肥胖儿童青少年血清非高密度脂蛋白胆固醇水平与代谢紊乱的相关性研究
发布时间：2019-07-10 11:25
【摘要】：目的 1.探讨肥胖青少年血清非高密度脂蛋白胆固醇(Non-HDL-C)水平与体重正常儿童Non-HDL-C的差异。 2.研究肥胖儿童青少年Non-HDL-C水平变化及与糖脂代谢紊乱、非酒精性脂肪肝、高尿酸血症的关系。 3.评估肥胖儿童青少年Non-HDL-C升高的危险因素。 方法 收集2011年6月至2013年1月在天津医科大学总医院儿科内分泌门诊就医的肥胖儿童青少年449例,同时选取219例地域、年龄、性别与之相匹配的健康体检儿童青少年为正常对照组。采集所有研究对象的临床资料；测定空腹血糖(FPG)、空腹胰岛素(FINS)、糖负荷后2小时血糖(2h-PG)、糖负荷后2小时胰岛素(2h-INS)糖化血红蛋白(HbAlc)、血清尿酸(UA)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)。并计算非高密度脂蛋白胆固醇(Non-HDL-C=TC-HDL-C),采用稳态模型评估胰岛素抵抗指数(HOMA-IR)=(FPG X FINS)/22.5,动脉粥样硬化指数(AI)=1g10(TG/HDL-C)。对肥胖儿童青少年进行腹部肝脏超声波检查。1.比较正常儿童青少年和肥胖及代谢综合征儿童青少年血清Non-HDL-C水平之间的差异。2.根据包含代谢综合征因素组分多少分为4组,第1组为有1个代谢综合征因素组,第2组为有2个代谢综合征因素组,第3组为有3个代谢综合征因素组,第4组为有4个代谢综合征因素组。并分析各组血清Non-HDL-C水平的差异。3.将肥胖儿童青少年按照非酒精性脂肪肝的诊断标准分为2组：肥胖不伴NAFLD组；肥胖伴NAFLD组,并分析两组间Non-HDL-C的差异及其与Non-HDL-C的关系。3.根据高尿酸血症诊断标准将肥胖儿童青少年分为2组：血尿酸正常组；高尿酸血症组,并分析两组间Non-HDL-C的差异及其与Non-HDL-C的关系。4.分析Non-HDL-C与各指标的相关性及其影响因素。 结果 1.代谢综合征组(MS)及单纯肥胖组TC、TG、HDL-C、LDL-C、Non-HDL-C、 ALT.ASL均高于正常对照组,差异有统计学意义(P0.05),MS组TC、TG、LDL-C、 Non-HDL-C、ALT高于单纯肥胖组,差异有统计学意义(P0.05)。 2.随着代谢综合征组分的增加Non-HDL-C水平增高,第4组血Non-HDL-C平均水平最高。除第1组与第2组之间差异无统计学意义外,其他各组之间差异均存在统计学意义(P0.01)。 3.肥胖儿童青少年非酒精性脂肪肝分组,肥胖伴NAFLD组与肥胖不伴NAFLD组之间Non-HDL-C水平差异无统计学意义(P0.05),肥胖伴NAFLD组ALT高于肥胖不伴NAFLD组,差异具有统计学意义(P0.01)。logistic回归分析,WC、AC、 HbAlc是非酒精脂肪肝的影响因素。 4.肥胖儿童青少年高尿酸血症组血清Non-HDL-C水平明显高于血尿酸正常组,差异具有统计学意义(P0.01)。Logistic回归分析Non-HDL-C、HOMA-IR、AI为高尿酸血症的影响因素。 5.相关分析显示Non-HDL-C与WHR、TC、TG、LDL-C、ALT、AST、2h-PG、 UA、HbAlc、HOMA-IR、AI呈正相关(P0.05或P0.01)。多元线性逐步回归分析显示,TC、HDL-C、LDL-C. AI、HOMA-IR是Non-HDL-C的影响因素。 结论 1.MS组和单纯肥胖组Non-HDL-C均高于正常对照组,且MS组Non-HDL-C高于单纯肥胖组。随着代谢综合征组分的增加,Non-HDL-C水平增高。提示Non-HDL-C与肥胖儿童青少年的肥胖程度和代谢综合征组分多少有关,Non-HDL-C可以作为MS的预测因子。 2.肥胖儿童青少年Non-HDL-C与动脉粥样硬化指数存在正相关,且动脉粥样硬化指数是Non-HDL-C的影响因素。因此,Non-HDL-C可能参与了动脉粥样硬化的形成机制,Non-HDL-C可用于预测心血管疾病发病的危险性。 3.肥胖儿童青少年血清Non-HDL-C水平与胰岛素抵抗指数、糖负荷后血糖2小时血糖呈正相关。表明Non-HDL-C可能在肥胖进展为糖尿病的过程中发挥了一定的病生理作用。 4.肥胖伴NAFLD组与肥胖不伴NAFLD组之间Non-HDL-C水平差异无统计学意义,而相关分析发现,Non-HDL-C与肥胖儿童青少年肝酶有密切联系,因此随着Non-HDL-C增高,可能会造成肝细胞损伤。 5.肥胖儿童青少年血清Non-HDL-C水平与血清尿酸呈正相关,Non-HDL-C、胰岛素抵抗指数、动脉粥样硬化指数为高尿酸血症的影响因素,提示尿酸水平高的肥胖儿童更易发生动脉粥样硬化,因此,尿酸、Non-HDL-C及胰岛素抵抗共同参与动脉粥样硬化的发生和发展。
[Abstract]:Purpose 1. To study the difference between the serum non-high-density lipoprotein cholesterol (Non-HDL-C) level and the normal weight of the normal children, Non-HDL-C. The changes of the non-alcoholic fatty liver and hyperuricemia were studied in the study of the changes of the non-alcoholic fatty liver and hyperuricemia in the obese children. 3. Assessment of the increase in the number of Non-HDL-C in obese children to be in danger Risk factors. Methods:449 children with obesity were collected from June 2011 to January 2013 in the pediatric endocrinology clinic of the General Hospital of Tianjin Medical University, and 219 healthy children with geographical, age and sex were selected. The adolescents were in the normal control group. The clinical data of all the subjects were collected; fasting blood glucose (FPG), fasting insulin (FINS), blood glucose (2h-PG) after the sugar loading,2 hours of insulin (2 h-INS), hemoglobin (HbAlc), serum uric acid (UA), and trough were measured after the sugar loading. alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol Sterol (LDL-C). The non-high-density lipoprotein cholesterol (Non-HDL-C = TC-HDL-C) was calculated and the insulin resistance index (HOMA-IR) = (FPG X FINS)/ 22.5, the atherosclerotic index (AI) = 1 g10 ( TG/ HDL-C). Abdomen for obese children and adolescents Liver ultrasound examination.1. Comparison of serum Non-HDL-C for adolescent and obese and metabolic syndrome in normal children 2. In group 1, there were 1 metabolic syndrome factor group, group 2 had 2 metabolic syndrome factor groups, group 3 had 3 metabolic syndrome factor groups, and 4 in group 4. A group of metabolic syndrome factors, and the serum Non-HDL in each group was analyzed. 3. The non-alcoholic fatty liver was divided into two groups: obesity without NAFLD, obesity with NAFLD, and analysis of the difference between the two groups of Non-HDL-C and its relationship with Non-H. 3. The relationship between the two groups: the normal group of the blood uric acid, the hyperuricemia group, and the difference between the two groups of Non-HDL-C and their relationship with the Non-H. The relationship of DL-C.4. Analysis of Non-HDL-C and index related Results 1. The contents of TC, TG, HDL-C, LDL-C, Non-HDL-C, ALT and ASL in the group of metabolic syndrome (MS) and the simple obesity group were higher than those in the normal control group (P0.05). The difference of TC, TG, LDL-C, Non-HDL-C and ALT in the MS group was higher than that of the simple obesity group. 2. With the increase of the component of the metabolic syndrome, the level of Non-HDL-C was increased, and the fourth group of blood The average of the Non-HDL-C was the highest. There was no significant difference between the other groups except for the difference between Group 1 and Group 2. There was no significant difference in the level of non-alcoholic fatty liver (P 0.01).3. There was no significant difference in the level of Non-HDL-C between the obese children and the non-alcoholic fatty liver group (P0.05). Logistic regression analysis, WC, AC, HbAlc was a non-alcoholic fatty liver.4. The level of serum Non-HDL-C in the hyperuricemia group in the obese children was significantly higher than that in the normal group of blood uric acid (P0.01). Logistic regression analysis of Non-HDL-C, HO The effects of MA-IR and AI on hyperuricemia.5. Correlation analysis showed that Non-HDL-C and WHR, TC, TG, LDL-C, ALT, AST, 2h-PG, UA, HbAlc, HOMA-I R and AI were positively correlated (P0.05 or P0.01). The multiple linear step-by-step Regression analysis showed that TC, HDL-C, LDL-C. AI, H OM Conclusion 1. The non-HDL-C of both the MS group and the simple obesity group were higher than that in the normal group. In the control group, the non-HDL-C of the MS group was higher than that of the simple obesity group. The increase of the component of metabolic syndrome and the increase of the level of Non-HDL-C. Non-HDL-C can be used as a predictor of the MS.2. The Non-HDL-C and the atherosclerosis index of the obese children are positive. Correlated, and the atherosclerosis index is the influence factor of Non-HDL-C. Therefore, Non-HDL-C may be involved in the formation of atherosclerosis System, Non-HDL-C can be used to predict the risk of cardiovascular disease.3. Non-obese children's serum Non-HD There was a positive correlation between the level of L-C and the insulin resistance index and the blood glucose of 2 hours after the sugar loading. L-C may play a certain physiological role in the progression of obesity.4. There is no statistical difference between the level of Non-HDL-C between the obese and NAFLD groups, and the correlation analysis found that the Non-HDL-C and the obese children's liver enzymes The serum Non-HDL-C level of the obese children is positively related to the serum uric acid, and the Non-HDL-C, the insulin resistance index and the atherosclerosis index are hyperuricemia. The influential factors indicate that the obese children with high uric acid level are more prone to atherosclerosis, and therefore, the urine
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.8
本文编号：2512570
[Abstract]:Purpose 1. To study the difference between the serum non-high-density lipoprotein cholesterol (Non-HDL-C) level and the normal weight of the normal children, Non-HDL-C. The changes of the non-alcoholic fatty liver and hyperuricemia were studied in the study of the changes of the non-alcoholic fatty liver and hyperuricemia in the obese children. 3. Assessment of the increase in the number of Non-HDL-C in obese children to be in danger Risk factors. Methods:449 children with obesity were collected from June 2011 to January 2013 in the pediatric endocrinology clinic of the General Hospital of Tianjin Medical University, and 219 healthy children with geographical, age and sex were selected. The adolescents were in the normal control group. The clinical data of all the subjects were collected; fasting blood glucose (FPG), fasting insulin (FINS), blood glucose (2h-PG) after the sugar loading,2 hours of insulin (2 h-INS), hemoglobin (HbAlc), serum uric acid (UA), and trough were measured after the sugar loading. alanine aminotransferase (ALT), aspartate aminotransferase (AST), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol Sterol (LDL-C). The non-high-density lipoprotein cholesterol (Non-HDL-C = TC-HDL-C) was calculated and the insulin resistance index (HOMA-IR) = (FPG X FINS)/ 22.5, the atherosclerotic index (AI) = 1 g10 ( TG/ HDL-C). Abdomen for obese children and adolescents Liver ultrasound examination.1. Comparison of serum Non-HDL-C for adolescent and obese and metabolic syndrome in normal children 2. In group 1, there were 1 metabolic syndrome factor group, group 2 had 2 metabolic syndrome factor groups, group 3 had 3 metabolic syndrome factor groups, and 4 in group 4. A group of metabolic syndrome factors, and the serum Non-HDL in each group was analyzed. 3. The non-alcoholic fatty liver was divided into two groups: obesity without NAFLD, obesity with NAFLD, and analysis of the difference between the two groups of Non-HDL-C and its relationship with Non-H. 3. The relationship between the two groups: the normal group of the blood uric acid, the hyperuricemia group, and the difference between the two groups of Non-HDL-C and their relationship with the Non-H. The relationship of DL-C.4. Analysis of Non-HDL-C and index related Results 1. The contents of TC, TG, HDL-C, LDL-C, Non-HDL-C, ALT and ASL in the group of metabolic syndrome (MS) and the simple obesity group were higher than those in the normal control group (P0.05). The difference of TC, TG, LDL-C, Non-HDL-C and ALT in the MS group was higher than that of the simple obesity group. 2. With the increase of the component of the metabolic syndrome, the level of Non-HDL-C was increased, and the fourth group of blood The average of the Non-HDL-C was the highest. There was no significant difference between the other groups except for the difference between Group 1 and Group 2. There was no significant difference in the level of non-alcoholic fatty liver (P 0.01).3. There was no significant difference in the level of Non-HDL-C between the obese children and the non-alcoholic fatty liver group (P0.05). Logistic regression analysis, WC, AC, HbAlc was a non-alcoholic fatty liver.4. The level of serum Non-HDL-C in the hyperuricemia group in the obese children was significantly higher than that in the normal group of blood uric acid (P0.01). Logistic regression analysis of Non-HDL-C, HO The effects of MA-IR and AI on hyperuricemia.5. Correlation analysis showed that Non-HDL-C and WHR, TC, TG, LDL-C, ALT, AST, 2h-PG, UA, HbAlc, HOMA-I R and AI were positively correlated (P0.05 or P0.01). The multiple linear step-by-step Regression analysis showed that TC, HDL-C, LDL-C. AI, H OM Conclusion 1. The non-HDL-C of both the MS group and the simple obesity group were higher than that in the normal group. In the control group, the non-HDL-C of the MS group was higher than that of the simple obesity group. The increase of the component of metabolic syndrome and the increase of the level of Non-HDL-C. Non-HDL-C can be used as a predictor of the MS.2. The Non-HDL-C and the atherosclerosis index of the obese children are positive. Correlated, and the atherosclerosis index is the influence factor of Non-HDL-C. Therefore, Non-HDL-C may be involved in the formation of atherosclerosis System, Non-HDL-C can be used to predict the risk of cardiovascular disease.3. Non-obese children's serum Non-HD There was a positive correlation between the level of L-C and the insulin resistance index and the blood glucose of 2 hours after the sugar loading. L-C may play a certain physiological role in the progression of obesity.4. There is no statistical difference between the level of Non-HDL-C between the obese and NAFLD groups, and the correlation analysis found that the Non-HDL-C and the obese children's liver enzymes The serum Non-HDL-C level of the obese children is positively related to the serum uric acid, and the Non-HDL-C, the insulin resistance index and the atherosclerosis index are hyperuricemia. The influential factors indicate that the obese children with high uric acid level are more prone to atherosclerosis, and therefore, the urine
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R725.8
【参考文献】
相关期刊论文 前1条
1 张德平;刘静民;郑秀瑗;;内脏脂肪与血脂的关系及其对血脂异常的临床预测价值[J];肠外与肠内营养;2012年05期
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