CAJ | 학술논문

目的研究北京儿童青少年胰岛素抵抗指数的分布,探讨血液瘦素/脂联素比值(LEP/APN)对儿童胰岛素抵抗状态的诊断价值.方法选取北京地区6～18岁儿童青少年代谢综合征研究队列的3506名儿童青少年,以中国肥胖问题工作组2004年制定的中国学龄儿童青少年超重、肥胖筛查体质指数(BMI)分类标准将研究对象分为正常体重人群(1628人)、超重人群(659人)和肥胖人群(1219人),进行体量指标和青春发育程度的评价以及测定空腹血糖、血脂、真胰岛素、LEP和APN等.以稳态模型胰岛素抵抗指数(HOMA-IR)评价胰岛素抵抗状态.在健康儿童青少年中,按HOMA-IR百分位分布确定评价儿童青少年胰岛素抵抗界值.采用相关和回归分析评价LEP/APN与HOMA-IR的相关性,受试者工作特征曲线(ROC曲线)探讨LEP/APN对儿童胰岛素抵抗状态的诊断价值.结果尝试建立北京地区健康儿童青少年胰岛素抵抗界值:青春发育前期HOMA-IR≥2.6；青春发育期HOMA-IR≥ 3.4.超重和肥胖儿童胰岛素抵抗检出率分别为22.2％和42.9％.相关分析显示LEP/APN与HOMA-IR相关(相关系数为0.51,偏相关系数为0.40,P＜0.01).多元线性回归分析提示LEP/APN独立于其他因素对HOMA-IR的影响最大(偏回归系数0.273,标准化偏回归系数为0.467,P＜0.01).ROC曲线分析显示LEP/APN对胰岛素抵抗预测能力高于LEP、APN和评价肥胖的体量指标(如腰围、BMI和体脂率).结论评价儿童青少年胰岛素抵抗需考虑青春发育状况,超重和肥胖儿童存在明显胰岛素抵抗.LEP/APN可作为一项反映儿童青少年胰岛素抵抗的新指标,对肥胖相关代谢紊乱的预测具有参考价值.
목적 연구북경인동청소년이도소저항지수적분포,탐토혈액수소/지련소비치(LEP/APN)대인동이도소저항상태적진단개치.방법 선취북경지구6～18세인동청소년대사종합정연구대렬적3506명인동청소년,이중국비반문제공작조2004년제정적중국학령인동청소년초중、비반사사체질지수(BMI)분류표준장연구대상분위정상체중인군(1628인)、초중인군(659인)화비반인군(1219인),진행체량지표화청춘발육정도적평개이급측정공복혈당、혈지、진이도소、LEP화APN등.이은태모형이도소저항지수(HOMA-IR)평개이도소저항상태.재건강인동청소년중,안HOMA-IR백분위분포학정평개인동청소년이도소저항계치.채용상관화회귀분석평개LEP/APN여HOMA-IR적상관성,수시자공작특정곡선(ROC곡선)탐토LEP/APN대인동이도소저항상태적진단개치.결과 상시건립북경지구건강인동청소년이도소저항계치:청춘발육전기HOMA-IR≥2.6；청춘발육기HOMA-IR≥ 3.4.초중화비반인동이도소저항검출솔분별위22.2％화42.9％.상관분석현시LEP/APN여HOMA-IR상관(상관계수위0.51,편상관계수위0.40,P＜0.01).다원선성회귀분석제시LEP/APN독립우기타인소대HOMA-IR적영향최대(편회귀계수0.273,표준화편회귀계수위0.467,P＜0.01).ROC곡선분석현시LEP/APN대이도소저항예측능력고우LEP、APN화평개비반적체량지표(여요위、BMI화체지솔).결론 평개인동청소년이도소저항수고필청춘발육상황,초중화비반인동존재명현이도소저항.LEP/APN가작위일항반영인동청소년이도소저항적신지표,대비반상관대사문란적예측구유삼고개치.
Objective To analysis the distribution of HOMA-IR,and explore the diagnostic value of leptin/adiponectin ratio (LEP/APN) on insulin sensitivity in Beijing children and adolescents.Methods A total of 3506 schoolchildren,selected from the Beijing Child and Adolescent Metabolic Syndrome Study (BCAM study),were included in the current study,among them 659 were overweight and 1219 were obese.Age-and sex-specific body mass index (BMI) percentiles,developed by the Working Group for Obesity in China,were used to classify participants as normal weight (BMI ＜ 85％),overweight (BMI ≥85％ but ＜ 95％),or obese (BMI ≥ 95％).Examination included anthropometry,pubertal development,and levels of fasting lipid profile,insulin,LEP and APN.Insulin resistance (IR) was evaluated by HOMA-IR.Correlation analysis and receiver operating characteristic curve (ROC) were used in the statistical analysis.Results According to the distribution of HOMA-IR in healthy children and adolescents,the cutoff value for IR was ≥2.6 in pre-pubertal stage and ≥3.4 in pubertal phase,respectively.The prevalence of IR was 22.2％ and 42.9％ respectively in overweight and obese children and adolescences.The LEP/APN ratio was progressively increased from normal group to overweight group and to obesity group,and correlated with HOMA-IR significantly (Pearson correlation coefficient was 0.51 and partial correlation coefficient was 0.40).After adjusting for age,sex,puberty and other confounding factors,the LEP/APN ratio is an independent predicator for HOMA-IR by multivariate linear regression analysis (unstandardized coefficient was 0.273 and standardized coefficient was 0.467,P ＜ 0.01).Area under the ROC curve of LEP/APN ratio for diagnosing of IR was larger than those of LEP,APN,BMI,waist circumference and FAT％.Conclusions Evaluation of IR needs to consider puberty status and prevalence of IR is obvious in overweight and obese children and adolescents.The LEP/APN ratio is expected to be early biomarker of IR state,and an early potent predicator of metabolic disorders.