【作者】 陈青云；

【导师】 经承学；

【作者基本信息】 广西医科大学 ， 儿科学， 2007， 博士

【摘要】 研究背景代谢综合征(metabolic syndrome,MS)是指多种代谢异常聚集于同一个体的现象。代谢异常可能包括:胰岛素抵抗和高胰岛素血症、中心性肥胖、高血压、脂质代谢异常、血液高凝状态、血管异常、内皮功能障碍、慢性炎性反应、高尿酸血症等。已有研究证实MS在成人中的流行并严重危害成人的健康,那么儿童青少年MS的流行情况及其对儿童青少年健康的影响也应引起足够的重视。但目前关于代谢综合征的定义和组成成分以及诊断标准还没有一个统一的标准。在广西儿童青少年中MS的流行情况也没有文献报道。目的本研究旨在了解学龄儿童青少年代谢综合征及其组分的检出率和影响检出率的因素,探讨适宜广西儿童青少年代谢综合征肥胖诊断的体重指数(bodv mass index,BM)切点以及代谢综合征的诊断标准。方法1、通过分层随机整群抽样的方法对5985例广西贺州市中小学生的调查,分析学龄儿童青少年糖调节受损、血脂异常、肥胖、高血压、高尿酸血症的检出率。2、用特异度、敏感度以及受试者工作特征(receiver operatingcharacteristic,ROC)曲线距离筛选出代谢综合征组分中的肥胖BMI诊断切点。3、分析不同诊断标准对代谢综合征及其组分检出率的影响。结果1、空腹血糖受损(impaired fasting glucose,IFG)(5.6≤FBG＜7.0)检出率:0.46%,糖耐量受损(impaired glucose tolerance,IGT)检出率:0.54%,超重检出率5.25%,肥胖2.03%,超重和肥胖7.28%,高血压(BP≥P90)检出率16.80%,血脂异常检出率:甘油三酯(triglyceride,TG)增高14.68%、高密度脂蛋白胆固醇(high density lipoproteill cholesterol,HDL-c)降低6.74%、低密度脂蛋白胆固醇(lower density lipoprotein cholesterol,LDL-c)增高6.28%、总胆固醇(total cholesterol,TC)增高6.25%、血尿酸(uricacid,UA)增高2.07%。2、中学组糖耐量受损、血脂异常、高尿酸血症检出率较小学组高(p＜0.01);小学组超重和肥胖、高血压检出率较中学组高(p＜0.001)。3、肥胖组高血压和高TG检出率高于正常体重组(p＜0.00l和p＜0.05),超重组高血压检出率高于正常体重组(p＜0.05)。肥胖或超重组的血压、空腹胰岛素、胰岛素抵抗、TG、LDL-c、TC和UA水平高于正常体重组(p＜0.05)。4、比较不同BMI分层检出代谢综合征组分的特异度、敏感度以及ROC曲线距离得出诊断肥胖的最佳BMI切点为BMI≥同年龄同性别的第97百分位数值(the 97th percentile,P97),超过此切点容易出现MS组分的聚集,发生假阳性和假阴性的几率最低。5、按照血压大于等于2000中国学生体质与健康调研报告人群同年龄同性别的第90百分位数值为高血压标准则高血压检出率为16.8%,按照血压超过公式计算20mmHg为高血压标准则高血压检出率为2.74%,前者检出率明显高于后者,前者检出率是后者的6倍余。6、以空腹血糖(fasting blood glucose,FBG)下限5.6mmol/L为切点的IFG2检出率比以空腹血糖下限6.1mmol/L为切点的IFGl检出率高,IFG2标化检出率为0.61%,IFG1标化检出率为0.11%。7、根据本研究的适宜BMI切点值,综合现有MS定义的优缺点,提出以下MS诊断标准供探讨:①BMI≥P97;②FBG≥5.6或糖负荷后2h血糖(2-h postchallenge glucose,2h-PG)≥7.8mmol/L;③TG≥1.24mmol/L;④HDL-c≤1.04mmol/L;⑤收缩压或舒张压≥P90。具备其中任意三点及以上即为MS。8、按照本研究自定义标准,MS检出率为0.31%,两个组分检出率为5.43%,一个组分检出率为27.00%。肥胖组代谢综合征检出率高于非肥胖组。结论1、通过在较大样本儿童青少年人群中的调查,报道广西儿童青少年代谢综合征及其组分检出率,并分析其影响因素,为预防和控制儿童青少年心血管疾病的危险因素、减少成年期心血管疾病的发病制定方案提供有参考意义的数据。2、适合于诊断儿童青少年代谢综合征肥胖的体重指数切点为同年龄同性别的第97百分位数值,超过该切点值容易出现代谢综合征组分的聚集。体重指数切点的分析研究为儿童青少年代谢综合征肥胖的诊断标准的制定提供理论依据。3、根据体重指数适宜切点值,综合现有不同的代谢综合征诊断标准的优缺点提出了可供探讨的儿童青少年自定义代谢综合征标准;①体重指数≥同年龄同性别的第97百分位数值;②空腹血糖≥5.6或糖负荷后2h血糖≥7.8mmol/L;③血清甘油三脂≥1.24mmol/L;④血清高密度脂蛋白胆固醇≤1.04 mmol/L;⑤收缩压或舒张压≥同年龄同性别的第97百分位数值。具备其中任意三点及以上即为代谢综合征。更多还原

【Abstract】 Objective:①To estimate the prevalence and distribution of metabolic syndrome among children and adolescents in Hezhou city in Guangxi.②To identify the appropriate cut-offs of body mass index(BMI)for children and adolescents in Guangxi as a component of metabolic syndrome.Methods:Male and female respondents aged 6 to 18 years(n=5985).The prevalence of metabolic syndrome and its components were analyzed with different definitions or criteria.The sensitivity,specificity and distance in ROC curve by different cut-offs of BMI for identifying one,two or more risk components of metabolic syndrome were estimated to fred the cut-off point for children and adolescents with the shortest distance in ROC curve.Results:①The prevalence of impaired fasting glucose(5.6≤FBG＜7.0mmol/L) was 0.46%,impaired glucose tolerance 0.54%,overweight 5.25%,obesity2.03%, hypertension 16.80%,high triglycerides(TG)14.68%,low HDL cholesterol 6.74%,high LDL cholesterol 6.28%,high total cholesterol(TC)6.25%,high uric acid(UA)2.07%,respectively.②The rates of impaired glucose tolerance (p＜0.001),high TG(p＜0.001),low HDL cholesterol(p＜0.001),high LDL cholesterol(p＜0.05),high TC(p＜0.05)and high UA(p＜0.05)were higher in high school boys and girls than that in elementary school boys and girls,but it is reversed for overweight(p＜0.001),obesity(p＜0.001)and hypertension (p＜0.001).③Overweight or obese children and adolescents had higher prevalence of hypertension(p＜0.001)and high triglycerides(p＜0.05)than nonobese children and adolescents.Overweight or obese children and adolescents had higher levels of blood pressure,triglycerides,fasting serum insulin,insulin resistance index(homeostasismodel assessment),TC,UA and lower HDL cholesterol than nonobese children and adolescents(p＜0.001 or p＜0.05).④BMI≥the age- and sex-specific 97th percentile corresponded to the shortest distance in ROC curve,namely,at these cut-offs,the rates of false positive and false negative for identifying clustering of risk components were the minimum.⑤The prevalence of hypertension with the criterion of systolic or diastolic blood pressure≥the age- and sex-specific 90th percentile was higher than that with the criterion of by calculation in a formula(16.8%vs 2.74%,p＜0.001).⑥The prevalence of IFG2(5.6≤FBG＜7.0mmol/L)was higher than that of IFG1(6.1≤FBG＜7.0mmol/L).The rate of IFG2 adjusted by age and gender was 0.61%,while IFG1 was 0.11%.⑦We suggested abnormalities of components of metabolic syndrome as follow:a)BMI≥the age- and sex-specific 97th percentile;b)blood pressure≥the age- and sex-specific 90th percentile;c)fasting blood glucose≥5.6mmol/L,or 2-h postchallenge glucose≥7.8mmol/L;d)TG≥1.24mmol/L;e)HDL cholesterol≤1.04mmol/L.Subjects who met at least three of the five criteria were classified as having a metabolic syndrome.⑧The prevalence of metabolic syndrome among children and adolescents aged 6 to 18 years was 0.31%with using the difenition in this paper.It is higher in obesity children and adolescents than in nonobesity children and adolescents.Conclusion:①There is prevalence of metabolic syndrome and its components among children and adolescents in Hezhou city in Guangxi,especially in obese children and adolescents.②BMI≥the age- and sex-specific 97th percentile is the appropriate cut-offs for children and adolescents in Guangxi as a component of metabolic syndrome.③If a child had three or more of the following components,metabolic syndrome could be defined:BMI≥the age-and sex-specific 97th percentile,SBP or DBP≥the age- and sex-specific 90th percentile,TG≥1.24mmol/L,HDL-C≤1.04mmol/L and fasting blood glucose 5.6mmol/L or 2-h postchallenge glucose≥7.8mmol/L.This recommendation need further confirmed in representative sample of Chinese population.更多还原