儿童血清FGF21水平与代谢综合征关系的初步研究

发布时间：2019-03-14 07:24

【摘要】：目的： 近年来,由于成纤维细胞生长因子21(FGF21)在动物模型中改善糖脂代谢的良好效果,人们将其作为治疗2型糖尿病的潜在药物寄予厚望。然而,FGF21在人体中的病理生理作用尚不明确,部分研究显示在肥胖、2型糖尿病患者体内FGF21的水平增高,提示存在FGF21抵抗。本研究利用大样本学龄儿童资料,观察血清FGF21水平在儿童的分布及其影响因素,探讨FGF21与儿童期肥胖及代谢综合征(MS)的关系。 方法： 对来自2004年“北京儿童青少年代谢综合征研究”中整群抽样获得的景山学校820名6-18岁学龄儿童,进行体量指标、Tanner分期、空腹血脂谱、空腹血糖、以及血清胰岛素、瘦素、脂联素、抵抗素和FGF21水平测定。FGF21采用双抗体夹心放大酶联免疫法检测；儿童MS采用改良的美国国家胆固醇计划成人治疗小组第3次报告(ATPⅢ)中的定义进行诊断。 结果： 1.血清FGF21水平在两性无显著性差异(P=0.082)。青春发育中期两性FGF21水平均有增加趋势。正常体重、超重和肥胖组儿童FGF21水平逐步升高,但无统计学意义。MS组与非MS组,具有MS组分或不具该组分组FGF21水平无显著性差异。 2.全体对象中,FGF21与腰围、体重指数(BMI)、体脂含量、收缩压(SBP)、舒张压(DBP)、空腹血糖、胰岛素、血脂谱、瘦素、脂联素、抵抗素的双变量分析显示,FGF21仅与舒张压(r=0.08,P=0,023)、瘦素(1=0.085,P=0.015)及抵抗素(r=0.078,P=0.027)具有相关性,调整年龄、性别、BMI后,空腹血糖亦与FGF21显著相关(r=0.074,P=0.038)。 3.将全体儿童按FGF21四分位数分组,可以看到各分组中肥胖儿童比例一致。儿童MS.MS各组分的发生率均表现为FGF21第1分位组较高,第2、第3分位较低,第4分位再度增高的J型曲线。全体对象中MS组分≥1个的比例组间比较具有统计学差异(P=0.016),肥胖儿童中MS发生比例亦具有统计学差异(P=0.044)。女孩中低脂联素血症的发生率随FGF21四分位变化亦表现为上述J型曲线。 4.logistic回归显示,全体儿童中FGF21水平的升高(OR=I.681,P=0.041)或者降低(OR=I.924,P=0.009)均与儿童携带MS组分的风险增加显著相关,肥胖儿童中FGF21的升高与儿童罹患MS风险的增加显著相关(OR=19.971,P=0.013),且这种风险度的增加独立于儿童的年龄、性别和BMI。 结论： 儿童人群中FGF21水平与肥胖无显著相关性。儿童人群中存在FGF21相对缺乏和FGF21抵抗两种状态。过低或过高的FGF21水平均与儿童不良代谢状况相关,提示全体儿童携带MS组分以及肥胖儿童罹患MS风险的增加。
[Abstract]:Aim: in recent years, fibroblast growth factor 21 (FGF21) has been regarded as a potential drug for the treatment of type 2 diabetes mellitus (T2DM) because of its good effect on improving glucose and lipid metabolism in animal models. However, the pathophysiological role of FGF21 in human remains unclear. Some studies have shown that the level of FGF21 in obese and type 2 diabetic patients is higher, suggesting the existence of FGF21 resistance. In this study, a large sample of school-age children was used to observe the distribution of serum FGF21 level in children and its influencing factors, and to explore the relationship between FGF21 and childhood obesity and metabolic syndrome (MS). Methods: 820 6-18-year-old school-age children from Jingshan School were selected from Beijing Children and adolescents Metabolic Syndrome study in 2004. The mass index, Tanner stage, fasting blood lipid spectrum and fasting blood glucose were measured. Serum insulin, leptin, adiponectin, resistin and FGF21 were measured. Children's MS was diagnosed using the definition contained in the modified American National cholesterol Program Adult treatment team's third report (ATP III). Results: 1. There was no significant difference in serum FGF21 level between male and female (P < 0. 082). There was an increasing trend of FGF21 levels in both sexes in the middle of puberty. The levels of FGF21 in children with normal weight, overweight and obesity increased gradually, but there was no significant difference between the MS group and the non-MS group. There was no significant difference in the FGF21 level between the MS group and the non-MS group. 2. In all subjects, bivariate analysis of FGF21 and waist circumference, body mass index (BMI), body fat content, systolic (SBP), diastolic blood pressure (DBP), fasting blood glucose, insulin, blood lipid spectrum, leptin, adiponectin, resistin showed that the blood glucose, insulin, lipid spectrum, leptin, adiponectin and resistin were measured by bivariate analysis. FGF21 was only correlated with diastolic blood pressure (r = 0.08, P < 0. 0023), leptin (0. 085, P < 0. 015) and resistin (r = 0. 078, P < 0. 027). After adjusting for age, sex and fasting blood glucose after BMI, fasting blood glucose was also significantly correlated with FGF21 (r = 0. 074, P < 0. 038). 3. All the children were grouped according to the FGF21 quartile, and the proportion of obese children in each group was the same. The incidence of each component of MS.MS in children was higher in FGF21 group 1, lower in 2nd and 3rd fractions, and increased again in 4th fraction. The proportion of MS 鈮，

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