高胰岛素血症在股骨头骨骺滑脱中的作用。

The Role of Hyperinsulinemia in Slipped Capital Femoral Epiphysis.

机构信息

Departments of Pediatric Orthopaedic Surgery.

Pediatric Endocrinology, Civil Hospital of Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, Mexico.

出版信息

J Pediatr Orthop. 2020 Sep;40(8):413-417. doi: 10.1097/BPO.0000000000001557.

DOI:10.1097/BPO.0000000000001557

PMID:32251114

Abstract

BACKGROUND

Obesity in the prepuberal stage has been directly associated with slipped capital femoral epiphysis (SCFE). Serum insulin level increases in the prepuberal and adolescence stage, to a greater extent in the obese population. The main objective of this article was to analyze the relationship between insulin levels and SCFE.

METHODS

A case-control study was conducted between January 2018 and April 2019. The study group was formed with patients with SCFE and the control group with patients from the pediatric obesity clinic of our hospital selected during their initial evaluation. None were being treated for obesity. Anthropometric measurements of size, weight, waist circumference, and blood pressure were taken. Body mass index (BMI) and waist-height index of all patients were calculated. According to BMI for age, they were classified as normal, overweight, or obese. Serum determinations of glucose, insulin, glycated hemoglobin, lipid profile, and complete blood count were analyzed. Insulin resistance was diagnosed with Homeostatic Model Assessment (HOMA) >3. Insulin levels >13 U/mL for girls and >17 U/mL for boys were considered as hyperinsulinemia.

RESULTS

We studied 14 patients with SCFE and 23 in the control group. The mean age and BMI in both groups were similar. The elevation of serum insulin was significantly higher in the SCFE group (P=0.001) as was HOMA (P=0.005). Triglycerides and very-low-density lipoprotein were higher in the SCFE group (P=0.037 and 0.009, respectively). Glycemia, glycated hemoglobin, total cholesterol, high-density lipoprotein, low-density lipoprotein, and neutrophils showed no significant difference.

CONCLUSIONS

Patients with SCFE showed elevated levels of insulin, HOMA, triglycerides, and very-low-density lipoprotein, even higher than the control group. Our study demonstrates a significant association between abnormally high serum insulin levels and SCFE. The known effects of insulin on growth cartilage may explain the physeal mechanical insufficiency to support the abnormally high or repetitive loads in accelerated growth stages that lead to SCFE.

LEVEL OF EVIDENCE

Level III-case-control, prognostic study.

摘要

背景

青春期前肥胖与股骨颈骨骺滑脱（SCFE）直接相关。青春期前和青春期阶段，血清胰岛素水平会升高，肥胖人群的升高幅度更大。本文的主要目的是分析胰岛素水平与 SCFE 之间的关系。

方法

我们进行了一项病例对照研究，时间为 2018 年 1 月至 2019 年 4 月。研究组由 SCFE 患者组成，对照组由我院儿科肥胖诊所的患者组成，这些患者在初次评估时被选中，且均未接受肥胖治疗。我们对所有患者的身高、体重、腰围和血压进行了测量，计算了体重指数（BMI）和腰高比。根据年龄计算 BMI，将其分为正常、超重或肥胖。对所有患者的血糖、胰岛素、糖化血红蛋白、血脂谱和全血细胞计数进行了血清学检测。采用稳态模型评估（HOMA）>3 诊断胰岛素抵抗，女性血清胰岛素水平>13 U/mL，男性>17 U/mL 被认为是高胰岛素血症。

结果

我们研究了 14 名 SCFE 患者和 23 名对照组患者。两组的平均年龄和 BMI 相似。SCFE 组的血清胰岛素水平显著升高（P=0.001），HOMA 也显著升高（P=0.005）。SCFE 组的甘油三酯和极低密度脂蛋白水平也更高（分别为 P=0.037 和 0.009）。血糖、糖化血红蛋白、总胆固醇、高密度脂蛋白、低密度脂蛋白和中性粒细胞无显著差异。