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目的探讨单纯性肥胖青少年血脂紊乱、胰岛素抵抗与血管弹性的关系。方法选取80例单纯肥胖青少年,按照血脂水平分为血脂正常组45例,血脂紊乱组35例。空腹抽取静脉血检测空腹血糖(FPG)、空腹胰岛素(FINS)、甘油三酯(TG)、总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)水平,计算稳态模型胰岛素抵抗指数(HOMA-IR)。彩色多普勒超声诊断仪测定颈动脉内膜中层厚度(IMT)、颈动脉血管硬化值(β)、血管弹性系数(Ep)、血管顺应性(AC)、增大指数(AI)、脉搏波传播速度(PWVβ),测量颈动脉收缩期血管内径(Ds)和颈动脉舒张期血管内径(Dd)。结果血脂紊乱组TG、TC、LDL-C和HOMA-IR均明显高于血脂正常组,HDL-C低于血脂正常组,差异均有统计学意义(P<0.05);两组体质指数(BMI)、IMT、FPG、餐后2h血糖(2hPG)差异均无统计学意义(P>0.05)。两组颈动脉弹性参数β、Ep和AI差异均有统计学意义(P<0.05)。相关性分析显示,BMI、TG、LDL-C、HOMA-IR分别与β、Ep、AI、PWVβ呈正相关,与AC呈负相关,与Ds、Dd无明显相关性。TC、HDL-C、SBP、DBP与颈动脉各弹性参数无明显相关性(P>0.05)。结论肥胖青少年存在血脂代谢紊乱、胰岛素抵抗和动脉内膜增厚等血管病变;血脂紊乱和胰岛素抵抗与动脉血管弹性密切相关,高甘油三酯血症和HOMA-IR是影响血管弹性的高危因素。
Objective To investigate the relationship between dyslipidemia, insulin resistance and vascular elasticity in simple obesity adolescents. Methods Eighty simple obese adolescents were selected and divided into 45 cases of normal lipid group and 35 cases of dyslipidemia group according to the level of serum lipids. Fasting blood glucose (FPG), fasting insulin (FINS), triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol ) Level, calculate the homeostasis model insulin resistance index (HOMA-IR). Color Doppler echocardiography was used to measure carotid intima - media thickness (IMT), carotid artery sclerosis (β), vascular elasticity (Ep), vascular compliance (AC), augmentation index Propagation velocity (PWVβ), carotid systolic vascular diameter (Ds) and carotid diastolic vascular diameter (Dd) were measured. Results The levels of TG, TC, LDL-C and HOMA-IR in patients with dyslipidemia were significantly higher than those with normal blood lipids and HDL-C in patients with dyslipidemia (P <0.05). The body mass index ), IMT, FPG, postprandial 2h blood glucose (2hPG) showed no significant difference (P> 0.05). The difference of carotid artery elasticity parameters β, Ep and AI between the two groups was statistically significant (P <0.05). Correlation analysis showed that BMI, TG, LDL-C and HOMA-IR were positively correlated with β, Ep, AI and PWVβ, negatively correlated with AC, and had no significant correlation with Ds and Dd. TC, HDL-C, SBP, DBP and carotid artery elastic parameters were not significantly correlated (P> 0.05). Conclusion Obese adolescents have vascular dysfunction such as dyslipidemia, insulin resistance and intimal hyperplasia. Dyslipidemia and insulin resistance are closely related to arterial elasticity. Hypertriglyceridemia and HOMA-IR are the risk factors of vascular elasticity.