Li Ge, Xu Linxin, Zhao Yanglu, Li Lujiao, Fu Junling, Zhang Qian, Li Naishi, Xiao Xinhua, Li Changhong, Mi Jie, Gao Shan, Li Ming
Department of Endocrinology, Key Laboratory of Endocrinology, National Health and Family Planning Commission, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing, China.
Department of Endocrinology, The Frist Affiliated Hospital, Shanxi Medical University, Taiyuan, China.
PLoS One. 2017 Oct 11;12(10):e0186222. doi: 10.1371/journal.pone.0186222. eCollection 2017.
Leptin and adiponectin have opposite effects on subclinical inflammation and insulin resistance, both involved in the development of metabolic syndrome (MS). We aimed to investigate whether leptin/adiponectin ratio (L/A), as a marker of these two adipokines imbalance, may improve diagnosis of MS in children and adolescents, and determined its cut-off value in the diagnosis of MS.
A total of 3,428 subjects aged 6-18 years were selected from Beijing Child and Adolescent Metabolic Syndrome study. Adipokine leptin and adiponectin were measured using enzyme-linked immunosorbent assay. Odds ratio of MS per 1 z-score of adipokine was examined using logistic regression. Diagnosis accuracy was assessed using c-statistics (AUC) and net reclassification index.
The levels of leptin and L/A increased with number of positive MS components, while the levels of adiponectin declined in both boys and girls (all P <0.001). AUCs for diagnosis of MS in girls were 0.793, 0.773, and 0.689 using L/A, leptin and adiponectin, respectively; and AUCs in boys were 0.822, 0.798, and 0.697 for L/A, leptin and adiponectin, respectively. Notably, L/A outperformed individual leptin or adiponectin in discriminating a diagnosis of MS (all P < 0.02 in AUC comparisons). In addition, the optimal cut-offs of L/A by ROC curve differed by genders and pubertal stages, which were 1.63, 1.28, 1.95 and 1.53 ng/ug for total, pre-, mid- and postpubertal boys, respectively and 2.19, 0.87,1.48 and 2.27 ng/ug for total, pre-, mid- and postpubertal girls, respectively, yielding high sensitivity and moderate specificity for a screening test.
In this pediatric population, leptin-adiponectin imbalance, as reflected by an increase in L/A level, was found to be a better diagnostic biomarker for MS than leptin or adiponectin alone. Future longitudinal studies are needed to further validate the gender-specific cutoff values.
瘦素和脂联素对亚临床炎症和胰岛素抵抗具有相反作用，二者均与代谢综合征（MS）的发生发展有关。我们旨在研究瘦素/脂联素比值（L/A）作为这两种脂肪因子失衡的标志物，是否可改善儿童和青少年MS的诊断，并确定其在MS诊断中的临界值。
从北京儿童和青少年代谢综合征研究中选取3428名6 - 18岁的受试者。采用酶联免疫吸附测定法检测脂肪因子瘦素和脂联素。使用逻辑回归分析每1个标准差的脂肪因子对应的MS比值比。采用c统计量（AUC）和净重新分类指数评估诊断准确性。
瘦素水平和L/A随MS阳性组分数量增加而升高，而脂联素水平在男孩和女孩中均下降（所有P<0.001）。女孩中，使用L/A、瘦素和脂联素诊断MS的AUC分别为0.793、0.773和0.689；男孩中，L/A、瘦素和脂联素诊断MS的AUC分别为0.822、0.798和0.697。值得注意的是，在鉴别MS诊断方面，L/A优于单独的瘦素或脂联素（AUC比较中所有P<0.02）。此外，ROC曲线得出的L/A最佳临界值因性别和青春期阶段而异，青春期前、青春期中期和青春期后期男孩的L/A临界值分别为1.63、1.28、1.95和1.53 ng/μg，青春期前、青春期中期和青春期后期女孩的L/A临界值分别为2.19、0.87、1.48和2.27 ng/μg，对筛查试验具有高敏感性和中等特异性。
在该儿科人群中，L/A水平升高所反映的瘦素 - 脂联素失衡被发现是比单独的瘦素或脂联素更好的MS诊断生物标志物。未来需要进行纵向研究以进一步验证性别特异性临界值。
