【摘要】：目的：現(xiàn)單純性肥胖逐漸成為兒童常見病，其導致的脂肪沉積、胰島素抵抗可增加兒童糖尿病的發(fā)病率。故本課題對單純性肥胖兒童血漿游離脂肪酸（Freefatty acid，F(xiàn)FA）濃度水平進行探討，并分析FFA與胰島素抵抗(Insulinresistance，IR)的相關(guān)性，以助改善當代兒童體質(zhì)情況。 方法：本實驗選取2013年9月至2014年3月間，在大連醫(yī)科大學附屬第二臨床醫(yī)院兒科住院的7-14周歲兒童作為研究對象，常規(guī)測量體重、身高，并計算其相應的體重指數(shù)（Body mass index，BMI），依照2004年中國肥胖問題工作組制定的中國學齡兒童青少年超重、肥胖篩查體重指數(shù)(BMI)分類標準進行篩選。共有45名兒童，分為單純性肥胖組25例，體質(zhì)正常組20例，并排除了感染及其他非感染性疾病的影響。空腹采集靜脈血標本，用全自動生化分析儀測定其空腹血糖（FPG）、甘油三酯（TG）及總膽固醇（TC）的濃度，用放射免疫方法測定其空腹血胰島素（FINS）的濃度，采用ELISA方法測定血清中游離脂肪酸水平。用穩(wěn)態(tài)模型胰島素抵抗指數(shù)（Homeostasis model assessment-insulin resistance，HOMA-IR）評價胰島素敏感性，計算HOMA-IR=FPG×FINS/22.5。 結(jié)果： 1．單純性肥胖組兒童的BMI（28.77±3.63）kg/m2，明顯高于對照組BMI（16.99±1.48）kg/m2，兩組間差異具有顯著統(tǒng)計學意義（P＜0.01）。 2.肥胖組兒童血清空腹血糖（FPG）濃度（4.77±0.32）mmol/L，對照組兒童FPG（4.58±0.38）mmol/L，兩組間差異無統(tǒng)計學意義（P=0.082）。肥胖組兒童血清空腹胰島素（FINS）濃度為（19.32±7.68）uU/ml，高于正常對照組兒童血清FINS（8.56±2.26）uU/ml，兩組間差異有顯著統(tǒng)計學意義（P＜0.01）。肥胖組兒童胰島素抵抗指數(shù)（HOMA-IR）為（4.11±1.68），，高于正常對照組兒童HOMA-IR（1.74±0.48），兩組間差異有顯著統(tǒng)計學意義（P＜0.01）。 3.肥胖組兒童血清游離脂肪酸(FFA)濃度（9.18±3.08）ng/ml，明顯高于正常對照組兒童血清FFA濃度（4.90±1.75）ng/ml，兩組間差異有顯著統(tǒng)計學意義（P＜0.01）。肥胖組兒童的甘油三酯（TG）濃度（1.52±0.61）mmol/L、總膽固醇（TC）濃度（4.26±0.60）mmol/L，均高于對照組TG濃度（0.82±0.22）mmol/L、TC濃度（3.75±0.47）mmol/L，差異均有顯著統(tǒng)計學意義（P＜0.01）。 4.肥胖組兒童血清空腹胰島素、胰島素抵抗與BMI呈正相關(guān)（相關(guān)系數(shù)r=0.795，0.798），且具有顯著統(tǒng)計學意義（P＜0.01）。 5.肥胖組兒童血清FFA和BMI、HOMA-IR分別呈正相關(guān)（相關(guān)系數(shù)分別為r=0.677，0.841），上述相關(guān)性均有顯著統(tǒng)計學意義（P＜0.01）。 結(jié)論： 1.單純性肥胖兒童血清游離脂肪酸濃度明顯高于體質(zhì)正常兒童。 2.單純性肥胖兒童胰島素抵抗指數(shù)明顯高于體質(zhì)正常兒童，且與BMI呈正相關(guān)，提示單純性肥胖兒童易發(fā)生胰島素抵抗。 3.單純性肥胖兒童血清游離脂肪酸水平與胰島素抵抗指數(shù)呈正相關(guān)，提示游離脂肪酸參與了胰島素抵抗的發(fā)生。
[Abstract]:Aim: simple obesity has gradually become a common disease in children, which leads to fat deposition and insulin resistance can increase the incidence of diabetes in children. Therefore, the level of plasma free fatty acid (Freefatty acid,FFA) in children with simple obesity was discussed, and the correlation between FFA and insulin resistance (Insulinresistance,IR) was analyzed in order to improve the physique of contemporary children. Methods: from September 2013 to March 2014, 7-year-old 14-year-old children hospitalized in the Department of Pediatrics, affiliated to Dalian Medical University, were selected as subjects, and their weight and height were measured routinely. The corresponding body mass index (Body mass index,BMI) was calculated and screened according to the (BMI) classification standard of overweight and obesity screening for Chinese school-age children and adolescents established by the China Obesity working Group in 2004. A total of 45 children were divided into simple obesity group (n = 25) and normal physique group (n = 20). Infection and other non-infectious diseases were excluded. Fasting venous blood samples were collected and their fasting blood glucose levels of (FPG), triglyceride (TG) and total cholesterol (TC) were measured by automatic biochemical analyzer, and their fasting blood insulin (FINS) concentrations were measured by radioimmunoassay. The levels of free fatty acids in serum were determined by ELISA. Insulin sensitivity was evaluated by homeostasis model insulin resistance index (Homeostasis model assessment-insulin resistance,HOMA-IR), and HOMA-IR=FPG 脳 FINS/22.5. was calculated. Results: 1. BMI (28.77 鹵3.63) kg/m2, in simple obesity group was significantly higher than that in BMI (16.99 鹵1.48) kg/m2, group (P < 0.01). 2. There was no significant difference in serum fasting blood glucose (FPG) concentration (4.77 鹵0.32) mmol/L, between the two groups (P < 0.082). There was no significant difference between the two groups in FPG (4.58 鹵0.38) mmol/L, in the control group (P < 0.05). The fasting insulin (FINS) concentration in obese children was significantly higher than that in normal controls (19.32 鹵7.68 uU/ml, vs 8.56 鹵2.26 uU/ml, P < 0.01). The insulin resistance index (HOMA-IR) of obese children was (4.11 鹵1.68), which was higher than that of normal children (1.74 鹵0.48). There was significant difference between the two groups (P < 0.01). 3. The serum free fatty acid (FFA) concentration in obese children was significantly higher than that in normal controls (9.18 鹵3.08 ng/ml, vs 4.90 鹵1.75 ng/ml, P < 0.01). Triglyceride (TG) concentration (1.52 鹵0.61) mmol/L, total cholesterol (TC) concentration (4.26 鹵0.60) mmol/L, in obese children was higher than that in control group (0.82 鹵0.22) mmol/L,. There was significant difference in TC concentration between (3.75 鹵0.47) mmol/L, and (3.75 鹵0.47) mmol/L, (P < 0.01). 4. Fasting insulin and insulin resistance were positively correlated with BMI in obese children (r = 0.795, 0.798). 5. There was a positive correlation between serum FFA and BMI,HOMA-IR in obese children (r = 0.677, 0.841, respectively). All of the above correlations were statistically significant (P < 0.01). Conclusions: 1. The serum free fatty acid concentration of simple obese children was significantly higher than that of normal children. 2. The insulin resistance index of simple obese children was significantly higher than that of normal children, and there was a positive correlation between insulin resistance and BMI, suggesting that simple obese children were prone to insulin resistance. 3. There was a positive correlation between serum free fatty acid level and insulin resistance index in children with simple obesity, suggesting that free fatty acid was involved in the occurrence of insulin resistance.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R723.14

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