Liang Xue-jun, Zhu Cheng, Yan Chun, Ni Gui-chen, Liu Zhong-liang, Du Zhong-min, Li Ming
Department of Internal Medicine, Beijing Children's Hospital, Capital University of Medical Sciences, Beijing 100045, China.
Zhonghua Er Ke Za Zhi. 2004 Jun;42(6):405-7.
The strong relation between type 2 diabetes mellitus and obesity with acanthosis nigricans is widely concerned. This study investigated the pancreatic beta-cell function in obese children with acanthosis nigricans, so as to find out the role of insulin secretion and insulin resistance in obese children with acanthosis nigricans.
Thirty-five obese children with acanthosis nigricans (19 males and 16 females with mean age 12.8 +/- 1.5 years) were enrolled in this study. Thirty-eight obese children (21 boys and 17 girls with mean age 11.9 +/- 2.6 years) and 39 normal children (20 boys and 19 girls with mean age 11.2 +/- 2.2 years) were recruited as obese and normal control groups. The levels of serum fasting insulin, C-peptide, proinsulin and true insulin were measured in all the subjects. The ratios of proinsulin/insulin and proinsulin/C-peptide were calculated. Homeostasis model assessment was applied to assess the status of insulin resistance and basic function of pancreatic beta-cell.
The levels of fasting insulin, C-peptide proinsulin, true insulin, the ratios of proinsulin/insulin and proinsulin/C-peptide, insulin resistance index and insulin secretion index of obese children with acanthosis nigricans, obese control children and normal control children were: 18.5 (5.0-60.5) pmol/L, 12.4 (6.1-35.8) pmol/L and 5.1 (2.0-32.8) pmol/L; 3.9 (1.3-14.0) microg/L, 2.4 (1.1-4.0) microg/L and 1.1 (1.0-4.2) microg/L; 28.8 (9.9-64.2) pmol/L, 9.5 (2.2-34.5) pmol/L and 4.2 (2.0-16.0) pmol/L; 33.0 (6.2-66.0) pmol/L, 10.6 (4.8-29.4) pmol/L and 4.5 (1.3-30.1) pmol/L; 1.2 (0.4-8.9), 0.9 (0.2-1.9) and 0.8 (0.4-2.0); 6.9 (2.5-36.6), 4.7 (1.2-12.3) and 3.6 (1.2-9.6); 5.0 (0.8-14.1), 2.6 (1.3-8.1) and 1.2(0.4-6.9); 303.3 (52.2-1,163.8), 213.6 (84.6-572.0) and 51.1 (19.1-561.4). The levels of fasting insulin, C-peptide, proinsulin, true insulin, the ratios of proinsulin/insulin and proinsulin/C-peptide, insulin resistance index and insulin secretion index in obese children with acanthosis nigricans were significantly higher than those in obese children (P < 0.001) and normal children (P < 0.001).
Obese children with acanthosis nigricans had higher insulin resistance and pancreatic beta-cell dysfunction; acanthosis nigricans may be a skin sign of high risk of type 2 diabetes mellitus.
2型糖尿病及肥胖与黑棘皮病之间的密切关系备受广泛关注。本研究对患有黑棘皮病的肥胖儿童的胰岛β细胞功能进行了调查，以明确胰岛素分泌及胰岛素抵抗在患有黑棘皮病的肥胖儿童中所起的作用。
本研究纳入了35例患有黑棘皮病的肥胖儿童（19例男性，16例女性，平均年龄12.8±1.5岁）。选取38例肥胖儿童（21例男孩，17例女孩，平均年龄11.9±2.6岁）和39例正常儿童（20例男孩，19例女孩，平均年龄11.2±2.2岁）作为肥胖对照组和正常对照组。测定了所有受试者的血清空腹胰岛素、C肽、胰岛素原和真胰岛素水平。计算了胰岛素原/胰岛素及胰岛素原/C肽的比值。采用稳态模型评估法来评估胰岛素抵抗状态及胰岛β细胞的基本功能。
患有黑棘皮病的肥胖儿童、肥胖对照儿童及正常对照儿童的空腹胰岛素、C肽、胰岛素原、真胰岛素水平，胰岛素原/胰岛素及胰岛素原/C肽的比值，胰岛素抵抗指数及胰岛素分泌指数分别为：18.5（5.0 - 60.5）pmol/L、12.4（6.1 - 35.8）pmol/L和5.1（2.0 - 32.8）pmol/L；3.9（1.3 - 14.0）μg/L、2.4（1.1 - 4.0）μg/L和1.1（1.0 - 4.2）μg/L；28.8（9.9 - 64.2）pmol/L、9.5（2.2 - 34.5）pmol/L和4.2（2.0 - 16.0）pmol/L；33.0（6.2 - 66.0）pmol/L、10.6（4.8 - 29.4）pmol/L和4.5（1.3 - 30.1）pmol/L；1.2（0.4 - 8.9）、0.9（0.2 - 1.9）和0.8（0.4 - 2.0）；6.9（2.5 - 36.6）、4.7（1.2 - 12.3）和3.6（1.2 - 9.6）；5.0（0.8 - 14.1）、2.6（1.3 - 8.1）和1.2（0.4 - 6.9）；303.3（52.2 - 1,163.8）、213.6（84.6 - 572.0）和51.1（19.1 - 561.4）。患有黑棘皮病的肥胖儿童的空腹胰岛素、C肽、胰岛素原、真胰岛素水平，胰岛素原/胰岛素及胰岛素原/C肽的比值，胰岛素抵抗指数及胰岛素分泌指数均显著高于肥胖儿童（P < 0.001）和正常儿童（P < 0.001）。
患有黑棘皮病的肥胖儿童具有更高的胰岛素抵抗及胰岛β细胞功能障碍；黑棘皮病可能是2型糖尿病高风险的皮肤标志。
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