Fu Jun-fen, Liang Li, Dong Guan-ping, Jiang You-jun, Zou Chao-chun
Department of Endocrinology, Children's Hospital of Zhejiang University, School of Medicine, Hangzhou 310003, China.
Zhonghua Er Ke Za Zhi. 2004 Dec;42(12):917-9.
The prevalence of obesity and of type 2 diabetes mellitus in children have increased in the Chinese population over the past two decades, and thus diabetes prevention has become a major concern of public health agencies. Identification of individuals at risk for diabetes is an essential first step in designing and implementing intervention programs. Insulin resistance is the hallmark of the pathophysiology of type 2 diabetes mellitus. Subjects with hyperinsulinemia and impaired glucose tolerance are well accepted as being at high risk for diabetes. Acanthosis nigricans (AN) has been proposed as a reliable marker of hyperinsulinemia, but its utility for predicting hyperinsulinemia has not been systematically evaluated in obese children. In order to further explore the relationship between obese childhood with benign acanthosis nigricans and insulin resistance and type 2 diabetes mellitus, we examined 19 obese children with benign acanthosis nigricans.
Nineteen of seventy six obese children (25%) with BMI over 25 enrolled in the Children' Hospital of Zhejiang University School of Medicine fromJune 1st to September 1st in 2003 were studied. Skin biopsies were performed in these 19 obese children with acanthosis nigricans for final diagnosis. Levels of glucose, insulin, and glucose/insulin ratio were measured on fasting blood specimens and anthropometric parameters including waist/hip ratio, fat mass, body fat percentage and body mass index were examined. Oral glucose tolerance tests were also performed in these 19 children with benign acanthosis nigricans.
Anthropometric parameters including waist/hip ratio, fat mass, body fat percentage and body mass index as well as fasting insulin level in acanthosis nigricans group were significantly higher than that of healthy controls (P < 0.01). Fasting glucose to insulin ratio (FGIR) of these 19 obese children with benign acanthosis nigricans was 4.27 +/- 0.53, indicating apparent insulin resistance. One of them was diagnosed as type 2 diabetes mellitus and ten of them showed impaired oral glucose tolerance.
Childhood benign acanthosis nigricans is tightly associated with obesity, hyperinsulinemia, insuline resistance and type 2 diabetes mellitus, and may be used as a reliable index of insulin resistance.
在过去二十年中，中国儿童肥胖症和2型糖尿病的患病率有所上升，因此糖尿病预防已成为公共卫生机构的主要关注点。识别糖尿病高危个体是设计和实施干预项目的重要第一步。胰岛素抵抗是2型糖尿病病理生理学的标志。高胰岛素血症和糖耐量受损的个体被公认为糖尿病高危人群。黑棘皮病（AN）已被提议作为高胰岛素血症的可靠标志物，但其在预测肥胖儿童高胰岛素血症方面的效用尚未得到系统评估。为了进一步探讨肥胖儿童伴良性黑棘皮病与胰岛素抵抗及2型糖尿病之间的关系，我们对19例肥胖伴良性黑棘皮病儿童进行了检查。
选取2003年6月1日至9月1日在浙江大学医学院附属儿童医院登记的76例BMI超过25的肥胖儿童中的19例（25%）进行研究。对这19例肥胖伴黑棘皮病儿童进行皮肤活检以明确诊断。检测空腹血标本中的血糖、胰岛素水平以及血糖/胰岛素比值，并检查包括腰臀比、脂肪量、体脂百分比和体重指数在内的人体测量参数。对这19例伴良性黑棘皮病的儿童还进行了口服葡萄糖耐量试验。
黑棘皮病组的人体测量参数包括腰臀比、脂肪量、体脂百分比和体重指数以及空腹胰岛素水平均显著高于健康对照组（P < 0.01）。这19例肥胖伴良性黑棘皮病儿童的空腹血糖与胰岛素比值（FGIR）为4.27±0.53，表明存在明显的胰岛素抵抗。其中1例被诊断为患2型糖尿病，10例口服葡萄糖耐量受损。
儿童良性黑棘皮病与肥胖、高胰岛素血症、胰岛素抵抗及2型糖尿病密切相关，可作为胰岛素抵抗的可靠指标。
