摘要
目的 调查儿童、青少年肥胖者 2型糖尿病 (DM )及其高危者的发生率 ,探讨高危因素。方法 对 13 5例肥胖者 ( 7～ 2 0岁 )进行口服葡萄糖耐量试验 ,测定空腹和 2h血糖、胰岛素水平及计算胰岛素抵抗值 (Homa IR)及胰岛 β细胞功能 (Homa β)并对糖代谢异常者中的 14例进行干预治疗。 结果 ( 1)在 13 5例肥胖者中发现 2型DM 3例 ( 2 .2 % ) ,糖耐量异常 (IGT) 18例 ( 13 .3 % ) ,高胰岛素血症 72例 ( 5 3 .3 % ) ;( 2 )青少年肥胖组其 2h血糖、胰岛素水平、2h胰岛素与葡萄糖之比、Homa IR及Homa β显著高于儿童肥胖组及非肥胖组 ,且糖代谢异常的发生率显著高于儿童组 (P <0 .0 5～P <0 .0 0 1) ;( 3 )糖代谢异常者各指标明显高于单纯性肥胖者 (P <0 .0 5～P <0 .0 0 1) ;( 4 ) 93例糖代谢异常中 44例 ( 4 7.3 % )有 2型DM家族史 ,3 2例 ( 3 4.4% )有黑棘皮病样表现 ;( 5 ) 14例患者经药物治疗 ( 2 .9± 1.7)个月 ,糖代谢指标显著改善 (P <0 .0 5～P <0 .0 1)。结论 学龄期应开始肥胖干预、糖尿病筛查 ,以降低青少年 2型DM发生率。
Objective To investigate the incidence of type 2 diabetes mellitus (DM) and those with high risk among children and adolescents with obesity and to explore the susceptible factors. Methods Oral glucose tolerance test (OGTT) and insulin release test were performed in 135 obese subjects aged 7-20 years, and insulin resistance (Homa-IR) and β-cell function (Homa-β) were calculated by Homa method. Forteen obese subjects with abnormal glucose metabolism underwent intervention therapy. Results (1) Three cases (2.2%) with type 2 DM, 18 (13.3%) with impaired glucose tolerance (IGT) and 72 (53.3%) with hyperinsulinism (HINS) were found in 135 obese subjects. (2) The levels of 2hPG, FINS, PINS, FINS/2hPG, Homa-IR and Homa-β in adolescent obesity group were higher than those in obese children group and non-obese group, and the incidences of DM, IGT and HINS in adolescentobesitygroupwerehigherthan those in obese children group (P<0.05-P<0.001). (3) The various glucose metabolic markers were significantly higher in abnormal glucose metabolic groups than those in simple obesity group (P<0.05-P<0.001). But there were no differences among different groups with various degrees of obesity. (4) There were 44 cases (47.3%) with family history of type 2 DM and 32 cases (34.4%) with acanthosis nigricans-like sign among 93 subjects with abnormal gluocse metabolism. (5) The abnormal metabolic markers were improved remarkably aftercombinedtreatmentwithdietcontrol, metformin and lipid-reducing drug for (2.9±1.7)monthsin14patientswithabnormalglucosemetabolism (P<0.05-P<0.01). Conclusion The main risk factors for type 2 diabetes mellitus are obesity (especially in adolescent), insulin resistance and family history of type 2 DM. The prevention for obesity and screening for DM should be started in school-aged children in order to reduce the incidence of type 2 DM in adolescents.
出处
《中华内分泌代谢杂志》
CAS
CSCD
北大核心
2004年第2期132-135,共4页
Chinese Journal of Endocrinology and Metabolism
基金
上海市高等学校科学技术发展基金项目 (2 0 0 0B1 2 )
关键词
儿童
肥胖
2型糖尿病
口服糖耐量试验
胰岛素抵抗
Obesity
Diabetes mellitus, type 2
Oral glucose tolerance test
Insulin resistance
