肥胖和胰岛素抵抗对儿童左心房大小的影响。

Influence of obesity and insulin resistance on left atrial size in children.

作者信息

Hirschler Valeria, Acebo H Laura Perez, Fernandez Graciela B, de Luján Calcagno María, Gonzalez Claudio, Jadzinsky Mauricio

机构信息

Department of Nutrition and Diabetes of Durand Hospital, Buenos Aires, Argentina.

出版信息

Pediatr Diabetes. 2006 Feb;7(1):39-44. doi: 10.1111/j.1399-543X.2006.00139.x.

DOI:10.1111/j.1399-543X.2006.00139.x

PMID:16489973

Abstract

BACKGROUND

Left atrial (LA) enlargement has been linked to obesity and insulin resistance in adults.

OBJECTIVE

The purpose of this study was to determine the association in children between LA area and: (i) different components of the metabolic syndrome including obesity (OB), measures of body mass index (BMI) and waist circumference (WC), homeostasis model assessment-insulin resistance (HOMA-IR, proinsulin), and blood pressure (BP); and (ii) left ventricular mass (LVM) and diastolic function, measured using echo Doppler.

METHODS AND RESULTS

Eighty-four (44 females) subjects, [40 OB (BMI>95%), 28 overweight (BMI>85%)], 16 non-OB (BMI<85%)] aged 9+/-2.24 yrs were matched for sex and age. BMI, WC, BP, Tanner stage, and Mode M, 2-dimensional and Doppler transmitral echocardiography were assessed. A standard oral glucose tolerance test (OGTT) was done, measuring glucose, insulin, and proinsulin concentrations. Hypertension was only present in OB subjects (25%). Significant univariate association (p<0.001) was found between LA area and height (r=0.52), age (r=0.45), Tanner stage (r=0.45), BMI (r=0.66), WC (r=0.70), systolic BP (r=0.52), diastolic BP (r=0.53), proinsulin (r=0.36), and HOMA-IR (r=0.36). In the multivariate regression analysis, independent variables were entered in a stepwise fashion: initially, gender (p=0.006) and Tanner stage (p=0.011) were still significant independent correlates of LA area after adjusting for age, gender, and Tanner stage. Subsequently, incorporation of WC showed that WC (p=0.018) was a significant independent correlate of LA area. A larger model constructed to test the significance of adjustment factors, including WC, BP, LVM, and HOMA-IR showed that WC (p<0.001) was the only significant independent variable.

CONCLUSION

LA enlargement is present in childhood and is related to abdominal OB and insulin resistance, suggesting that children with central OB are at increased risk for cardiovascular disease.

摘要

背景

成人左心房（LA）增大与肥胖和胰岛素抵抗有关。

目的

本研究旨在确定儿童LA面积与以下因素之间的关联：（i）代谢综合征的不同组成部分，包括肥胖（OB）、体重指数（BMI）和腰围（WC）测量值、稳态模型评估胰岛素抵抗（HOMA-IR、胰岛素原）以及血压（BP）；（ii）使用超声多普勒测量的左心室质量（LVM）和舒张功能。

方法与结果

84名（44名女性）受试者，[40名OB（BMI>95%），28名超重（BMI>85%）]，16名非OB（BMI<85%），年龄9±2.24岁，按性别和年龄匹配。评估了BMI、WC、BP、坦纳分期以及M型、二维和多普勒经二尖瓣超声心动图。进行了标准口服葡萄糖耐量试验（OGTT），测量血糖、胰岛素和胰岛素原浓度。高血压仅存在于OB受试者中（25%）。发现LA面积与身高（r=0.52）、年龄（r=0.45）、坦纳分期（r=0.45）、BMI（r=0.66）、WC（r=0.70）、收缩压（r=0.52）、舒张压（r=0.53）、胰岛素原（r=0.36）和HOMA-IR（r=0.36）之间存在显著的单变量关联（p<0.001）。在多变量回归分析中，自变量以逐步方式输入：最初，在调整年龄、性别和坦纳分期后，性别（p=0.006）和坦纳分期（p=0.011）仍然是LA面积的显著独立相关因素。随后，纳入WC显示WC（p=0.018）是LA面积的显著独立相关因素。构建了一个更大的模型来测试调整因素（包括WC、BP、LVM和HOMA-IR）的显著性，结果显示WC（p<0.001）是唯一显著的独立变量。