Terlemez Semiha, Bozdemir Erkin, Kalkan Uçar Sema, Kabaroğlu Ceyda, Habif Sara, Kayıkçıoğlu Meral, Çoker Mahmut
Gazi University Medıcıne Faculty Pediatrıc Cardıology Department, Ankara 06100, Turkey, Phone: 00905327217689.
Çiğli Regional Education Hospital Department of Biochemistry, Izmir, Turkey.
J Pediatr Endocrinol Metab. 2018 Dec 19;31(12):1349-1354. doi: 10.1515/jpem-2018-0337.
Background The aim of the study was to investigate whether there is insulin resistance in children with familial hyperlipidemia (FHL) and to determine the factors affecting insulin resistance. Methods Hyperlipidemic children aged between 4 and 18 years and followed up with an FHL diagnosis were included in the study. The children of adults followed up with an FHL diagnosis were also recruited after the screening period. The scanned children were divided into two groups as hyperlipidemic and normolipidemic. A total of 77 patients of whom 52 were hyperlipidemic and 25 were normolipidemic were assessed in the study. Insulin resistance was evaluated (homeostatic model assessment of insulin resistance [HOMA-IR]) by performing the oral glucose tolerance test (OGTT). Results Of the patients, 36 were male and 41 were female; the average age was 11.6±3.9 years, and the body mass index (BMI) was established to be 20.3±4.4. In hyperlipidemic and normolipidemic patients, the following were determined: fasting insulin: 10.6 (±0.89) μU/mL, 4.9 (±0.45) μU/mL (p=0.000); 2-h insulin: 28.7 (±12.7) μU/mL, 18.9 (±10.5) μU/mL (p=0.000); and HOMA-IR: 1.9 (±0.17), 0.86 (±0.7) (p=0.000). No relationship was identified between lipid profiles and insulin resistance. Nevertheless, there was a positive correlation between insulin resistance and apolipoprotein B (Apo B) levels (0.52), and a negative correlation was determined in carnitine levels (-0.64). Conclusions Insulin resistance was established to be higher in children with FHL compared to normolipidemic children. Insulin resistance was not related to lipid phenotypes, but to Apo B levels and carnitine levels. Insulin resistance should be a routine method of evaluation in the follow-up of children with FHL.
背景 本研究的目的是调查家族性高脂血症(FHL)患儿是否存在胰岛素抵抗,并确定影响胰岛素抵抗的因素。方法 本研究纳入了4至18岁且经FHL诊断并随访的高脂血症患儿。在筛查期后,还招募了经FHL诊断并随访的成人的子女。扫描的儿童被分为高脂血症组和正常血脂组。本研究共评估了77例患者,其中52例为高脂血症患者,25例为正常血脂患者。通过进行口服葡萄糖耐量试验(OGTT)评估胰岛素抵抗(胰岛素抵抗稳态模型评估[HOMA-IR])。结果 患者中,36例为男性,41例为女性;平均年龄为11.6±3.9岁,体重指数(BMI)为20.3±4.4。在高脂血症和正常血脂患者中,测定了以下指标:空腹胰岛素:10.6(±0.89)μU/mL,4.9(±0.45)μU/mL(p=0.000);2小时胰岛素:28.7(±12.7)μU/mL,18.9(±10.5)μU/mL(p=0.000);HOMA-IR:1.9(±0.17),0.86(±0.7)(p=0.000)。未发现血脂谱与胰岛素抵抗之间存在关联。然而,胰岛素抵抗与载脂蛋白B(Apo B)水平呈正相关(0.52),与肉碱水平呈负相关(-0.64)。结论 与正常血脂儿童相比,FHL患儿的胰岛素抵抗更高。胰岛素抵抗与血脂表型无关,而与Apo B水平和肉碱水平有关。在FHL患儿的随访中,胰岛素抵抗应作为一种常规评估方法。