血浆促酰化蛋白水平与儿童青少年肥胖和代谢综合征的关联性分析

目的探讨儿童青少年血浆促酰化蛋白（ASP）水平与肥胖及代谢综合征（MS）的关系。方法以2004年北京市儿童青少年代谢综合征（BCAMS）调查总样本中1603名6～18岁儿童青少年为研究对象。采用中国肥胖问题工作组推荐的标准诊断超重和肥胖。符合下述5项指标中的3项及以上者诊断为MS：①腹型肥胖（腰围≥‰）；②高血压（≥P90）；③高密度脂蛋白胆固醇≤1．03mmol·L^-1；④三酰甘油≥1．24mmol·L^-1；⑤高空腹血糖（≥5．60mmol·L^-1）。采用ELISA法检测血浆ASP水平，免疫透射比浊法检测补体3（c3）水平。采用方差分析比较超重、肥胖及MS儿童青少年的血浆ASP水平，多因素Logistic回归分析血浆ASP水平与超重、肥胖及MS的关系。结果1603名研究对象中男性873名（54．5％）、女性730名（45．5％）；超重和肥胖者分别为291名（18．2％）和709名（44．2％）；MS为376名（23．4％）。正常体重、超重和肥胖组MS检出率分别为2．2％（13／603名）、15．5％（45／291名）和44．9％（318／709名）。正常体重组血浆ASP水平男性低于女性，差异有统计学意义（t=2．527，P〈0．05）。正常体重、超重和肥胖组血浆ASP的几何均值（P25-P75），男性分别为37．52（22．36～64．58）、57．88（34．10～95．11）和60．63（35．30～109．72）nmol·L^-1；女性分别为44．16（27．27～74．72）、60．25（35．68～113．15）和66．68（44．56-113．97）nmol·L^-1，均呈逐渐升高趋势（男性：，=34．329，P〈0．001；女性：F=22．246，P〈0．001）。C3水平仅在肥胖女性中升高（P〈0．01）。血浆ASP水平随MS组分聚集的数目增加而升高（男性：F=16．422，P〈0．001；女性：F=9．661，P〈0．001），与高血压、腹型肥胖和高空腹血糖的关系尤为密切。血浆ASP水平升高与儿童青少年超重、肥胖和MS的患病风险密切相关，相对于最低5分位值，位于最高5分位值的ASP水平与超重、肥胖和MS关系的OR值（95％CI）分别为3．90（2．38～6．39）、6．05（4．06～9．01）和2．89（1．93～4．33）。结论超重、肥胖和MS儿童青少年血浆ASP水平明显升高，血浆ASP水平可能对儿童青少年超重、肥胖和MS的发生具有较好的预测价值。

nalysis on the association of elevated plasma acylation stimulating protein with obesity and metabofic syndrome in Chinese children and adolescents

Objective To investigate the relationship between plasma acylation stimulating protein （ASP） and obesity and metabolic syndrome （ MS ） among Chinese children and adolescents. Methods Based on the Beijing Child and Adolescent Metabolic Syndrome （BCAMS） study,1 603 children and adolescents （873 boys and 730 girls） aged from 6 to 18 years old were randomly selected from the control group （ without any MS component） and the case group （ with at least one of the five MS components）, and divided into three groups of normal weight （ n = 603 ）, overweight （ n = 291 ） and obese （ n = 709 ） according to the sex-age-specific body mass index cutoffs recommended by Chinese Working Group on Obesity （ WGOC ）. The presence of pediatric MS was defined with modified NCEP ATP Ⅲ criteria by the presence of three or more items of the following five components：（1）central obesity was defined as waist circumference ≥90th percentile for age and gender （established according to the BCAMS study） ;（2）elevated systolic and/or diastolic blood pressure ≥90th percentile for age and sex （according to the BCAMS study） ;（3）hypertriglyceridemia was defined as TG t〉 1.24 mmol ·L^-1; （4）low serum high-density lipoprotein cholesterol （HDL-C） was defined as ~〈 1.03 mmol·L^-1 ; （5）impaired fasting glucose （IFG） was defined as 5.60 mmol ·L^-1. Data including anthropometric measurements （ height, weight and waist circumference）, systolic and diastolic blood pressure, fat mass percentage by bioimpedance analysis, pubertal development stage were collected. Venous blood samples were obtained by direct vein puncture after an overnight （minimum 12 h） fast. Plasma glucose was detected by the glucose oxidase method. Serum total cholesterol, triglyceride, HDL-C and low-density lipoprotein cholesterol （LDL-C） were measured. Plasma ASP was measured by enzyme-linked immunosorbent assay （ELISA）, and plasma complement 3 （C3） concentration was determined by turbidimetric assay using a polyclonal anti-human antibody specific against C3 （ Lin-Fei Co, P.R. China）. For C3 and ASP, the intra- and inter- assay coefficients of variations were 〈4.% and 〈 8%. The percentage of C3 converted to ASP （% ASP/C3） was calculated to evaluate the extent of conversion C3 to ASP. One-way analysis of variance （ANOVA） and general linear model were used to compare the levels of plasma ASP and C3 among various weight status groups. The odds ratios （ORs） and 95% confidence intervals （CIs） were analyzed with multivariable Logistic regression model to investigate the effect of ASP on metabolic abnormalities. Results Within the total groups, 376 subjects were with the presence of MS, and the prevalence rates were 2.2% , 15.5% and 44.9% in normal weight, overweight and obese groups, respectively. Girls had higher plasma ASP than boys （ t = 2. 527, P 〈 0.05 ）. Plasma ASP levels were increased in overweight group and obese group compared with in normal weight group in boys （ geometric mean： 57.88 nmol·L^-1, 60.63nmol. L i vs37.58 nmol·L^-1, F=34-.329, P〈0.001） and girls （geometric mean： 60.25 nmol·L^-1, 66.68 nmol·L^-1 vs 44.16 nmol·L^-1, F = 22. 246, P 〈 0. 001 ）. C3 was higher in obese group than that in normal weight group only in girls （P 〈0.01 ）. The percentage of C3 converted to ASP （% ASP/C3 ） was also increased in overweight group and obese group versus in normal weight group in both boys （ F = 17. 382, P 〈 0.00! ） and girls （ F = 6.317, P = 0. 002 ）. Plasma ASP increased with the clustering of MS components in boys （ F = 16. 422, P 〈 0. 001 ） and girls （ F = 9. 661, P 〈 0.001 ）. Increased ASP was also associated with the presence of one single metabolic abnormality （especially hypertension, abdominal obesity or hyperglycemia）. With age,gender and pubertal development as covariants and the lowest quintile of plasma ASP as reference, the ORs（95%Cls） of the highest quintile of ASP were 3.90（2.38-6.39）,6.05（4.06-9.01） and 2.89（1.93-4.33） for predicting overweight, obesity and MS, respectively. But the statistical significance of OR （95 % CI） for MS was vanished （P 〉 0.05） after further adjustment for body mass index. Conclusions Elevated plasma ASP levels in obese children and adolescents are associated with the clustering of MS components, and distinct metabolic abnormalities. The level of plasma ASP may be a predictor of overweight, obesity and MS in children and adolescents.