非高密度脂蛋白胆固醇对肥胖儿童非脂性心血管疾病危险因素的预测作用

Non-high-density-cholesterol as a predictor of non-lipid cardiovascular disease risk factors in obese children

摘要:

目的：了解非高密度脂蛋白胆固醇（non-HDL-C）对肥胖儿童高血压、糖尿病前期及糖尿病等心血管疾病（CVD）危险因素的预测作用。方法：根据有无高血压、糖尿病前期及糖尿病的发生，将810名中心性肥胖儿童分为无并发症（n=311）和有并发症（n=499）两组，并设立年龄、性别相匹配的正常对照组（n=164），应用logistic回归和ROC曲线分析各项血脂指标对于非脂性CVD危险因素的预测能力。结果：高non-HDL-C血症（>3.76 mmol/L）的肥胖儿童高血压、糖尿病前期的发生率均显著升高（P＜0.01）。预测肥胖儿童非脂性CVD危险因素的ROC曲线显示，在性别、年龄匹配的前提下，应用logistic回归分析校正腰围Z值后，non-HDL-C的ROC曲线下面积最大，为0.680，低密度脂蛋白胆固醇、总胆固醇、载脂蛋白 B分别为0.659、0.669、0.647，其结果均具有统计学意义（P＜0.001）。结论：相对于其他血脂指标，non-HDL-C能更好地预测肥胖儿童发生非脂性CVD的危险，应在肥胖儿童中进行non-HDL-C筛查。

Abstract:

OBJECTIVE: To investigate the role of non-high density lipoprotein cholesterol (non-HDL-C) in the assessment of cardiovascular disease (CVD) risk factors such as hypertension, pre-diabetes and diabetes in obese children. METHODS: According to the presence of complications (hypertension, pre-diabetes and diabetes), 810 children with central obesity were divided into two groups: one group with complications (n=499) and one group without complications (n=311). One hundred and sixty-four age- and sex-matched children served as the control group. Logistic regression analysis and receiver operating characteristic (ROC) curves were used to analyze the detection of non-lipid CVD risk factors by seven lipid markers. RESULTS: The prevalence rates of hypertension and pre-diabetes were significantly higher in obese children with high non-HDL-C concentrations (≥3.76 mmol/L). After adjusting for waist circumference Z-scores, the area under the ROC curve for non-HDL-C was 0.680 to detect non-lipid CVD risk factors, while the areas for low-density lipoprotein cholesterol, total cholesterol and apoprotein B were 0.659, 0.669 and 0.647 respectively. CONCLUSIONS: Compared with the other lipid markers, non-HDL-C is a better predictor for non-lipid CVD risk factors in obese children. Measurement of non-HDL-C concentations is recommended for obese children.