Nemours Children's Clinic, 807 Children's Way, Jacksonville, Florida 32207, USA.
J Clin Endocrinol Metab. 2010 Mar;95(3):1060-8. doi: 10.1210/jc.2009-1887. Epub 2010 Jan 8.
Metabolic syndrome (MS)-related comorbidities in obesity, such as hypertension, dyslipidemia, and glucose intolerance, are increasingly recognized in children, predisposing them to early cardiovascular disease.
The objective of the study was to investigate whether markers of inflammation and prothrombosis are abnormal in obese children without established MS comorbidities across puberty, as compared with lean, age-matched controls.
Obese children (body mass index >95%) with normal fasting glucose, blood pressure, cholesterol and triglycerides were recruited; lean controls (body mass index 10-75%) had no first-degree relatives with MS. High-sensitivity C-reactive protein (hsCRP), IL-6, plasminogen activator inhibitor 1, and fibrinogen concentrations were measured. Body composition was assessed by waist circumference and dual-energy x-ray absorptiometry.
Of 623 children screened, 203 enrolled (106 males, 97 females), aged 7-18 yr, 115 obese, 88 lean (balanced for age and gender), 99 prepubertal, and 104 pubertal. Many screen failures were due to silent comorbidities. Obese subjects with insulin resistance but without MS comorbidities had about 10 times higher hsCRP concentrations than controls and higher fibrinogen, IL-6, and plasminogen activator inhibitor-1 (P < 0.01 all). Differences were significant, even in the prepubertal cohort. hsCRP and fibrinogen correlated with waist circumference (r = 0.73 and 0.40, respectively) and percent fat mass (r = 0.76 and 0.47) (P < 0.0001).
Childhood obesity per se is associated with a proinflammatory and prothrombotic state before other comorbidities of the MS are present and even before the onset of puberty. Whether biomarkers like hsCRP and fibrinogen are useful in assessing cardiovascular risk and whether these abnormalities are reversible with earlier therapeutic interventions in very young obese children requires further study.
代谢综合征（MS）相关的肥胖合并症，如高血压、血脂异常和葡萄糖耐量受损，在儿童中越来越被认识，使他们易患早期心血管疾病。
本研究旨在探讨青春期前肥胖儿童中是否存在无 MS 合并症的炎症和血栓前标志物异常，与瘦、年龄匹配的对照组相比。
招募肥胖儿童（BMI＞95%），空腹血糖、血压、胆固醇和甘油三酯正常；瘦对照组（BMI 10-75%）无 MS 一级亲属。测量高敏 C 反应蛋白（hsCRP）、IL-6、纤溶酶原激活物抑制剂 1 和纤维蛋白原浓度。通过腰围和双能 X 线吸收法评估身体成分。
在筛查的 623 名儿童中，有 203 名儿童入组（106 名男性，97 名女性），年龄 7-18 岁，115 名肥胖，88 名瘦（年龄和性别均衡），99 名青春期前，104 名青春期。许多筛选失败是由于隐匿性合并症所致。有胰岛素抵抗但无 MS 合并症的肥胖患者的 hsCRP 浓度比对照组高 10 倍，且纤维蛋白原、IL-6 和纤溶酶原激活物抑制剂 1 更高（均 P＜0.01）。即使在青春期前组，差异也很显著。hsCRP 和纤维蛋白原与腰围（r=0.73 和 0.40）和体脂百分比（r=0.76 和 0.47）呈正相关（P＜0.0001）。
儿童肥胖本身与其他 MS 合并症出现之前，甚至在青春期之前就与促炎和血栓前状态相关。hsCRP 和纤维蛋白原等生物标志物是否有助于评估心血管风险，以及这些异常是否可以通过对非常年轻的肥胖儿童进行早期治疗干预来逆转，还需要进一步研究。
