血清25-羟基维生素D水平与骨密度变化在肥胖患儿中的临床意义

doi:10.3969/j.issn.1673-8640.2018.08.001

摘要/Abstract

摘要：

目的探讨单纯性肥胖患儿25-羟基维生素D [25（OH）D]水平、骨定量超声与血脂、血糖、胰岛素抵抗等的关系。方法分别检测109例单纯性肥胖患儿（肥胖组）及104名体检健康儿童（正常对照组）25（OH）D、空腹血糖（FBG）、空腹胰岛素（FINS）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、尿酸（UA）,计算胰岛素抵抗指数（HOMA-IR）,并测量左侧胫骨中段骨超声传播速度（SOS）。按体重指数（BMI）将肥胖组分为轻度肥胖组、中度肥胖组和重度肥胖组,比较3组之间25（OH）D水平和骨SOS值。采用Pearson直线相关分析评价25（OH）D与其他指标的相关性。结果肥胖组UA、TG、TC、LDL-C及FBG水平均高于正常对照组（P<0.05）,25（OH）D水平及骨SOS值均低于正常对照组（P<0.05）。相关分析显示,肥胖组25（OH）D与TG呈负相关（r=-0.279,P<0.05）,而与FINS、FBG、HOMA-IR、UA、TC、HDL-C及LDL-C无相关性（r值分别为-0.144、-0.027、-0.144、-0.049、-0.106、0.021、-0.137,P>0.05）。轻度肥胖组、中度肥胖组和重度肥胖组25（OH）D水平和骨SOS值随肥胖程度的增加而逐渐降低,各组间差异均有统计学意义（P<0.05）。结论单纯性肥胖患儿血清25（OH）D水平和骨SOS值随肥胖程度的增加而逐渐降低。维生素D缺乏可能与肥胖有关。

关键词: 25-羟基维生素D, 骨密度, 肥胖儿童

Abstract:

Objective To investigate the relations of 25-hydroxyvitamin D [25（OH）D] and bone mineral density with blood lipid,blood glucose and insulin resistance in children with simple obesity.Methods The levels of 25（OH）D,fasting blood glucose（FBG）,fasting insulin（FINS）,total cholesterol（TC）,triglyceride（TG）,high-density lipoprotein cholesterol（HDL-C）,low-density lipoprotein cholesterol（LDL-C） and uric acid（UA）were determined in 109 children with simple obesity（obesity group） and 104 healthy children（healthy control group）. The homeostasis model assessment for insulin resistance（HOMA-IR） was calculated. The speed of sound（SOS） of left tibial bone was measured by ultrasonography. The obesity group was classified into mild obesity,moderate obesity and severe obesity groups according to body mass index （BMI）. The levels of 25（OH）D and SOS among the 3 groups were compared. The correlation between 25（OH）D and other indicators was evaluated by Pearson linear correlation analysis.Results The UA,TG,TC,LDL-C and FBG in obesity group were higher than those in healthy control group（P<0.05）,while 25（OH）D and SOS were lower（P<0.05）. In obesity group,25（OH）D was negatively correlated to TG（r=-0.279,P<0.05）,while there was no correlation between 25（OH）D and FINS,FBG,HOMA-IR,UA,TC,HDL-C and LDL-C（r=-0.144,-0.027,-0.144,-0.049,-0.106,0.021 and -0.137,P>0.05）. The levels of 25（OH）D and SOS in mild obesity,moderate obesity and severe obesity groups were gradually decreased with the degrees of obesity with statistical significance（P<0.05）.Conclusions The levels of 25（OH）D and SOS are gradually decreased in children with simple obesity with the degrees of obesity. Vitamin D deficiency may be related to obesity.

Key words: 25-Hydroxyvitamin D, Bone mineral density, Children with obesity

中图分类号:

R446.1

林祥泉, 陈虹. 血清25-羟基维生素D水平与骨密度变化在肥胖患儿中的临床意义[J]. 检验医学, 2018, 33(8): 669-673.

LIN Xiangquan, CHEN Hong. Roles of serum 25-hydroxyvitamin D and bone mineral density in children with obesity[J]. Laboratory Medicine, 2018, 33(8): 669-673.

图/表 2

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组别	例数	25（OH）D（ng/mL）	SOS（m/s）	UA（μmol/L）	TG（mmol/L）	TC（mmol/L）
肥胖组	109	23.91±6.18	3 744.83±134.16	382.00±98.29	1.01±0.43	4.80±0.88
正常对照组	104	27.09±6.58	3 802.16±140.67	296.39±57.23	0.83±0.64	4.56±0.76
t值		-2.817	-2.792	7.847	2.424	2.144
P值		0.006	0.006	0.000	0.016	0.033
组别	HDL-C（mmol/L）		LDL-C（mmol/L）	FBG（mmol/L）	FINS（μIU/mL）	HOMA-IR
肥胖组	1.61±0.43		2.90±0.64	5.15±0.40	16.27±7.00	3.74±1.69
正常对照组	1.63±0.34		2.71±0.73	4.78±0.51	9.74±2.43	2.07±0.58
t值	-0.371		1.988	5.830	9.013	9.517
P值	0.711		0.048	0.000	0.000	0.000

组别	例数	25（OH）D（ng/mL）	SOS（m/s）	UA（μmol/L）	TG（mmol/L）	TC（mmol/L）
肥胖组	109	23.91±6.18	3 744.83±134.16	382.00±98.29	1.01±0.43	4.80±0.88
正常对照组	104	27.09±6.58	3 802.16±140.67	296.39±57.23	0.83±0.64	4.56±0.76
t值		-2.817	-2.792	7.847	2.424	2.144
P值		0.006	0.006	0.000	0.016	0.033
组别	HDL-C（mmol/L）		LDL-C（mmol/L）	FBG（mmol/L）	FINS（μIU/mL）	HOMA-IR
肥胖组	1.61±0.43		2.90±0.64	5.15±0.40	16.27±7.00	3.74±1.69
正常对照组	1.63±0.34		2.71±0.73	4.78±0.51	9.74±2.43	2.07±0.58
t值	-0.371		1.988	5.830	9.013	9.517
P值	0.711		0.048	0.000	0.000	0.000

组别	例数	25（OH）D（ng/mL）	SOS （m/s）
轻度肥胖组	60	25.22±6.68	3 778.63±131.35
中度肥胖组	34	22.59±5.00	3 708.50±120.08
重度肥胖组	15	21.67±4.88	3 671.50±128.02
F值		3.232	5.049
P值		0.043	0.008

组别	例数	25（OH）D（ng/mL）	SOS （m/s）
轻度肥胖组	60	25.22±6.68	3 778.63±131.35
中度肥胖组	34	22.59±5.00	3 708.50±120.08
重度肥胖组	15	21.67±4.88	3 671.50±128.02
F值		3.232	5.049
P值		0.043	0.008