综合干预防治肥胖儿童2型糖尿病、代谢综合征的研究

目的对肥胖儿童2型糖尿病及代谢综合征进行综合干预,分析评价其效果。方法对2005年1月至2009年9月就诊的肥胖儿童153例,测量其身高、体质量、腰围、臀围、血压,进行口服葡萄糖耐量试验,测定空腹和餐后2h血糖、胰岛素水平,并采集空腹肘静脉血测定血清总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）。其中73例患儿在家长知情同意下予以综合干预治疗,包括健康教育、生活方式的干预（合理饮食结构、适合个体的运动方案、纠正不良生活行为）、个体心理干预、护肝及二甲双胍降糖药等药物治疗。对坚持完成综合干预3个月治疗的60例患儿,分别测定以上指标,比较前后的变化。结果 60例（7～16岁）肥胖患儿中,2型糖尿病2例、空腹血糖受损7例、糖耐量受损25例、胰岛素抵抗37例,符合代谢综合征诊断指标的41例。通过综合干预,患儿体质量指数、腰围、血压、血脂水平及患儿糖耐量水平、胰岛素抵抗值（HO-MA-IR）,均有不同程度下降（均P〈0.01）。结论根据患儿的具体情况,给予综合的干预,能使肥胖儿童体质量指数降低,脂代谢改善,血压下降,患儿糖耐量水平改善,能有效地防控肥胖儿童2型糖尿病及代谢综合征的发生及发展,对预防成人疾病起到了积极的作用。

Comprehensive Intervention and Prevention in Obese Children with Type 2 Diabetes and Metabolic Syndrome

Objective To evaluate the effectiveness of a comprehensive intervention in obese children with type 2diabetes and metabolic syndrome.Methods Between January 2005 and September 2009,153 obese children were recruited,and their height,weight,waist circumference,hip circumference and blood pressure were measured.The oral glucose tolerance test was performed in all subjects,and the fasting and 2 hours plasma glucose levels and insulin levels were determined.Furthermore,fasting venous blood samples were drawn from the children to measure the total cholesterol（TC）,triglycerides（TG）,high density lipoprotein cholesterol（HDL-C）and low density lipoprotein cholesterol（LDL-C）.With the informed consent of their parents,a 3-month comprehensive intervention was conducted in 73 children,including health education,lifestyle intervention（reasonable diet,exercise programs for individuals,change in unhealthy lifestyle）,individual psychological intervention,liver protection,and treatment with hypoglycemic drugs such as metformin.At the end of intervention,the above-mentioned indicators were measured,and were compared with the indicators before intervention.Results Among the 73 obese children,60 completed follow-up of the intervention,13 cases did not adnere to treatment.Of the 60 children（7～16years old）,2had type 2diabetes mellitus,7had impaired fasting glucose,25 had impaired glucose tolerance,37 had insulin resistance,and 41 met the diagnostic indicators of metabolic syndrome.The indexes such as body mass index（BMI）,waist circumference,blood pressure,blood lipid levels,glucose tolerance,and insulin resistance（HOMA-IR）declined significantly in the obese children after the comprehensive intervention（all P〈0.01）.Conclusion According to the specific situation of children,the comprehensive intervention can reduce BMI,improve fat metabolism,decrease blood pressure,and improve glucose tolerance in obese children.Therefore,the comprehensive intervention can effectively control the occurrence and development of type 2 diabetes and metabolic syndrome in obese children,and will play apositive role in adult disease prevention.