Relationship of vitamin D deficiency with risk factors of cardiovascular and metabolic disorders in obese children
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摘要:目的 探讨肥胖儿童维生素D缺乏与心血管及代谢紊乱危险因素的关系。方法 选择50例肥胖儿童为肥胖组, 另选健康儿童50例为对照组。比较肥胖组和对照组儿童、肥胖组维生素D缺乏和非维生素D缺乏儿童、对照组维生素D缺乏和非维生素D缺乏儿童心血管及代谢紊乱危险因素指标差异。分析25-羟基维生素D水平与其他指标的相关性。结果 肥胖组体质量指数(BMI)、胰岛素抵抗指数(HOMA-IR)、甘油三酯、低密度脂蛋白胆固醇(LDL-C)、谷丙转氨酶(ALT)、维生素D缺乏者占比、右侧颈动脉内膜中层厚度(CIMT)、左侧CIMT均高于对照组，差异有统计学意义(P < 0.05)。所有入组儿童中, 25-羟基维生素D水平与年龄、体质量、BMI、左侧CIMT呈负相关(P < 0.05); 肥胖儿童中, 25-羟基维生素D水平与年龄、体质量、BMI、左侧CIMT呈负相关(P < 0.05)。结论 肥胖儿童血清25-羟基维生素D水平与CIMT心血管危险因素显著相关，而与HOMA-IR、总胆固醇、甘油三酯、高密度脂蛋白胆固醇、LDL-C等代谢紊乱危险因素无关。Abstract:Objective To investigate the relationship of vitamin D deficiency with risk factors of cardiovascular and metabolic disorders in obese children.Methods Fifty obese children were selected as obese group and 50 healthy children were selected as control group. The risk factors of cardiovascular and metabolic disorders were compared in children between the obese group and the control group, vitamin D deficiency and non-vitamin D deficiency children in the obese group, and children with vitamin D deficiency and non-vitamin D deficiency in the control group. The correlations between 25-hydroxyvitamin D level and other indexes were analyzed.Results Body mass index (BMI), the homeostasis model assessment-estimated insulin resistance (HOMA-IR), triglyceride, low-density lipoprotein cholesterol (LDL-C), alanine transaminase (ALT), ratio of vitamin D deficiency, right carotid intima-media thickness (CIMT) and left CIMT in the obesity group were significantly higher than those in the control group (P < 0.05). The 25-hydroxyvitamin D level was negatively correlated with age, body mass, BMI and left CIMT of all enrolled children (P < 0.05). In the obese children, 25-hydroxyvitamin D level was negatively correlated with age, body mass, BMI and left CIMT (P < 0.05).Conclusion Serum 25-hydroxyvitamin D level in the obese children is significantly correlated with cardiovascular risk factors of CIMT. It is not associated with HOMA-IR, total cholesterol, triglyceride, high-density lipoprotein cholesterol, LDL-C and other risk factors for metabolic disorders.
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表 1 肥胖组和对照组儿童临床指标比较(x±s)[n(%)]
指标 肥胖组(n=50) 对照组(n=50) 年龄/岁 10.85±3.55 10.24±3.27 男性 32(64.00) 28(56.00) BMI/(kg/m2) 22.15±4.62* 19.44±3.05 空腹血糖/(mg/dL) 84.16±12.62 83.41±13.02 HOMA-IR 4.54±1.58* 2.19±0.48 总胆固醇/(mg/dL) 185.26±25.85 180.55±26.87 总胆固醇≥200 mg/dL 12(24.00) 8(16.00) 甘油三酯/(mg/dL) 125.36±31.55* 98.14±26.15 HDL-C/(mg/dL) 40.52±13.02 42.02±14.15 LDL-C/(mg/dL) 110.65±31.08* 89.62±25.05 LDL-C≥130 mg/dL 10(20.00) 6(12.00) AST/(U/L) 25.26±8.22 26.03±7.91 ALT/(U/L) 18.62±5.06* 11.55±3.41 ALT>40 U/L 3(6.00) 1(2.00) 25-羟基维生素D/(ng/dL) 19.48±5.11 18.02±4.62 维生素D缺乏 < 20 ng/dL 35(70.00)* 22(44.00) CIMT/mm 右侧 0.55±0.11* 0.45±0.07 左侧 0.55±0.12* 0.44±0.06 LVMI(g/m2) 27.54±6.18 25.64±7.49 BMI: 体质量指数; HOMA-IR: 胰岛素抵抗指数;
HDL-C: 高密度脂蛋白胆固醇; LDL-C: 低密度脂蛋白胆固醇;
AST: 谷草转氨酶; ALT: 谷丙转氨酶; CIMT: 颈动脉内膜中层厚度;
LVMI: 左心室质量指数。与对照组比较, *P < 0.05。
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表 2 肥胖组维生素D缺乏和非维生素D缺乏儿童临床指标比较(x±s)
指标 维生素D缺乏
(n=35)非维生素D缺乏
(n=15)空腹血糖/(mg/dL) 83.87±11.52 84.37±11.68 HOMA-IR 4.48±1.53 4.56±1.67 总胆固醇/(mg/dL) 184.12±26.02 187.55±25.17 甘油三酯/(mg/dL) 124.53±30.74 127.05±32.49 HDL-C/(mg/dL) 41.02±12.33 39.84±14.01 LDL-C/(mg/dL) 111.85±30.52 109.11±32.05 CIMT/mm 右侧 0.54±0.10 0.55±0.12 左侧 0.54±0.11 0.55±0.09 LVMI/(g/m2) 27.11±6.02 27.84±6.33 HOMA-IR: 胰岛素抵抗指数;
HDL-C: 高密度脂蛋白胆固醇; LDL-C: 低密度脂蛋白胆固醇;
CIMT: 颈动脉内膜中层厚度; LVMI: 左心室质量指数。
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表 3 对照组维生素D缺乏和非维生素D缺乏儿童临床指标比较(x±s)
指标 维生素D缺乏
(n=22)非维生素D缺乏
(n=28)空腹血糖/(mg/dL) 84.55±12.62 83.01±13.37 HOMA-IR 2.24±0.51 2.11±0.45 总胆固醇/(mg/dL) 181.02±26.44 179.22±26.93 甘油三酯/(mg/dL) 99.32±28.11 98.01±25.94 HDL-C/(mg/dL) 41.78±12.59 42.32±14.33 LDL-C/(mg/dL) 90.15±24.62 88.61±25.31 CIMT/mm 右侧 0.45±0.10 0.45±0.06 左侧 0.45±0.12 0.44±0.04 LVMI/(g/m2) 26.38±6.68 25.07±7.76 HOMA-IR: 胰岛素抵抗指数; HDL-C: 高密度脂蛋白胆固醇;
LDL-C: 低密度脂蛋白胆固醇; CIMT: 颈动脉内膜中层厚度;
LVMI: 左心室质量指数。
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表 4 入组儿童25-羟基维生素D水平与其他指标的相关性
因素 全部(n=100) 肥胖组(n=50) 对照组(n=50) r P r P r P 年龄 -0.31 0.01 -0.36 0.02 -0.18 0.14 体质量 -0.26 0.03 -0.51 0.00 -0.17 0.16 BMI -0.25 0.04 -0.54 0.00 -0.18 0.15 空腹血糖 -0.07 0.61 -0.01 0.96 0.06 0.78 HOMA-IR -0.06 0.73 -0.07 0.72 -0.05 0.72 总胆固醇 -0.06 0.65 -0.08 0.62 -0.22 0.09 甘油三酯 -0.19 0.13 -0.17 0.30 -0.09 0.68 HDL-C 0.11 0.38 -0.01 0.97 0.22 0.10 LDL-C -0.12 0.36 -0.17 0.32 -0.28 0.09 ALT -0.63 0.61 -0.01 0.98 -0.07 0.63 右侧CIMT -0.18 0.15 -0.06 0.73 -0.06 0.66 左侧CIMT -0.25 0.04 -0.35 0.03 -0.20 0.12 LVMI -0.08 0.59 -0.16 0.35 -0.12 0.24 BMI: 体质量指数; HOMA-IR: 胰岛素抵抗指数; HDL-C: 高密度脂蛋白胆固醇; LDL-C: 低密度脂蛋白胆固醇;
ALT: 谷丙转氨酶; CIMT: 颈动脉内膜中层厚度; LVMI: 左心室质量指数。
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