肥胖儿童维生素D营养状况与胰岛素抵抗、内皮损伤及脂代谢的相关性分析

许君 杨素红 叶蓓

[摘要] 目的 研究肥胖兒童维生素D营养状况与胰岛素抵抗、内皮损伤、脂代谢的相关性。 方法 选取2017年9月～2019年3月我院就诊的肥胖患儿85例为观察组，128例正常儿童为对照组。观察两组维生素D、胰岛素抵抗、内皮损伤及脂代谢相关指标水平，分析维生素D水平与胰岛素抵抗、内皮损伤及脂代谢相关指标之间的相关性。后观察组按维生素D水平分为缺乏组和不足组，观察不同维生素D水平患儿胰岛素抵抗、内皮损伤及脂代谢相关指标水平。 结果 观察组维生素D、胰岛素敏感指数、一氧化氮水平低于对照组，胰岛素抵抗指数、循环内皮细胞微粒高于对照组，差异有统计学意义（P<0.05）。维生素D水平与胰岛素抵抗指数、微循环内皮细胞微粒、TC、TG、LDL呈负相关，与胰岛素敏感指数、一氧化氮、HDL呈正相关，差异有统计学意义（P<0.05）。维生素D缺乏、不足患儿胰岛素抵抗指数、循环内皮细胞微粒高于对照组，胰岛素敏感指数、一氧化氮水平低于对照组，缺乏组上述指标均低于不足组，差异有统计学意义（P<0.05）。维生素D缺乏、不足患儿TC、TG、LDL水平高于对照组，缺乏组低于不足组，三组HDL水平比较，差异有统计学意义（P<0.05）。 结论 肥胖儿童维生素D水平与胰岛素抵抗、内皮损伤及脂代谢相关指标有相关性。

[关键词] 肥胖儿童;维生素D;营养状况;相关性

[中图分类号] R725.8          [文献标识码] A          [文章编号] 1673-9701（2020）17-0020-05

Correlation analysis of vitamin D nutrition status and insulin resistance， endothelial injury and lipid metabolism in obese children

XU Jun1   YANG Suhong2   YE Bei1

1.Department of Internal Medicine， Hangzhou Children's Hospital， Hangzhou   310000， China; 2.Department of Endocrinology， Hangzhou Children's Hospital， Hangzhou  310000， China

[Abstract] Objective To study the correlation between vitamin D nutrition status and insulin resistance， endothelial injury and lipid metabolism in obese children. Methods 85 obese children in our hospital were selected as the observation group from September 2017 to March 2019， and 128 normal non-obese children were selected as the control group. The correlation between vitamin D nutrition status and the indexes of insulin resistance， endothelial injury and lipid metabolism in two groups were observed. The correlation between vitamin D level and the indexes of insulin resistance， endothelial injury and lipid metabolism was analyzed. The observation group was divided into groups according to vitamin D level. The levels of insulin resistance， endothelial injury and lipid metabolism related indexes of children with different vitamin D levels were observed. Results The levels of vitamin D， insulin sensitivity index and nitric oxide in the observation group were significantly lower than those in the control group， and the insulin resistance index and circulating endothelial cell particles were significantly higher than those in the control group （P<0.05）.Vitamin D level was negatively correlated with insulin resistance index， microcirculation endothelial particles， TC， TG and LDL， and positively correlated with insulin sensitivity index， nitric oxide， HDL（P<0.05）. Insulin resistance and circulating endothelial cell particles in vitamin D deficiency and insufficiency children were significantly higher than those in the control group. The insulin sensitivity index and nitric oxide levels in the deficiency group and the  insufficiency group were significantly lower than those in the control group. The above indicators in the deficiency group were significantly lower than those in the  insufficiency group， and the difference was statistically significant（P<0.05）. The levels of TC， TG and LDL in children with vitamin D deficiency and insufficiency were significantly higher than those in the control group， and the indicators in the deficiency group was significantly lower than that in the insufficiency group. The difference in HDL levels was statistically significant among three groups（P<0.05）. Conclusion The vitamin D levels are significantly correlated with insulin resistance， endothelial injury and lipid metabolism related indexes in obese children.

[Key words] Obese children;Vitamin D;Nutritional status;Correlation

肥胖是由长期摄入过多食物或是机体代谢发生改变，导致体内脂肪积聚过多所引起。肥胖会导致心血管疾病、代谢性疾病、心理与精神疾病的发生，影响患儿生活质量和寿命。近年来，我国肥胖的发生率不断提升，其中儿童肥胖的发生率呈现显著升高趋势。研究指出，儿童肥胖普遍存在糖代谢异常、胰岛素抵抗等情况，更有患儿因肥胖出现心血管疾病[1]。维生素D缺乏与肥胖、血糖升高、胰岛素抵抗、血管内皮损伤之间存在的關系已被多种研究结果支持，但临床中并无关联性研究结果报道[2]。肥胖儿童体内维生素D含量可出现显著降低，但是其与胰岛素抵抗、内皮损伤及脂代谢等指标间的关系也尚未明确[3]。……