Abstract: Objective To investigate the relationship between serum hypersensitive C-reactive protein (hs-CRP) level andphysical and serum laboratory metabolic indicators in children and adolescents with metabolic syndrome (MetS). Methods The physical examination and metabolic indicators of 543 children and adolescents aged 10 - 15 years were retrieved from the national"11th Five-Year" Science and Technology Support Plan project Research on early identification and intervention technology of metabolic syndrome. The physical and metabolic indexes of children with different levels of hs-CRP were compared, and the association between hs-CRP and MetS related indexes was analyzed. Results Subjects with higher hs-CRP had significantly higher levels of triglyceride (TG), C-peptide, carotid intima media thickness (IMT), diastolic blood pressure and the prevalence of non-alcoholic fatty liver disease (NAFLD) (t=-3.150,-3.537,-3.662,-2.439,χ²=7.521,P<0.05), while significantly lower levels of fasting blood-glucose (FBG), glycosylated hemoglobin A1C ratio (HbA1C%) and the prevalence of hyperglycemia (t=3.859,4.060,χ²=8.268,P<0.05). hs-CRP level was positively correlated with TG, C-peptide, IMT and diastolic blood pressure (r=0.112, 0.223, 0.174, 0.140, P<0.05), and was negatively correlated with high density lipoprotein cholesterol (HDL-C) and FBG (r=-0.098, -0.234, P<0.001). After adjusting for gender and age, children with abdominal obesity (OR=1.215, 95%CI:1.002 - 1.472) and NAFLD (OR=1.741, 95%CI:1.332 - 2.275) had significantly higher hs-CRP levels, whereas children with hyperglycemia had significantly lower hs-CRP levels (OR=0.187, 95%CI:0.038 - 0.929). hs-CRP was still significantly lower in children with hyperglycemia after adjusting for gender, age, abdominal obesity and NAFLD (OR=0.178, 95%CI:0.034 - 0.924). Conclusions hs-CRP is an important early monitoring indicator for MetS in children and adolescents, and it is significantly correlated with abdominal obesity, glycolipid metabolism disorder, increased diastolic blood pressure and NAFLD. The association between hs-CRP and abdominal obesity is stronger than that of body mass index and C peptide is more important in predicting abnormal glucose metabolism than FBG in the early stage of MetS.

Key words: hypersensitive C-reactive protein, metabolic syndrome, children and adolescents, non-alcoholic fatty liver disease

摘要： 目的 探讨血清超敏C反应蛋白(hs-CRP)水平与儿童青少年代谢综合征(MetS)患者体格指标及血清实验室代谢指标的相关关系。方法 对来自国家“十一五”科技支撑计划项目“代谢综合征的早期识别和干预技术研究”中符合条件的543名10~15岁儿童青少年体格检查及代谢指标检测结果进行分析,并对不同hs-CRP水平儿童的体格及代谢指标进行比较,分析hs-CRP与MetS及其相关指标的关系。结果 高hs-CRP儿童甘油三酯(TG)、C肽、颈动脉内膜中层厚度(IMT)、舒张压水平及非酒精性脂肪肝(NAFLD)患病率显著增高(t=-3.150、-3.537、-3.662、-2.439,χ²=7.521,P<0.05),空腹血糖(FBG)、糖化血红蛋白比值(HbA1C%)水平及高血糖患病率显著降低(t=3.859、4.060,χ²=8.268,P<0.05)。Hs-CRP水平与TG、C肽、IMT及舒张压呈显著正相关(r=0.112、0.223、0.174、0.140,P<0.05),与高密度脂蛋白胆固醇(HDL-C)、FBG呈显著负相关(r=-0.098、-0.234,P<0.001)。校正性别及年龄因素后,腹型肥胖(OR=1.215, 95%CI:1.002~1.472)及NAFLD儿童的hs-CRP显著增高(OR=1.741,95%CI:1.332~2.275),高血糖者hs-CRP显著降低(OR=0.187,95%CI:0.038~0.929)。进一步校正腹型肥胖及NAFLD患病情况后,高血糖者hs-CRP仍然显著降低(OR=0.178, 95%CI:0.034~0.924)。结论 hs-CRP水平增高是儿童青少年MetS的重要早期监测因子,与腹型肥胖、糖脂代谢紊乱、舒张压升高、IMT增加及NAFLD的发生均显著相关。hs-CRP与腹型肥胖的关联性强于体重指数,C肽比FBG对于MetS早期更具有糖代谢异常的预警意义。

关键词: 超敏C反应蛋白, 代谢综合征, 儿童青少年, 非酒精性脂肪肝