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目的 判断肥胖儿童胰岛素抵抗与血管内皮功能损伤的关系.方法 肥胖176例、超重58例、正常45例三组儿童,B超检测颈动脉内中膜层厚度(IMT)和舒张功能;化验生化指标和血管慢性炎症指标,计算胰岛素抵抗指数和敏感指数.结果 三组间比较,动脉粥样硬化危险因素、部分慢性炎症指标、IMT(F=3.209,P=0.046)、颈动脉血管弹性(F=6.576,P=0.002)有显著性差别.胰岛素敏感指数与动脉粥样硬化危险因素、IMT(R=-0.201,P=0.010)、可溶性细胞间黏附分子1(R=-0.197,P=0.010)、脂联素(R=0.419,P=0.000)密切相关;随着胰岛素敏感指数的降低,动脉粥样硬化的危险因素和血管损伤逐渐增加.多元回归分析IMT与腹型肥胖程度、平均血压,胰岛素抵抗指数、高密度脂蛋白胆固醇有关.结论 肥胖儿童早期动脉粥样硬化已经启动,预防成人心脑血管疾病应该从预防儿童肥胖做起.

Objective To study the relationship between insulin resistance and vascular endothelial dysfunction in obese children. Methods A total of 176 obese children, 58 over-weight children and 45 healthy children were recruited. All the participants underwent hematologjc tests. Homeostasis model of assessment of insulin resistance ( HOMA-IR) and insulin sensitivity index were calculated. Ultrasound measurement was used to investigate carotid intima-media thickness ( IMT) and carotid artery compliance (CAC). Results There were significant difference among the three groups in risk factors of atherosclerosis, subclinical inflammation, IMT ( F = 3. 209, P = 0. 046 ), and CAC ( F = 6. 576, P = 0. 002 ) . In sulin sensitvity index was correlated with adiponectin (R = 0. 419, P = 0. 000) , risk factors of atherosclerosis, soluble intercellular adhesion molecule 1 (R= -0. 201 ,P = 0. 010) ,and IMT (R= -0. 201 ,P = 0. 010). The risk factors of atherosclerosis and vascular damage were increased as in sulin sensitvity index decreased. Multiple stepwise regression analysis revealed strong relationship between IMT and abdominal obesity, mean blood pressure, HOMA-IR and high-density lipoprotein cholesterol. Conclusion Early atherosclerosis may develop in obese children. Prevention of childhood obesity should be important in the prevention of adult cardiovascular and cerebrovascular diseases.