中华内分泌代谢杂志
中華內分泌代謝雜誌
중화내분비대사잡지
CHINESE JOURNAL OF ENDOCRINOLOGY AND METABOLISM
2014年
12期
1074-1079
,共6页
目的 研究Turner综合征(Turner syndrome,TS)患儿代谢综合征的发生率及其相关危险因素和临床特征,并探讨TS患儿代谢异常发生过程中的早期改变.方法 由临床和核型分析确诊TS患儿47例.测量体重、身高、腰围及血压,检测空腹血糖、胰岛素、总胆固醇、高密度脂蛋白胆固醇(HDL-C)、甘油三酯,并计算体重指数(BMI)、BMI-SDS、腰围身高比(WHtR)、非HDL-C及稳态模型评估的胰岛素抵抗指数(HOMA-IR).根据我国2012年6月最新提出的代谢综合征定义及诊断建议统计各代谢异常成分的发生率及其特征,并将≥10岁的38例患儿分为代谢综合征组、1项指标组、2项指标组、3项指标组及对照组,并进行组间比较分析.对6≤年龄＜10(岁)的9例患儿进行发病特征描述.结果 所有47例患儿中总胆固醇、非HDL-C及甘油三酯均与年龄呈正相关.在年龄≥10岁的38例患儿中,代谢综合征者发生率为13.15％,中央型肥胖者18.42％,高血压28.9％,低HDL-C或高非HDL-C者26.32％,高甘油三酯者23.68％,高血糖者15.79％,高胰岛素血症者5.26％,胰岛素抵抗者10.53％,糖尿病者2.63％.代谢综合征组的BMI、BMI-SDS、腰围、WHtR及甘油三酯均较对照组高[(21.50±0.78对16.89 ±0.61)kg/m2,1.08±0.39对-0.76±0.29,73.90±0.93对60.75±1.44)cm,0.54±0.01对0.45±0.01,1.65(0.61 ～ 2.69)对0.75(0.30～ 1.20) mmol/L,均P＜0.016 7].一项指标组WHtR较对照组高(P＜0.016 7).6≤年龄＜10(岁)的9例患儿中符合1项心血管疾病高危因素的患儿4例,符合2项的患儿1例.结论 TS患儿代谢综合征危险因素及代谢综合征的发生率高,并可早期出现代谢异常.高血压和血脂异常发生率最高,可能与TS自身的先天异常有关;与胰岛素分泌反应延迟及血糖不耐受相关的胰岛素抵抗可能是TS患者早期代谢异常改变的原因之一,中央型肥胖是TS患者代谢综合征发展过程中的早期改变.人体测量学检查WHtR较之腰围、BMI或BMI-SDS可能是更有效的早期预测TS患者发生代谢异常的指标.
目的 研究Turner綜閤徵(Turner syndrome,TS)患兒代謝綜閤徵的髮生率及其相關危險因素和臨床特徵,併探討TS患兒代謝異常髮生過程中的早期改變.方法 由臨床和覈型分析確診TS患兒47例.測量體重、身高、腰圍及血壓,檢測空腹血糖、胰島素、總膽固醇、高密度脂蛋白膽固醇(HDL-C)、甘油三酯,併計算體重指數(BMI)、BMI-SDS、腰圍身高比(WHtR)、非HDL-C及穩態模型評估的胰島素牴抗指數(HOMA-IR).根據我國2012年6月最新提齣的代謝綜閤徵定義及診斷建議統計各代謝異常成分的髮生率及其特徵,併將≥10歲的38例患兒分為代謝綜閤徵組、1項指標組、2項指標組、3項指標組及對照組,併進行組間比較分析.對6≤年齡＜10(歲)的9例患兒進行髮病特徵描述.結果 所有47例患兒中總膽固醇、非HDL-C及甘油三酯均與年齡呈正相關.在年齡≥10歲的38例患兒中,代謝綜閤徵者髮生率為13.15％,中央型肥胖者18.42％,高血壓28.9％,低HDL-C或高非HDL-C者26.32％,高甘油三酯者23.68％,高血糖者15.79％,高胰島素血癥者5.26％,胰島素牴抗者10.53％,糖尿病者2.63％.代謝綜閤徵組的BMI、BMI-SDS、腰圍、WHtR及甘油三酯均較對照組高[(21.50±0.78對16.89 ±0.61)kg/m2,1.08±0.39對-0.76±0.29,73.90±0.93對60.75±1.44)cm,0.54±0.01對0.45±0.01,1.65(0.61 ～ 2.69)對0.75(0.30～ 1.20) mmol/L,均P＜0.016 7].一項指標組WHtR較對照組高(P＜0.016 7).6≤年齡＜10(歲)的9例患兒中符閤1項心血管疾病高危因素的患兒4例,符閤2項的患兒1例.結論 TS患兒代謝綜閤徵危險因素及代謝綜閤徵的髮生率高,併可早期齣現代謝異常.高血壓和血脂異常髮生率最高,可能與TS自身的先天異常有關;與胰島素分泌反應延遲及血糖不耐受相關的胰島素牴抗可能是TS患者早期代謝異常改變的原因之一,中央型肥胖是TS患者代謝綜閤徵髮展過程中的早期改變.人體測量學檢查WHtR較之腰圍、BMI或BMI-SDS可能是更有效的早期預測TS患者髮生代謝異常的指標.
목적 연구Turner종합정(Turner syndrome,TS)환인대사종합정적발생솔급기상관위험인소화림상특정,병탐토TS환인대사이상발생과정중적조기개변.방법 유림상화핵형분석학진TS환인47례.측량체중、신고、요위급혈압,검측공복혈당、이도소、총담고순、고밀도지단백담고순(HDL-C)、감유삼지,병계산체중지수(BMI)、BMI-SDS、요위신고비(WHtR)、비HDL-C급은태모형평고적이도소저항지수(HOMA-IR).근거아국2012년6월최신제출적대사종합정정의급진단건의통계각대사이상성분적발생솔급기특정,병장≥10세적38례환인분위대사종합정조、1항지표조、2항지표조、3항지표조급대조조,병진행조간비교분석.대6≤년령＜10(세)적9례환인진행발병특정묘술.결과 소유47례환인중총담고순、비HDL-C급감유삼지균여년령정정상관.재년령≥10세적38례환인중,대사종합정자발생솔위13.15％,중앙형비반자18.42％,고혈압28.9％,저HDL-C혹고비HDL-C자26.32％,고감유삼지자23.68％,고혈당자15.79％,고이도소혈증자5.26％,이도소저항자10.53％,당뇨병자2.63％.대사종합정조적BMI、BMI-SDS、요위、WHtR급감유삼지균교대조조고[(21.50±0.78대16.89 ±0.61)kg/m2,1.08±0.39대-0.76±0.29,73.90±0.93대60.75±1.44)cm,0.54±0.01대0.45±0.01,1.65(0.61 ～ 2.69)대0.75(0.30～ 1.20) mmol/L,균P＜0.016 7].일항지표조WHtR교대조조고(P＜0.016 7).6≤년령＜10(세)적9례환인중부합1항심혈관질병고위인소적환인4례,부합2항적환인1례.결론 TS환인대사종합정위험인소급대사종합정적발생솔고,병가조기출현대사이상.고혈압화혈지이상발생솔최고,가능여TS자신적선천이상유관;여이도소분비반응연지급혈당불내수상관적이도소저항가능시TS환자조기대사이상개변적원인지일,중앙형비반시TS환자대사종합정발전과정중적조기개변.인체측량학검사WHtR교지요위、BMI혹BMI-SDS가능시경유효적조기예측TS환자발생대사이상적지표.
Objective To investigate the prevalence and clinical characteristics of metabolic syndrome (MetS) in Turner's syndrome (TS),and to analyze the possible early risk factors of MetS in TS girls.Methods The study comprised 47 TS patients confirmed by clinical manifestations and karyotype analysis carried out in First Affiliated Hospital of Sun Yat-sen University during 2010 to 2013.Height,weight,waist circumstance,and resting blood pressure were measured,and plasma fasting glucose,insulin,total cholesterol,high density lipoproteincholesterol (HDL-C),and triglycerides were determined before any treatment.Body mass index (B MI),BMI Z-Score (BMI-SDS),waist-to-height ratio (WHtR),and homeostasis model assessment for insulin resistance (HOMA-IR) were calculated.All data were analyzed and described according to the guideline on children and adolescents metabolic syndrome from Chinese Medical Association of pediatrics published in June 2012,38 patients older than or equal to 10 years of age were recruited in group Ⅰ,and 9 patients within 6 to 10 years old formed group Ⅱ.Group Ⅰ was further divided into 5 subgroups based on their metabolic components according to guideline,viz.MetS group,group with 1 variable,group with 2 variables,group with 3 variables,and control group.Statistical analysis was conducted in group Ⅰ,and the metabolic characteristics was described in group Ⅱ.Results Positive correlations existed in total cholesterol,non-HDL-C,and triglycerides with age (r =0.409,P＜0.01 ; r =0.35,P＜0.05 ; r =0.356,P＜0.05) while negative correlation existed in BMI-SDS(r =-0.35,P＜0.05) in all 47 TS patients.In group Ⅰ,the prevalence of MetS,insulin resistance,hypertension,low HDL-C or high non-HDL-C,hypertriglyceridemia,hyperglycemia,hyperinsulinism,diabetes,and central obesity was 13.15％,10.53％,28.9％,26.32％,23.68％,15.79％,5.26％,2.63％,and 18.42％ respectively.TS patients of MetS group had wasit circumference [(73.90±0.93vs60.75±1.44)cm,P＜0.0167],WHtR (0.54 ± 0.01 vs0.45±0.01,P＜0.0167),BMI [(21.50 ± 0.78 vs 16.89 ± 0.61) kg/m2,P＜0.016 7],BMI-SDS (1.08 ± 0.39 vs-0.76 ± 0.29,P＜0.016 7),triglycerides [1.65 (0.61-2.69) vs 0.75 (0.30-1.20) mmol/L,P＜0.016 7].WHtR (0.47 ± 0.01 vs 0.45 ± 0.01,P＜0.016 7) in the group with 1 variable was significantly higher than those in the control,while HDL-C was lower [1.19(0.75-1.63) vs 1.51 (1.21-1.81),P＜0.016 7].No significant difference was found in total cholesterol,blood pressure,non-HDL-C,and insulin or HOMA-IR among other groups.4 patients in group Ⅱ exhibited 1 cardiovascular risk component,3 with hypertension and 1 with lipid metabolic disorders.1 patient exhibited 2 cardiovascular risk components with central obesity and hypertension.Conclusion TS patients are prone to MetS,which may occur at early stage of the development of TS.Hypertension and dyslipidemia occur most frequently and may be related to congenital disorders of TS.The insulin resistance related to delayed β-cell response and glucose intolerance is possibly one of the early pathophysiological changes which cause the metabolic disorders in TS patients.Central obesity forms the early stage of the development of MetS.Anthropometric assessing like WHtR might predict the presence of early metabolic disorders much better than WC,wasit circumference,BMI,or BMI-SDS.
