■患有先天性肾上腺增生(CAH)的儿童和年轻人患肥胖症和胰岛素抵抗的风险增加。有证据表明,患有CAH的儿童内脏肥胖增加,与代谢综合征和心血管疾病(CVD)有关。脂肪因子脂联素已被证明与降低代谢风险相关,而脂肪因子内脂素和瘦素与内脏脂肪和脂肪细胞炎症相关,可以作为代谢风险增加的生物标志物。迄今为止,很少有研究表征患有先天性肾上腺增生的儿童和年轻人的脂肪因子水平。我们试图调查脂联素,瘦素和内脂素水平对CAH儿童和年轻人代谢危险因素和雄激素水平的影响。
■获得空腹血液的内脂素,瘦素,脂联素,葡萄糖,胰岛素,CRP,脂质面板,总胆固醇(TC),甘油三酯(TG)和HbA1c,以及评估肾上腺控制的标准实验室测试,来自21-羟化酶缺乏症导致的CAH儿童。基于空腹血糖和胰岛素计算HOMA-IR。还获得了BMI和腰臀比的拟人化测量值。
■脂联素和雄烯二酮呈负相关(R=-0.57,p=0.016)。瘦素与BMI百分位数呈正相关(R=0.63,p<0.001),瘦素与HOMA-IR呈正相关(R=0.63,p<0.01)。糖皮质激素剂量与HOMA-IR呈正相关(R=0.56,p=0.021)。内脂素与HDL胆固醇(R=-0.54,p=0.026)和总胆固醇(R=-0.49,p<0.05)呈负相关。超重儿童和年轻人的瘦素(p=0.02)和HOMA-IR(p=0.001)明显高于非超重儿童和年轻人。
■脂联素与雄烯二酮之间的反比关系表明,更好的CAH控制可以降低胰岛素抵抗和代谢综合征的风险。然而,高剂量的糖皮质激素似乎会增加胰岛素抵抗的风险,强调治疗CAH时需要的微妙平衡。
UNASSIGNED: Children and young adults with congenital adrenal hyperplasia (CAH) are at increased risk of obesity and insulin resistance. There is evidence that children with CAH have increased visceral adiposity, which has been linked to metabolic syndrome and cardiovascular disease (CVD). The adipokine adiponectin has been shown to correlate with reduced metabolic risk, whereas the
adipokines visfatin and leptin have been linked to visceral fat and adipocyte inflammation and can serve as biomarkers of increased metabolic risk. Few studies to date have characterized adipokine levels in children and young adults with congenital adrenal hyperplasia. We sought to investigate the relationship between adiponectin, leptin and visfatin levels to metabolic risk factors and androgen levels in children and young adults with CAH.
UNASSIGNED: Fasting blood was obtained for visfatin, leptin, adiponectin, glucose, insulin, CRP, lipid panel, total cholesterol (TC), triglycerides (TG) and HbA1c, as well as standard laboratory tests to assess adrenal control, from children with CAH due to 21-hydroxylase deficiency. HOMA-IR was calculated based on fasting glucose and insulin. Anthropomorphic measurements of BMI and waist-to-hip ratio were also obtained.
UNASSIGNED: Adiponectin and androstenedione were inversely correlated (R = -0.57, p =0.016). There was a positive correlation between leptin and BMI percentile (R = 0.63, p <0.001) as well as leptin and HOMA-IR (R = 0.63, p <0.01). Glucocorticoid dose had a positive correlation with HOMA-IR (R=0.56, p = 0.021). Visfatin was inversely correlated with HDL cholesterol (R = -0.54, p = 0.026) and total cholesterol (R = -0.49, p <0.05). Overweight children and young adults had a significantly higher leptin (p = 0.02) and HOMA-IR (p=0.001) than non-overweight children and young adults.
UNASSIGNED: The inverse relationship between adiponectin and androstenedione suggests that better CAH control can reduce the risk of insulin resistance and metabolic syndrome. However, a high glucocorticoid dose appears to increase the risk of insulin resistance, underscoring the delicate balance required when treating CAH.