發(fā)布時(shí)間：2018-08-18 09:35

【摘要】：目的 初步了解兒童及青少年肥胖患者糖脂代謝及肝臟、心臟等靶器官的異常情況，以期及早采取干預(yù)措施防止嚴(yán)重并發(fā)癥的發(fā)生。 方法 選擇2012年6月至2013年6月期間于鄭州人民醫(yī)院兒保門(mén)診就診的兒童及青少年，其中肥胖者199例，超重者291例，體檢體重正常者110例為對(duì)照組。取空腹靜脈血，分別檢測(cè)空腹血糖（FPG）、甘油三酯（TG）、總膽固醇（TC）、谷丙轉(zhuǎn)氨酶（ALT）、空腹胰島素（FINS）等指標(biāo)，并計(jì)算胰島素抵抗指數(shù)（HOMA～I(xiàn)R）及胰島β細(xì)胞功能值（HOMA～β）；口服糖耐量試驗(yàn)（OGTT）和胰島素釋放試驗(yàn)僅用于測(cè)試肥胖及超重兒童的相應(yīng)指標(biāo)。肥胖組、超重組及對(duì)照組兒童均行肝臟和心臟超聲檢查。 結(jié)果 與對(duì)照組收縮壓、舒張壓相比，肥胖組及超重組的血壓指標(biāo)均升高（P 0.05），高血壓的發(fā)生率在肥胖組、超重組及對(duì)照組分別為0.00%（0/110）、14.6%（29/199）、6.5%（19/291）。與對(duì)照組相比，F(xiàn)BG、FINS、HOMA～I(xiàn)R及HOMA～β在肥胖組及超重組均有所升高（P 0.05）；在脂代謝相關(guān)指標(biāo)中，除HDL～C較對(duì)照組降低外，其余三項(xiàng)（TC、TG、LDL～C）均升高，經(jīng)檢驗(yàn)，差異均有統(tǒng)計(jì)學(xué)意義（P 0.05）。脂肪肝發(fā)生率在超重及肥胖組中差異有統(tǒng)計(jì)學(xué)意義（P 0.05）。肥胖組及超重組患兒共有268例出現(xiàn)心包外脂肪增厚，平均厚度（3.369±0.099）mm，與對(duì)照組相比差異有統(tǒng)計(jì)學(xué)意義（P 0.05）。 結(jié)論 與體重正常的兒童相比，肥胖及超重兒童的高血壓發(fā)生風(fēng)險(xiǎn)及糖代謝異常發(fā)生率均有所升高，，糖代謝異常（包括空腹血糖受損、胰島素抵抗、糖耐量減低、高胰島素血癥和β細(xì)胞功能減低等）在超重時(shí)即可出現(xiàn)。此外，血脂紊亂在肥胖兒童中表現(xiàn)較為明顯，脂肪肝亦可同時(shí)發(fā)生，10歲后的肥胖兒童尤甚。與正常體重兒童相比，左心室肥大和心包外脂肪增厚在肥胖兒童尤為明顯。
[Abstract]:Objective to investigate the abnormalities of glucose and lipid metabolism, liver, heart and other target organs in obese children and adolescents so as to take early intervention measures to prevent the occurrence of serious complications. Methods from June 2012 to June 2013, 199 obese, 291 overweight and 110 normal weight children and adolescents were selected from the outpatient clinic of Zhengzhou people's Hospital. Fasting blood samples were collected and fasting blood glucose (FPG), triglyceride (TG), total cholesterol (TC), alanine aminotransferase (ALT), fasting insulin (FINS) were measured, and insulin resistance index (HOMA~IR) and islet 尾 cell function (Homa 尾) were calculated. Oral glucose tolerance test (OGTT) (OGTT) and insulin release test were used only to test the corresponding indexes of obese and overweight children. Liver and heart ultrasound were performed in obese group, superrecombinant group and control group. Results compared with the systolic blood pressure and diastolic blood pressure of the control group, the blood pressure indexes of the obese group and the hyperrecombination group were increased (P 0.05). The incidence of hypertension in the obese group, the superrecombinant group and the control group was 0.00% (0 / 110) or 14.6% (29 / 199) or 6.5% (19 / 291), respectively. Compared with the control group, HOMA-IR and HOMA- 尾 were increased in obese group and hyperrecombination group (P0. 05), except for the decrease of HDL~C in the control group, the other three items (TCU TGLDLX C) were higher than those in the control group (P 0. 05), and the difference was statistically significant (P 0. 05). The incidence of fatty liver was significantly different in overweight and obesity groups (P 0.05). In obesity group and superrecombinant children, the mean thickness of pericardial fat was (3.369 鹵0.099) mm, which was significantly higher than that in control group (P 0.05). Conclusion compared with normal weight children, the risk of hypertension and the incidence of abnormal glucose metabolism in obese and overweight children are increased, including impaired fasting blood glucose, insulin resistance and impaired glucose tolerance. Hyperinsulinemia and 尾-cell dysfunction can occur when overweight. In addition, dyslipidemia was more evident in obese children, especially in obese children after 10 years of age. Left ventricular hypertrophy and extrapericardial fat thickening were more pronounced in obese children than in normal weight children.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類(lèi)號(hào)】：R723.14

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