肥胖儿童黑色棘皮病与脂肪因子和代谢综合征的关系

Association between acanthosis nigricans and metabolic syndrome in children with obesity

摘要:

目的 了解肥胖伴黑色棘皮病(AN)患儿代谢特点及血清脂肪因子水平,探讨AN 对代谢综合征的预测价值。方法 将2012 年2 月至2013 年6 月收治的109 名肥胖儿童分为伴AN 组(n=44)和无AN 组(n=65),同期选取年龄、性别相匹配的健康儿童做为对照组(n=47)。采用ELISA 法检测血脂联素、瘦素、肿瘤坏死因子α 和视黄醇结合蛋白4 的水平,并对代谢综合征的危险因素进行多元logistic 回归分析。结果 肥胖伴AN 组腰臀比、收缩压、血甘油三酯、空腹胰岛素、胰岛素抵抗指数均较肥胖无AN 组和对照组升高(P<0.05)。肥胖伴AN 组和肥胖无AN 组脂联素水平均较对照组降低,肥胖伴AN 组瘦素水平较肥胖无AN 组和对照组明显升高(P<0.05)。Logistic 回归提示伴发AN(OR=3.469,95%CI:1.518~7.929)和高BMI(OR=7.108,95%CI:2.359~21.416)是代谢综合征的独立危险因素(P<0.05)。结论 AN 是胰岛素抵抗的皮肤标志,与脂肪因子分泌异常密切相关,降低AN 发生率和BMI 将减少代谢综合征的发生。

Abstract:

Objective To investigate adipokines levels in obese children with acanthosis nigricans (AN) and to explore the relationship between AN and metabolic syndrome (MS). Methods A cross-sectional study was performed on 109 obese children and 47 age-and gender-matched normal controls. The obese children were divided into two groups with AN and without AN. Serum levels of adiponectin, leptin, TNF-α and retinol-binding protein 4 (RBP4) were measured using ELISA. Multiple logistic regression analysis was performed to estimate the association of clinical parameters with MS. Results Waist-hip ratio, systolic blood pressure, triglyceride, fasting insulin and insulin resistance index (HOMA-IR) were significantly higher in obese children with AN than in those without AN and normal controls (P<0.05). The obese children with AN and without AN had lower adiponectin levels than normal controls (P<0.05), on the contrary, the obese children with AN had higher leptin levels than those without AN and normal controls (P<0.05). Multiple logistic regression analysis revealed that AN (OR=3.469, 95%CI: 1.518-7.929) and BMI (OR=7.108, 95%CI: 2.359-21.416) were independent risk factors for MS. Conclusions As a visible marker of insulin resistance, AN is associated with abnormal adipokines secretion. Reducing the incidence of AN and losing weight may prevent obesity associated MS.