有重要意义，可能是肥胖与代谢及发生心血管疾病之间的联系分子。

The Level and Relationship Between Leptin, Adiponectin, Free Fatty Acids and High -sensitive C Reactive Protein in Simple Overweight,Obese Adolescents

Objective To investigate the level and the association of leptin,adiponectin,free fatty acid and high-sensitive C reactive protein with blood glucose,lipid profiles metabolism in simple overweight,obese adolescents.Methods According to the paper of body mass index reference norm for screening overweight and obesity in Chinese and adolescents reported by Group of China Obesity Task Force,we studied 306 adolescents aged 15-years including 77obese(group1),120 overweight(group2),and 109 normal body mass index served as controls(group3).The level of fasting serum adiponectin,leptin,free fatty acids(FFA),high-sensitive C reactive protein(hs-CRP),insulin(Fins),blood glucose(FBG),lipids profile were measured and the clinical variables were also investigated in 306 cases.Results There were no significant difference of FBG in three groups.Following parameters had significantly increased trend from group3 to group1:TG,FFA,hs-CRP,Fins,insulin resistance index(HOMA-IR);however,the adiponectin and HDL-C had significantly decreased trend from group3 to group1.The leptin was significantly higher than that in group2 and group3,and there were not significantly different between group2 and group3.In multivariate model,BMI,HDL-C and hs-CRP were significantly independent predictors of serum adiponectin(R=0.429,R2=0.184),and BMI,Fins and LDL-C for leptin(R=0.364,R2=0.133),and BMI and TG for FFA(R=0.661,R2=0.437),and BMI,HDL-C and HOMA-IR for hs-CRP(R=0.445,R2=0.198),and leptin,BMI,FBG and FFA for HOMA-IR(R=0.574,R2=0.330).Conclusions Compared with controls,The level of FFA,leptin,hs-CRP significantly increased and adiponectin significantly decreased in simple overweight,obese adolescents.The BMI was the common independent predictors of leptin,adiponectin,HOMA-IR and hs-CRP.Adipocytokines play an important role in hyperglycemia,dyslipidemia and inflammation and may link obesity with metabolic and cardiovascular diseases.