摘要
目的观察盐酸二甲双胍治疗青少年代谢综合征（MS）前后血清脂联素水平和胰岛素敏感性的变化。方法对348例（男208例，女140例）7—16岁[（11．47±2．12）岁]中、重度肥胖青少年进行体检和生化检测、口服葡萄糖耐量试验，检出其中符合MS诊断标准的36例，设为MS组，无生化检测异常的单纯性肥胖61例，设为单纯肥胖组。另设24例非肥胖青少年为对照组。对三组进行总体胰岛素敏感指数、稳态模型胰岛素抵抗指数（HOMA-IR）和血清脂联素等的比较。对MS组患儿中20例给予连续口服盐酸二甲双胍治疗3个月，观察治疗前后的HOMA—IR和血清脂联素、生化指标的变化。结果（1）HOMA—IR水平由低到高依次为对照组、单纯性肥胖组、MS组；胰岛素敏感指数和血清脂联素水平排序正好相反；HOMA-IR、胰岛素敏感指数和血清脂联素在3组间比较，差异均有统计学意义（均P〈0．01）。（2）连续应用盐酸二甲双胍治疗满3个月的20例MS患儿：HOMA—IR下降[治疗前5．7（1．9—12．4），治疗后2．9（0．9—7．4），t=5．05，P〈0．01]，血清脂联素上升[治疗前（3．0±0．9）mg／L，治疗后（6．1±1．9）mg／L，t=6．19，P〈0．01]，血压、2h血糖、甘油三酯、胆固醇、肝酶均有不同程度下降，治疗前后比较，差异有统计学意义（均P〈0．01）。结论MS青少年脂联素水平和胰岛素敏感性比单纯性肥胖更低；应用盐酸二甲双胍治疗后MS青少年的脂联素水平上升，胰岛素敏感性改善，临床多项指标好转。
Objectives Metabolic syndrome （MS） in adolescents was reported to be closely associated with cardiovascular diseases in adulthood. However, no unified treatment measure for MS in adolescents is currently available. The aim of this study was to measure the changes of serum adiponectin levels, insulin sensitivity and other biochemical markers after mefformin therapy in adolescents with MS, which might provide some information for set up a unified therapeutic measure for MS in adolescents. Methods In this study, 348 moderately or severely obese adolescents and 24 non-obese healthy adolescents matched in age and sex were enrolled. The obese group included 208 males and 140 females aged from 7 to 16 years （ 11.5 ± 2. 1 years）. Oral glucose tolerance test and biochemical markers measurement were done to all these subjects. Whole body insulin sensitivity index （ WBISI）, homeostasis model assessment-insulin resistance （HOMA-IR） and fasting serum adiponectin were compared among 36 adolescents with MS （who had two or three abnormalities of hyperglycosemia, hypertension or dyslipidemia）, 61 simple obese subjects without abnormality of biochemical markers and 24 healthy controls. Moreover, the changes of WBISI, HOMA-IR and adiponectin levels in 20 eases with MS after mefformin therapy for 3 months were measured. Results （ 1 ） HOMA-IR in control group （ 1.3 ）, simple obese group （2. 3） and MS group （4. 9） increased by turns （ F = 54. 08,P 〈 0. 001 ）. WBISI and serum adiponectin in control group, simple obese group and MS group decreased by tunas with significant difference [89.6, 22.8 and 10.7,F=30.06;（7. 1 ±2.6）,（5.9 ±1.9）, （2.8 ±0.9） mg/L,F=64.93;P〈0.01 for all]. （2） HOMA-IR after mefformin therapy decreased [5.7 （ 1.9-12. 4） vs. 2. 9 （0. 9-7. 4） ,t =5. 05, P 〈0.01 ] ; while the serum adiponectin levels increased with significant differences[ （3.0 ±0.9） mg/L vs. （6. 1 ± 1.9） mg/L, t = 6. 19, P 〈 0. 01 ]. Systolic blood pressure [ （ 132. 4 ± 7.5 ） mm Hg vs. （ 116. 6 ±9.1） mmHg,t=8.36,P〈0.01], 2-hour glucose [（8.2±2.9） mmol/Lvs. （5.3±1.0） mmol/L, t= 3.96, P 〈 0.01 ], triglyceride [ （ 2. 8 ± 1.2） mmol/L vs. （ 1.3 ± 0. 9） mmol/L, t = 4. 22, P 〈 0. 01 ], total cholesterol [ （4. 9 ±0. 6） mmol/L vs. （4.0±0.6） mmol/L,t =4. 72,P 〈0. 01 ], alanine aminotransferase [80.5 （29.0-286.0） U/Lvs. 56.0 （23.0-163.0） U/L,t=3.80,P〈0.01].Conelusion Insulin sensitivity in adolescents with MS was lower than that of simple obese group. Mefformin can improve or ameliorate adiponectin levels, insulin sensitivity and some clinical markers.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2006年第2期118-121,共4页
Chinese Journal of Pediatrics
基金
浙江省科技厅重点国际合作科研项目(2005C24001)
