【摘要】 目的探讨口服葡萄糖耐量试验（OGTT）1 h血糖和25-羟维生素D₃[25-（OH）D₃]水平对糖耐量正常肥胖儿童3年自然转归的影响。方法选取2012年6月—2013年12月在保定市儿童医院、贵阳市儿童医院、济宁医学院附属医院及河北省儿童医院行OGTT的肥胖儿童297例,其中糖耐量正常者238例;根据OGTT 1 h血糖将糖耐量正常儿童分为对照组（OGTT 1 h血糖≤8.6 mmol/L,n=142）和观察组（OGTT 1 h血糖>8.6 mmol/L,n=96）;两组儿童均随访3年,根据随访结果分为A组（糖耐量正常,n=123）、B组（糖耐量异常,n=25）及C组[2型糖尿病（T2DM）,n=7]。比较对照组与观察组儿童基线实验室检查指标及随访3年自然转归,比较A组、B组和C组儿童基线实验室检查指标及随访结束时25-（OH）D₃水平;25-（OH）D₃水平与糖耐量正常肥胖儿童OGTT 1 h血糖的相关性分析采用Pearson相关性分析。结果随访3年,失访83例,失访率为34.9%;最终对照组共84例儿童完成随访,观察组共71例儿童完成随访。对照组与观察组儿童基线0 h胰岛素、2 h胰岛素及三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平比较,差异无统计学意义（P>0.05）;观察组儿童基线OGTT 0 h血糖、1 h血糖、2 h血糖高于对照组,基线25-（OH）D₃水平低于对照组（P<0.05）。随访3年,观察组儿童自然转归劣于对照组（P<0.05）。A组、B组及C组儿童基线0 h胰岛素、2 h胰岛素、OGTT 0 h血糖、OGTT 2 h血糖及TG、TC、HDL-C、LDL-C水平比较,差异无统计学意义（P>0.05）;B组和C组儿童基线OGTT1 h血糖高于A组,基线25-（OH）D₃水平低于A组（P<0.05）;C组儿童基线OGTT 1 h血糖高于B组,基线25-（OH）D₃水平低于B组（P<0.05）。B组C组儿童随访结束时25-（OH）D₃水平低于A组,C组儿童随访结束时25-（OH）D₃水平低于B组（P<0.05）。Pearson相关性分析结果显示,25-（OH）D₃水平与糖耐量正常肥胖儿童OGTT 1 h血糖呈负相关（r=-0.20,P<0.05）。结论 OGTT 1 h血糖和25-（OH）D₃水平均可影响糖耐量正常肥胖儿童3年自然转归,且OGTT 1 h血糖与25-（OH）D₃水平呈负相关。更多还原

【Abstract】 Objective To investigate the impact of OGTT 1-hour PG and 25-（ OH） D₃ on 3-year natural outcome in obese children with normal glucose tolerance. Methods From June 2012 to December 2013, a total of 297 children undergoing OGTT were selected in the Children’ s Hospital of Baoding, the Children’ s Hospital of Guiyang, the Affiliated Hospital of Jining Medical University and Hebei Provincial Children’ s Hospital, there into 238 cases’ glucose tolerance were normal; according to the OGTT 1-hour PG,the 238 children with normal glucose tolerance were divided into control group（ with OGTT 1-hour PG equal or less than 8. 6 mmol/L） and observation group（ with OGTT over 8. 6 mmol/L）; according to the 3-year follow-up results,the 155 children with normal glucose tolerance were divided into A group（ with normal glucose tolerance,n = 123）, B group（ with abnormal glucose tolerance, n = 25） and C group（ with T2 DM, n = 7）. Baseline laboratory examination results and 3-year natural outcome were compared between control group and observation group,baseline laboratory examination results and 25-（ OH） D₃ at the end of follow-up were compared among A group,B group and C group;Pearson correlation was used to analyze the correlation between 25-（ OH） D₃ and OGTT 1-hour PG in obese children with normal glucose tolerance. Results The rate of lost to follow-up was 34. 9%（ 83/238） durinng the 3-year follow-up; 84 cases of control group and 71 cases of observation group completed the follow-up eventually. No statistically significant differences of baseline 0-hour insulin,2-hour insulin,TG,TC,HDL-C or LDL-C was found between cotrrol group and observation group（ P > 0. 05）; baseline OGTT 0-hour PG,OGTT 1-hour PG and OGTT 2-hour PG of observation group were statistically significantly higher than those of control group, while baseline 25-（ OH） D₃ of observation group was statistically significantly lower than that of control group（ P < 0. 05）. Natural outcome of observation group was statistically significantly worse than that of control group（ P < 0. 05）. No statistically significant differences of baseline 0-hour insulin,2-hour insulin,OGTT 0-hour PG,OGTT 2-hour PG,TG,TC,HDL-C or LDL-C was found among the A group,B group and C group（ P > 0. 05）; baseline OGTT 1-hour PG of B group and C group was statistically significantly higher than that of A group,respectively,while baseline 25-（ OH） D₃ of B group and C group was statistically significantly lower than that of A group,respectively（ P < 0. 05）; baseline OGTT 1-hour PG of C group was statistically significantly higher than that of B group,while baseline 25-（ OH） D₃ of C group was statistically significantly lower than that of B group（ P < 0. 05）. At the end of follow-up,25-（ OH） D₃ of B group and C group was statistically significantly lower than that of A group,respectively,meanwhile 25-（ OH） D₃ of C group was statistically significantly lower than that of B group（ P < 0. 05）. Pearson correlation analysis results showed that,25-（ OH） D₃ was negatively correlated with OGTT 1-hour PG in obese children with normal glucose tolerance（ r =-0. 20,P < 0. 05）. Conclusion Both OGTT 1-hour PG and 25-（ OH） D₃ may affect the 3-year natural outcome in obese children with normal glucose tolerance, and OGTT 1-hour PG is negatively correlated with 25-（ OH） D₃.更多还原