探讨儿童期合并单纯性肥胖症与血浆脂联素(adiponectin)的关系，分析脂肪代谢紊乱相关因素。

选择2008年12月至2009年12月在本院保健科门诊就诊的单纯性肥胖症患儿105例纳入肥胖组。其中，男性为73例，女性为32例；年龄为6~13岁，平均为(8.99±1.94)岁；体重指数(body mass index, BMI)为(25.25±3.60)kg/m²。随机抽取同期在本院门诊体检的体重指数正常儿童50例纳入对照组。其中，男性为30例，女性为20例；年龄为6~13岁，平均为(8.78±1.66)岁；体重指数为(16.78±1.40)kg/m²(两组均排除遗传、代谢、内分泌等疾病)(本研究遵循的程序符合本院人体试验委员会制定的伦理学标准，分组征得患儿监护人的知情同意，并签署临床研究知情同意书)。采用ELISA法检测血浆脂联素水平。免疫比浊法测定血脂包括甘油三酯(triglyceride，TG)，总胆固醇(total cholesterol，TC)；血脂蛋白包括载脂蛋白A(apolipoprotein A，ApoA)，载脂蛋白B(apolipoprotein B，ApoB)；血生化指标包括谷丙转氨酶(alanine aminotransferase，ALT)，谷草转氨酶(aspartate aminotransferase，AST)，尿酸(uric acid，UA)，血糖(blood sugar, BS)。分析脂联素与体重指数、血脂及脂蛋白间的相关性。并行常规肝脏超声检查，明确非酒精性脂肪肝病(nonalcoholic fatty liver disease，NAFLD)发病率。

①肥胖组儿童血浆脂联素水平低于对照组，两组比较，差异有显著意义(P<0.01)。②肥胖组儿童甘油三酯、载脂蛋白B、谷草转氨酶、血糖水平升高与对照组比较，差异无显著意义 (P<0.05)；肥胖组儿童血总胆固醇、载脂蛋白A、载脂蛋白、尿酸水平升高与对照组比较，差异有显著意义(P>0.05)；③血浆脂联素与体重指数呈负相关(r＝－0.33, P<0.01)，与载脂蛋白A、载脂蛋白B、总胆固醇、甘油三酯亦呈负相关(r＝－0.138，r＝－0.06，r＝－0.09, r＝－0.12)，但差异无显著意义(P>0.05)。④肥胖组脂肪肝和非酒精性脂肪肝病检出率分别为20.21%(19/94)和9.57% (9/94)，对照组均为0.00 (0/50)。两组两种疾病检出率比较，差异有显著意义(P<0.05)。

作为新型脂源性激素，血浆脂联素水平变化与儿童单纯性肥胖症发病相关，脂联素变化早于部分血脂成分改变。检测血浆脂联素，常规肝脏超声检查，有助于早期判断儿童单纯性肥胖症发展趋势，为儿童单纯性肥胖症、脂肪代谢紊乱的早期防治开拓新的思路。

To investigate levels of plasma adiponectin and lipid disturbance in obese children and its clinical significance.

From December 2008 to December 2009, a total of 105 children from the age of 6 to 13, body mass index (BMI) of (25.25±3.60)kg/m^2, who were diagnosed as obesity were included into obesity group. Meanwhile, another 50 healthy children were enrolled into control group [at the age of 6 to 13, body mass index of (16.78±1.40)kg/m²]. Both groups were excluded the genetic, metabolic, endocrine and other diseases. Informed consent was obtained from all participates. The ELISA technique was used to determine levels of plasma adiponectin. The serum levels of triglyceride (TG), total cholesterol (TC), apoprotein A (ApoA), apoprotein B (ApoB), alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood glucose, uric acid (UA) were tested by the method of immunoturbidimetry. The correlation of plasma adiponectin, body mass index, blood lipid and apoprotein were analyzed. Ultrasonographic test of liver were done to explore nonalcoholic fatty liver disease (NAFLD).

①The level of plasma adiponectin decreased significantly in obesity group compared with control group(P<0.01). ②Triglyceride, apolipoprotein B, aspartate aminotransferase and blood sugar were not found to have significantly higher levels in obesity group (P<0.05), but total cholesterol, apolipoprotein A, alanine aminotransferase, uric acid did (P>0.05); ③The adiponectin level was inversely correlated with body mass index(r=-0.33, P<0.01). Adiponectin had no significant correlation with the other lipid or apoprotein components. ④Hepatic sonograms test demonstrated that 19 children had fatty liver and 9 children were diagnosed as nonalcoholic fatty liver disease. The prevalence of fatty liver was 20.21% (19/94) and that of nonalcoholic fatty liver disease was 9.57% (9/92) in obesity group, while those in control group were 0.00(0/50) and 0.00(0/50), respectively.

As a new adipocyte hormone in plasma, adiponectin is correlated with child obesity. The change of adiponectin occurred earlier than the changes in blood lipid or apoprotein. Measuring plasma adiponectin level and ultrasonographic test of liver may help in estimating the trend developing of childhood obesity. It may also provid a new method to prevent and treat childhood obesity.