刘枫凤 杨利琦

[摘要] 目的 研究不同程度肥胖兒童的代谢特征、维生素D及IGF-1（胰岛素样生长因子-1）的水平及与肥胖的关系。方法 收集2018年1月至2021年3月就诊于我院儿科并确诊为单纯性肥胖的儿童125例，其中轻度肥胖25例，中度肥胖55例，重度肥胖45例，同时选取入院行青春发育期相关检查的健康非肥胖儿童55例作为对照组，记录年龄、性别，测量身高、体重，检测血糖（FBG）、血清胰岛素（FINS）、三酰甘油（TG）、总胆固醇（TC）、尿酸（UA）、维生素D、IGF-1等指标。并计算体质量指数（BMI）、胰岛素抵抗指数（HOMA-IR）及根据性别、年龄调整后的IGF-1（aIGF-1）。结果 ①肥胖组的BMI、HOMA-IR、TG、UA水平均高于对照组，维生素D 水平低于对照组，aIGF-1水平为轻度肥胖组高于其他三组。②肥胖组两两比较结果：BMI、HOMA-IR、TG、UA水平是重度肥胖组>中度肥胖组>轻度肥胖组，维生素D、aIGF-1水平是轻度肥胖组>中度肥胖组>重度肥胖组。③肥胖组BMI的多元线性回归分析结果显示，UA、HOMA-IR与BMI呈正相关，aIGF-1及维生素D与BMI呈负相关，因此UA、HOMA-IR是肥胖儿童BMI增加的危险因素，aIGF-1、维生素D是保护因素。结论 随着肥胖程度的增加，发生胰岛素抵抗、高尿酸血症等代谢紊乱、维生素D缺乏、IGF-1低水平可能性增加，这些会不利于儿童的生长发育。

[关键词] 肥胖儿童;代谢特征;维生素D;胰岛素样生长因子-1

[中图分类号] R589.2          [文献标识码] A          [文章编号] 1673-9701（2021）33-0031-04

[Abstract] Objective To study the metabolic characteristics of children with different degrees of obesity， the levels of vitamin D and IGF-1 and their relationship with obesity. Methods A total of 125 children who were diagnosed as simple obesity in the Department of Pediatrics of our hospital from January 2018 to March 2021 in our hospital were collected， including 25 cases of mild obesity， 55 cases of moderate obesity and 45 cases of severe obesity. Meanwhile， 55 healthy non-obese children who were admitted to hospital for related examinations during puberty were selected as the control group. Their age and gender were recorded， and their height and weight were measured， and their fasting blood glucose （FBG）， fasting serum lisulin （FINS）， triacylglycerol （TC）， uric acid （UA）， vitamin D， and IGF-1 were measured. Body mass index （BMI）， insulin resistance index （HOMA-IR） and IGF-1 （aIGF-1） adjusted according to gender and age were calculated. Results ①The levels of BMI， HOMA-IR， TG and UA in the obesity group were higher than those in the control group， while the level of vitamin D was lower than that in control group， and the level of aIGF-1 was higher in the mild obesity group than in other three groups. ②Based on the results of pairwise comparison of obese groups， the levels of BMI， HOMA-IR， TG and UA were the highest in the severe obesity group， followed by the moderate obesity group and the mild obesity group. The levels of vitamin D and aIGF-1 in the mild obesity group were the highest， followed by the moderate obesity group and the severe obesity group. ③The results of multiple linear regression analysis of BMI in the obesity group showed that UA and HOMA-IR were positively correlated with BMI， while aIGF-1 and vitamin D were negatively correlated with BMI. Therefore， UA and HOMA-IR were the risk factors of BMI increase in obese children， while aIGF-1 and vitamin D were the protective factors. Conclusion With the increase of obesity， the possibility of insulin resistance， hyperuricemia and other metabolic disorders， vitamin D deficiency and low level of IGF-1 will increase， which will be detrimental to childrens growth and development.

[Key words] Obese children; Metabolic characteristics; Vitamin D; Insulin like growth factor-1

随着经济的发展和生活方式的转变，儿童肥胖率在世界范围内快速增长，我国青少年的身体健康状况不容乐观。一项调查研究发现，我国青少年总体肥胖率高达7.1%[1]。众所周知，肥胖是一种慢性健康杀手，是心脑血管疾病、2型糖尿病、高血压、代谢紊乱等的危险因素[2]。目前关于……