肥胖儿童青少年血清脂肪因子与其代谢特征的相关性研究

doi:10.3969/j.issn.1673-5501.2019.05.011

摘要/Abstract

摘要： 目的探讨肥胖儿童青少年血清脂肪因子瘦素、脂联素、神经调节蛋白4(Nrg4)及锌α-2糖蛋白(ZAG)与肥胖及代谢的关系。方法选取在南京医科大学附属儿童医院儿童保健科就诊的5~14岁肥胖儿童。测量身高、体重、腰围、体脂百分比(FM%)、血压、腰围身高比(WHtR)和体重指数标准差(BMISDS);测定ALT、AST及糖脂代谢指标;根据血压及糖脂代谢,将肥胖儿童分为代谢不健康型肥胖(MUO)和代谢健康型肥胖(MHO)。酶联免疫吸附法测定血清脂肪因子水平。结果 192例肥胖儿童(男138名)纳入分析,平均年龄(10.59±1.93)岁,平均BMISDS 2.86(2.38,3.26)。肥胖儿童中检出MUO 164例(85.4%),MHO 28例。校正年龄后,MUO组血清脂联素、Nrg4水平低于MHO组(P<0.05),两组瘦素、ZAG差异无统计学意义。相关性分析显示,MUO组血清瘦素水平与 BMISDS、FM%、WHtR呈正相关(P<0.05);脂联素与年龄、ALT、AST及胰岛素抵抗指数(HOMA-IR)呈负相关(P<0.05);Nrg4与BMISDS、WHtR、ALT、AST呈负相关(P<0.05);ZAG与FM%呈负相关(P<0.05)。logistic回归分析显示,脂联素和Nrg4是肥胖儿童代谢保护因子;ROC曲线显示,脂联素与Nrg4评估肥胖儿童代谢风险的界值点分别为5.56 μg·mL^-1和5.5 ng·mL^-1。结论肥胖合并代谢紊乱的儿童青少年血清瘦素、ZAG 水平与体脂含量密切相关,而脂联素、Nrg4水平与代谢紊乱程度相关。这些脂肪因子对于识别和干预肥胖儿童青少年代谢紊乱的发生发展具有重要意义。

关键词: 代谢, 儿童青少年, 肥胖, 脂肪因子

Abstract: Objective To investigate the relationship between four adipokines (leptin, adiponectin, Nrg4 and ZAG) and obesity and related metabolic disorders.Methods Obese children aged from 5 to 14 years were recruited from Children's Health Department of Children's Hospital of Nanjing Medical University. We measured height, weight, WC, fat mass percentage (FM%) and blood pressure, then calculated waist height ratio (WHtR) and BMISDS. Indicators of glucose and lipid metabolism were measured. Serum adipokines levels were measured by enzyme-linked immunosorbent assays (ELISA).According to blood pressure, glucose and lipid metabolism indicators, obese children were divided into metabolically unhealthy obesity (MUO) and metabolically healthy obesity (MHO). Then association between serum adipokines, obesity and metabolic status was analyzed.Results A total of 192 obese children were recruited in the study (138 boys and 54 girls, 10.59±1.93 years), with average BMISDS of 2.86 (2.38, 3.26). Among the obese children, 164 cases (85.4%) were MUO and 28 cases (14.6%) were MHO. After adjusting for age, MUO children had lower adiponectin and Nrg4 levels compared to MHO children (all P<0.05). Serum leptin and ZAG levels were no significant difference between the two groups. Correlation analysis indicated that serum leptin levels in MUO group were positively correlated with BMISDS, FM% and WHtR (P<0.05). Serum adiponectin levels were negatively correlated with age, ALT, AST and HOMA-IR (P<0.05). Serum Nrg4 levels were negatively correlated with BMISDS, WHtR, ALT and AST(P<0.05). Serum ZAG levels were negatively correlated with FM% (P<0.05). Logistic regression analysis showed that serum adiponectin and Nrg4 were protective factors for metabolism in obese children. ROC analysis showed that the diagnostic cut-off points of serum adiponectin and Nrg4 evaluating metabolic abnormalities in obese children were 5.56 μg·mL^-1 and 5.5 ng·mL^-1, respectively.Conclusions erum leptin and ZAG levels in obese children and adolescents with metabolic disorders are closely related to fat mass, while adiponectin and Nrg4 levels are associated with the degree of metabolic disorders. These adipokines are important for identifying and interfering with the occurrence and development of metabolic disorders in obese children and adolescents.

Key words: Adipokines, Children and adolescents, Metabolism, Obesity

杜苏苏, 彭璐婷, 武苏, 蒋志颖, 凌茹, 郁珽, 刘倩琦, 李晓南. 肥胖儿童青少年血清脂肪因子与其代谢特征的相关性研究[J]. 中国循证儿科杂志, 2019, 14(5): 374-379.

DU Su-su, PENG Lu-ting, WU Su, JIANG Zhi-ying, LING Ru, YU Ting, LIU Qian-qi, LI Xiao-nan. Correlation between serum adipokines and metabolic characteristics in obese children and adolescents[J]. Chinese Journal of Evidence -Based Pediatric, 2019, 14(5): 374-379.

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