儿童血清中可溶性肿瘤坏死因子-α受体2水平与胰岛素抵抗及葡萄糖耐量异常有关。
Serum levels of soluble tumor necrosis factor-alpha receptor 2 are linked to insulin resistance and glucose intolerance in children.
作者信息
Gupta Ashutosh, Ten Svetlana, Anhalt Henry
机构信息
Division of Pediatric Endocrinology, Maimonides Medical Center, Brooklyn, NY 11219, USA.
出版信息
J Pediatr Endocrinol Metab. 2005 Jan;18(1):75-82. doi: 10.1515/jpem.2005.18.1.75.
BACKGROUND
Obesity and insulin resistance are increasingly common problems in children. Tumor necrosis factor-alpha (TNF-alpha) has important effects on lipid and glucose metabolism. This effect may be mediated through soluble TNF-alpha receptor 2 (sTNFR2).
OBJECTIVE
To investigate the relationship between insulin resistance and the TNF-alpha system in childhood obesity.
CHILDREN AND METHODS
Twenty-one obese and six non-obese children were studied. Body mass index (BMI) z-scores, percent body fat (PBF) and waist to hip ratio (WHR) were determined. Fasting serum levels of total cholesterol, HDL-cholesterol, LDL-cholesterol, TNF-alpha and sTNFR2 were measured. A standard 2-hour oral glucose tolerance test (dose of glucose: 1.75 g/kg, max. 75 g) was done. Insulin resistance (IR) was estimated by fasting plasma insulin, plasma insulin at 120 min, homeostasis model assessment (HOMA) and insulin area under the curve (AUC) from OGTT. Insulin sensitivity was estimated by oral glucose insulin sensitivity (OGIS120).
RESULTS
Among the obese participants, one child (5.2%) was found to have diabetes mellitus and four others (21.1%) impaired glucose tolerance (IGT). Obese children had significantly elevated sTNFR2 levels. Furthermore, the group of obese children with IGT and the patient with newly diagnosed diabetes mellitus together (n = 5) had significantly higher levels of serum sTNFR2 (2,865+/-320 pg/ml) than the rest of the obese (2,460+/-352 pg/ml; p = 0.016) or lean (1,969+/-362 pg/ml; p = 0.014) children. Serum sTNFR2 levels correlated positively with insulin AUC, HOMA IR, fasting plasma insulin, plasma insulin at 120 min, total cholesterol and LDL/ HDL ratio, and negatively with OGIS120. Multiple regression analysis revealed that age, WHR, sTNFR2 and LDL predicted 81% of the variability in glucose at 120 min.
CONCLUSION
sTNFR2 is a candidate marker of insulin resistance and glucose intolerance.
背景
肥胖和胰岛素抵抗在儿童中日益常见。肿瘤坏死因子-α（TNF-α）对脂质和葡萄糖代谢具有重要影响。这种作用可能通过可溶性TNF-α受体2（sTNFR2）介导。
目的
研究儿童肥胖中胰岛素抵抗与TNF-α系统之间的关系。
对象与方法
对21名肥胖儿童和6名非肥胖儿童进行研究。测定体重指数（BMI）z评分、体脂百分比（PBF）和腰臀比（WHR）。测量空腹血清总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、TNF-α和sTNFR2水平。进行标准的2小时口服葡萄糖耐量试验（葡萄糖剂量：1.75 g/kg，最大75 g）。通过空腹血浆胰岛素、120分钟时的血浆胰岛素、稳态模型评估（HOMA）以及口服葡萄糖耐量试验的胰岛素曲线下面积（AUC）来评估胰岛素抵抗（IR）。通过口服葡萄糖胰岛素敏感性（OGIS120）评估胰岛素敏感性。
结果
在肥胖参与者中，发现1名儿童（5.2%）患有糖尿病，另外4名（21.1%）有糖耐量受损（IGT）。肥胖儿童的sTNFR2水平显著升高。此外，患有IGT的肥胖儿童组和新诊断糖尿病患者组（共5例）的血清sTNFR2水平（2,865±320 pg/ml）显著高于其余肥胖儿童（2,460±352 pg/ml；p = 0.016）或瘦儿童（1,969±362 pg/ml；p = 0.014）。血清sTNFR2水平与胰岛素AUC、HOMA-IR、空腹血浆胰岛素、120分钟时的血浆胰岛素、总胆固醇和低密度脂蛋白/高密度脂蛋白比值呈正相关，与OGIS120呈负相关。多元回归分析显示，年龄、WHR、sTNFR2和低密度脂蛋白可预测120分钟时血糖变异性的81%。
结论
sTNFR2是胰岛素抵抗和糖耐量异常的候选标志物。
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