【摘要】 目的 探讨单纯肥胖儿童血清微小RNA-122 (miR-122)、人去乙酰化酶4 (SIRT4)、网膜素-1(Omentin-1)水平与肥胖程度、胰岛素抵抗(IR)的相关性。方法 按照2∶1的比例选取2022年6月至2024年6月南阳市中心医院收治的204例单纯肥胖儿童(肥胖组)和生长发育门诊102例体检非肥胖儿童(对照组)纳入研究。比较两组儿童的血清miR-122、SIRT4、Omentin-1水平与稳态模型胰岛素抵抗指数(HOMA-IR)；比较不同肥胖程度患儿的基线资料及血清miR-122、SIRT4、Omentin-1水平；采用多分类Logistic回归方程分析miR-122、SIRT4、Omentin-1与肥胖程度的相关性，并建立多分类Logistic回归模型，分析该模型评估肥胖程度的准确性；采用Pearson相关性分析肥胖组miR-122、SIRT4、Omentin-1与HOMA-IR相关性。结果 肥胖组儿童的血清miR-122水平、HOMA-IR分别为1.19±0.39、2.04±0.50，明显高于对照组的0.78±0.20、1.59±0.44,SIRT4、Omentin-1水平分别为(0.95±0.31) mmol/L、(221.95±79.86) pg/mL，明显低于对照组的(1.34±0.27) mmol/L、(318.76±88.54) pg/mL，差异均有统计学意义(P<0.05)；重度肥胖患儿的血清miR-122水平、HOMA-IR分别为1.80±0.31、2.31±0.37，明显高于中度肥胖患儿的1.27±0.36、2.10±0.43和轻度肥胖患儿的0.80±0.25、1.82±0.39,SIRT4、Omentin-1水平分别为(0.59±0.18) mmol/L、(194.76±36.55) pg/mL，明显低于中度肥胖患儿的(0.90±0.27) mmol/L、(219.35±30.78) pg/mL和轻度肥胖患儿的(1.20±0.39) mmol/L、(238.54±34.71) pg/mL，差异均有统计学意义(P<0.05)；以轻度肥胖为参考项，miR-122、SIRT4、Omentin-1作为自变量，建立多分类Logistic回归模型，ln (重度肥胖/轻度肥胖)=1.669+0.566×miR-122-0.685×SIRT4-0.534×Omentin-1,ln (中度肥胖/轻度肥胖)=0.144+0.424×miR-122-0.839×SIRT4-0.738×Omentin-1，且miR-122、SIRT4、Omentin-1均与肥胖程度呈显著相关性(P<0.05)；多分类Logistic回归模型解释重度、中度、轻度肥胖的准确率分别为91.89%、94.57%、94.67%，总体准确率为94.12%，且拟合程度优良；Pearson相关性分析结果显示，肥胖组儿童miR-122与HOMA-IR呈正相关(r=0.771,P<0.05),SIRT4、Omentin-1与HOMA-IR呈负相关(r=-0.658、-0.615,P<0.05)。结论 单纯肥胖儿童血清miR-122水平升高，SIRT4、Omentin-1水平降低，miR-122与肥胖程度、HOMA-IR呈正相关，SIRT4、Omentin-1与肥胖程度、HOMA-IR呈负相关，早期检测其水平可用于评估儿童的肥胖程度和IR状态。更多还原

【Abstract】 Objective To investigate the correlation between the levels of serum microRNA-122(miR-122),human sirtuin 4(SIRT4), and omentin-1(Omentin-1) in children with simple obesity and their obesity severity and insulin resistance(IR). Methods According to 2:1, 204 children with simple obesity admitted to Nanyang Central Hospital from June 2022 to June 2024(obese group) and 102 non-obese children undergoing physical examination in the Growth and Development Clinic(control group) were selected for inclusion in the study. The levels of serum miR-122, SIRT4,and Omentin-1, as well as the Homeostatic Model Assessment of Insulin Resistance(HOMA-IR) index, were compared between the two groups of children. The baseline data and serum levels of miR-122, SIRT4, and Omentin-1 were compared among children with different degrees of obesity. Multiclass logistic regression equations were used to analyze the correlation between miR-122, SIRT4, Omentin-1 and the obesity severity, and a multiclass logistic regression model was established to analyze the accuracy of this model in assessing the obesity degree. Pearson correlation analysis was used to analyze the correlation between miR-122, SIRT4, Omentin-1 and HOMA-IR in the obese group. Results The serum levels of mi R-122 and HOMA-IR in obese group were 1.19±0.39 and 2.04±0.50, respectively, which were significantly higher than 0.78±0.20 and 1.59±0.44 in the control group; the levels of SIRT4 and Omentin-1 were(0.95±0.31) mmol/L and(221.95±79.86) pg/mL, respectively, which were significantly lower than(1.34±0.27) mmol/L and(318.76±88.54) pg/mL in the control group; the differences were statistically significant(P<0.05). The serum levels of miR-122 and HOMA-IR in severely obese children were 1.80±0.31 and 2.31±0.37, respectively, which were significantly higher than 1.27±0.36and 2.10±0.43 in moderately obese children and 0.80±0.25 and 1.82±0.39 in mildly obese children; the levels of SIRT4and Omentin-1 were(0.59±0.18) mmol/L and(194.76±36.55) pg/mL, respectively, which were significantly lower than(0.90±0.27) mmol/L and(219.35±30.78) pg/mL in moderately obese children and(1.20±0.39) mmol/L and(238.54±34.71) pg/mL in mildly obese children; the differences were statistically significant(P<0.05). Using mild obesity as the reference category, miR-122, SIRT4, and Omentin-1 as independent variables, a multiclass logistic regression model was established: ln(severe obesity/mild obesity)=1.669+0.566×miR-122-0.685×SIRT4-0.534×Omentin-1, ln(moderate obesity/mild obesity)=0.144+0.424×miR-122-0.839×SIRT4-0.738×Omentin-1. miR-122, SIRT4, and Omentin-1showed a significant correlation with the severity of obesity(P<0.05). The accuracy of the multiclass logistic regression model in predicting severe, moderate, and mild obesity was 91.89%, 94.57%, and 94.67%, respectively, with an overall accuracy of 94.12%. The model also demonstrates good fit. Pearson correlation analysis results indicate that in obese children, miR-122 was positively correlated with HOMA-IR(r=0.771, P<0.05), while SIRT4 and Omentin-1 were negatively correlated with HOMA-IR(r=-0.658,-0.615, P<0.05). Conclusion In children with simple obesity, serum levels of miR-122 are elevated, while levels of SIRT4 and Omentin-1 are reduced. miR-122 positively correlates with obesity severity and HOMA-IR, while SIRT4 and Omentin-1 negatively correlate with obesity severity and HOMA-IR. Early detection of the three indexes can be used to assess the severity of obesity and IR status in children.更多还原