不同肥胖程度儿童血清Apo A5、SIRT4 水平 与糖脂代谢及胰岛素抵抗的相关性

目的 探讨不同肥胖程度儿童血清Apo A5、人去乙酰化酶4（SIRT4）水平，以及与糖脂代谢 及胰岛素抵抗的相关性。方法 选取2016 年1 月—2018 年8 月新乡市中心医院收治的肥胖儿童102 例作为 肥胖组，参照体重指数（BMI）将患者分为轻度肥胖组、中度肥胖组和重度肥胖组。同期于该院随机选取50 例健康体检儿童作为对照组。收集各组临床病历资料，分析肥胖儿童BMI 影响因素及肥胖儿童血清Apo A5、 SIRT4 与糖脂代谢、胰岛素抵抗及BMI 的关系。结果 肥胖组BMI、腰围、臀围、甘油三酯（TG）、总胆 固醇（TC）、低密度脂蛋白（LDL）、空腹胰岛素（FINS）及胰岛素抵抗指数（HOMA-IR）高于对照组（P <0.05）， 高密度脂蛋白（HDL）、Apo A5 及SIRT4 水平低于对照组（P <0.05）；重度肥胖组和中度肥胖组BMI、腰围、 臀围、TG、TC、LDL、FINS 及HOMA-IR 高于轻度肥胖组（P <0.05），且重度肥胖组高于中度肥胖组（P <0.05）； 重度肥胖组和中度肥胖组HDL、Apo A5 及SIRT4 水平低于轻度肥胖组（P <0.05），且重度肥胖组低于中度 肥胖组（P <0.05）。多重线性回归分析显示，腰围、臀围、TG、TC、LDL、FINS、HOMA-IR 是影响儿童 BMI 的危险因素（P <0.05），HDL、Apo A5 及SIRT4 是儿童BMI 保护因素（P <0.05）。肥胖儿童血清Apo A5、SIRT4 与BMI、FINS、TG、TC、LDL 及HOMA-IR 均呈负相关（P <0.05），与HDL 呈正相关（P <0.05）。 结论 血清Apo A5、SIRT4 表达下调与儿童肥胖密切相关，早期检测可反映儿童肥胖程度及糖脂代谢紊乱和 胰岛素抵抗，从而为改善肥胖儿童预后提供指导。

Relevance between serum Apo A5, SIRT4 levels and glycolipid metabolism, insulin resistance in children with different degrees of obesity

Objective To explore the relevance between serum polipoprotein A5 (Apo A5), sirtuin 4 (SIRT4) levels and glycolipid metabolism, insulin resistance (HOMA-IR) in children with different degrees of obesity. Methods A total of 102 obese children aged 10-12 who were admitted to Xinxiang Central Hospital were selected, and they were divided into mild obesity group (n = 51), moderate obesity group (n = 28) and severe obesity group (n = 23) according to the body mass index (BMI), and 50 healthy children were randomly selected as control group at the same time. The clinical data of each group was collected, and the influencing factors of BMI in obese children and the relationship of serum Apo A5, SIRT4 with glycolipid metabolism, insulin resistance and BMI in obese children were analyzed. Results The BMI, waist circumference, hip circumference, triglyceride (TG), total cholesterol (TC), low density lipoprotein (LDL), fasting insulin (FINS), insulin resistance index (HOMA-IR) of obese children were higher than those of the control group, and the levels of high density lipoprotein (HDL), Apo A5 and SIRT4 were lower than those of the control group (P < 0.05). The BMI, waist circumference, hip circumference, TG, TC, LDL, FINS and HOMA-IR in the severe obesity group and moderate obesity group were higher than that in the mild obesity group (P < 0.05), and the severe obesity group were higher than that in the moderate obesity group (P < 0.05). The HDL, Apo A5, SIRT4 in the severe obesity group and moderate obesity group were lower than that in the mild obesity child (P < 0.05), and the severe obesity group were lower than that in the moderate obesity group (P < 0.05). Multiple linear regression analysis showed that waist circumference, hip circumference, TG, TC, LDL, FINS and HOMA-IR were risk factors for BMI in children (P < 0.05), and HDL, Apo A5 and SIRT4 were protective factors for BMI in children (P < 0.05). Serum Apo A5 and SIRT5 were negatively associated with BMI, FINS, TG, TC, LDL and HOMA-IR (P < 0.05), and positively associated with HDL (P < 0.05). Conclusions The downregulation of serum Apo A5 and SIRT4 is closely related to obese children. Early detection can reflect the degree of obese children, disorder of glycolipid metabolism and insulin resistance, so as to provide guidance for formulating intervention measures to improve the prognosis of obese children.