瘦素水平在肥胖儿童胰岛素抵抗与非酒精性脂肪肝间的中介效应

白敏; 黄烈平; 朱蓓; 吴金华; 吴琼; 洪开听; 虞优娜

doi:10.16766/j.cnki.issn.1674-4152.003296

瘦素水平在肥胖儿童胰岛素抵抗与非酒精性脂肪肝间的中介效应

doi: 10.16766/j.cnki.issn.1674-4152.003296

1.
舟山市妇女儿童医院儿科, 浙江舟山 316000
2.
舟山市妇女儿童医院科教科
3.
舟山市妇女儿童医院检验科

基金项目:

浙江省医药卫生科技计划项目 2023KY1305

详细信息

通讯作者:
黄烈平，E-mail：huanglp816@126.com

中图分类号: R725.8 R575.5
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出版历程
- 收稿日期: 2023-05-24
- 网络出版日期: 2024-01-29

Mediating effect of leptin levels between insulin resistance and nonalcoholic fatty liver disease in obese children

1.
Department of Pediatrics, Zhoushan Women's and Children's Hospital, Zhoushan, Zhejiang 316000, China

摘要

摘要: 目的小儿非酒精性脂肪肝(NAFLD)是儿童中最常见的慢性肝病，其患病率随着超重和肥胖率的增加而上升，瘦素是第一个被分离和鉴定的脂肪因子，本研究探讨瘦素水平在肥胖儿童胰岛素抵抗与NAFLD间的中介作用。方法将舟山市妇女儿童医院2022年1月—2023年3月收治的肥胖儿童80例作为研究对象，根据是否存在NAFLD分为NAFLD组(32例)和非NAFLD组(48例)。收集所有研究对象一般资料、体格资料、胰岛素抵抗指数、瘦素水平及肝功能等，同时采用Pearson相关分析上述变量间的相关性；采用中介效应分析瘦素水平在肥胖儿童胰岛素抵抗与非酒精性脂肪肝间的作用。结果 NAFLD组稳态模型胰岛素抵抗指数(HOMA-IR)、瘦素、谷丙转氨酶(ALT)、谷草转氨酶(AST)、肝内脂肪(IHL)水平均较非NAFLD组高(均P < 0.05)；Pearson相关性分析显示：HOMA-IR与瘦素、IHL具有较强的正相关关系(r=0.573，P < 0.001；r=0.577，P < 0.001)；瘦素与肝内脂肪IHL具有较强的正相关关系(r=0.557，P < 0.001)；中介效应分析显示：HOMA-IR作为直接效应占总效应的56.48%(0.340)，脂肪因子作为中介效应占总效应的43.52%(0.262)。结论肥胖儿童的胰岛素抵抗与非酒精性脂肪肝有关，这种关系可由脂肪因子介导。
- 瘦素 /
- 肥胖症 /
- 胰岛素抵抗 /
- 非酒精性脂肪肝
Abstract: Objective Paediatric non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease in children and its prevalence is increasing with the rise in overweight and obesity. Leptin was the first adipokine to be isolated and identified. Therefore, the mediating role of leptin levels between insulin resistance and NAFLD in obese children is discussed. Methods Eighty obese children admitted to Zhoushan Women's and Children's Hospital from January 2022 to March 2023 were selected as research objects, and divided into NAFLD group (32 cases) and non-NAFLD group (48 cases) according to the presence or absence of NAFLD. General data, physical data, insulin resistance index, leptin level and liver function of all subjects were collected, and Pearson correlation was used to analyze the correlation between the above variables. Mediation effects were used to analyze the effects of leptin levels on insulin resistance and non-alcoholic fatty liver disease in obese children. Results Homeostasis model assessment forinsulin resistance (HOMA-IR), leptin, alanine transaminase (ALT), aspartate transaminase (AST) and intrahepatic lipiol (IHL) levels in the NAFLD group were higher than those in the non-NAFLD group (all P < 0.05). Pearson correlation showed that HOMA-IR was positively correlated with leptin and IHL (r=0.573, P < 0.001; r=0.577, P < 0.001); leptin was positively correlated with IHL (r=0.557, P < 0.001). Mediation effect analysis showed that HOMA-IR as a direct effect accounted for 56.48% (0.340) of the total effect and adipokines as a mediating effect accounted for 43.52% (0.262). Conclusion Insulin resistance in obese children is associated with non-alcoholic fatty liver disease, which may be mediated by adipokines.
- Leptin /
- Obesity /
- Insulin resistance /
- Non-alcoholic fatty liver disease

HTML全文

图 1 瘦素水平在肥胖儿童胰岛素抵抗与非酒精性脂肪肝间的中介效应

Figure 1. Mediating effect of leptin levels between insulin resistance and nonalcoholic fatty liver disease in obese children

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表 1 2组肥胖儿童一般资料比较

Table 1. General data analysis of the two groups in obese children

项目	NAFLD组 (n=32)	非NAFLD组 (n=48)	统计量	P值
性别(男/女，例)	20/12	28/20	0.139^a	0.709
年龄(x±s，岁)	10.26±3.16	10.38±3.31	0.163^b	0.871
BMI(x±s)	28.26±1.26	27.79±1.19	1.671^b	0.100
腰围(x±s，cm)	87.36±10.23	86.26±10.16	0.472^b	0.638
臀围(x±s，cm)	93.26±10.69	90.69±10.98	1.042^b	0.301
代谢参数
FPG(x±s，mmol/L)	6.25±0.98	4.94±1.02	1.702^b	0.094
HOMA-IR(x±s)	4.56±1.16	4.02±1.01	2.146^b	0.036
瘦素(x±s，μg/L)	13.96±2.11	12.11±2.40	3.643^b	0.001
ALT(x±s，U/L)	55.27±6.56	31.76±7.84	14.510^b	< 0.001
AST(x±s，U/L)	53.15±7.65	30.42±7.62	13.040^b	< 0.001
IHL(x±s，%)	10.57±2.58	4.58±0.90	12.631^b	< 0.001
注：^a为χ²值，^b为t值。

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表 2 瘦素水平在肥胖儿童胰岛素抵抗与非酒精性脂肪肝间的相关性分析

Table 2. Correlating leptin levels with insulin resistance and nonalcoholic fatty liver disease in obese children

变量	HOMA-IR	瘦素	ALT	AST	肝内脂肪IHL
HOMA-IR	1
瘦素	0.573^a	1
ALT	0.143	0.358	1
AST	0.190	1.359	0.894^a	1
肝内脂肪IHL	0.577^a	0.557^a	0.810^a	0.818^a	1
注：^aP < 0.001。

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