Barkai László, Paragh György
Debreceni Egyetem, Orvos- ś Egészségtudományi Centrum, Gyermekegészségügyi Továbbképzo Intézet, Miskolc.
Orv Hetil. 2006 Feb 12;147(6):243-50.
Metabolic syndrome has an outstanding impact on public health due to its increasing prevalence and poor prognosis. The development of insulin resistance, as a consequence of obesity, can be demonstrated even in childhood which has a pivotal role in the pathomechanism of the syndrome. Besides obesity, low birth weight, increased gain in body mass in early childhood, decreased pubertal insulin sensitivity and clinical markers of insulin resistance (acanthosis nigricans, polycystic ovarian syndrome, premature adrenarche) confer risk of metabolic syndrome. Currently, there are no consistent and consensus based diagnostic criteria of metabolic syndrome in children and adolescents. The most recent definition of the International Diabetes Federation [central obesity plus any two of four factors (raised triglyceride, reduced high-density lipoprotein-cholesterol, raised blood pressure and raised fasting plasma glucose)] is not approved for children and epidemiology data are not yet available. Applying the modified version of the most commonly used Adult Treatment Panel III diagnostic system for children and adolescents, the prevalence is given as 4.2% in the literature. As the components of the syndrome, frequency were as follows: 9.8-17.9% for abdominal obesity, 21.0-23.4% for elevated triglyceride, 18.3-23.3% for reduced high-density lipoprotein-cholesterol, 4.9-7.1% for elevated blood pressure and 0.8-1.7% for impaired fasting glucose. High frequency of morphological and functional disturbances of the vascular and endothelial systems seen frequently among children with signs of metabolic syndrome suggests early cardiovascular events and underlines the clinical significance of this entity. The most effective tool for prevention of metabolic syndrome is to avoid the development of childhood obesity. In case of established disease, the effective treatment should address the different components of the syndrome. The authors emphasize the need of elaboration of consensus based pediatric diagnostic criteria, national prevalence data, protocols for prevention, early recognition and effective treatment.
代谢综合征因其患病率不断上升和预后不良而对公众健康产生了显著影响。肥胖导致的胰岛素抵抗在儿童期就可出现，这在该综合征的发病机制中起着关键作用。除肥胖外，低出生体重、幼儿期体重增加过快、青春期胰岛素敏感性降低以及胰岛素抵抗的临床标志物（黑棘皮症、多囊卵巢综合征、肾上腺早现）均会增加代谢综合征的风险。目前，儿童和青少年代谢综合征尚无基于共识的一致诊断标准。国际糖尿病联盟的最新定义（中心性肥胖加四项因素中的任意两项，即甘油三酯升高、高密度脂蛋白胆固醇降低、血压升高和空腹血糖升高）不适用于儿童，且尚无流行病学数据。应用最常用的成人治疗小组III诊断系统的修订版用于儿童和青少年，文献报道的患病率为4.2%。作为该综合征的组成部分，其发生率如下：腹部肥胖为9.8 - 17.9%，甘油三酯升高为21.0 - 23.4%，高密度脂蛋白胆固醇降低为18.3 - 23.3%，血压升高为4.9 - 7.1%，空腹血糖受损为0.8 - 1.7%。在有代谢综合征体征的儿童中，血管和内皮系统形态和功能紊乱的高发生率提示早期心血管事件，并突出了该疾病实体的临床意义。预防代谢综合征最有效的方法是避免儿童肥胖的发生。对于已确诊的疾病，有效的治疗应针对该综合征的不同组成部分。作者强调需要制定基于共识的儿科诊断标准、全国患病率数据、预防方案、早期识别和有效治疗方法。
