소아와 청소년에서 Adiponectin과 인슐린 저항성에 관한 연구
A Study of Serum Adiponectin and Insulin Resistance in Children and Adolescents
0
조회
0
다운로드
2
인용
0
참고문헌
초록
목 적 : 성인의 연구에서 adiponectin과 인슐린 저항성과의 관계는 여러 연구에서 보였다. 그러나 소아청소년기에는 사춘기 때 여러 변화로 나타나는 생리적인 인슐린 저항성이 있어 adiponectin이 실제로 어느 정도 기여하는지에 대하여 불분명하였다. 본 연구에서는 소아청소년기에 나타나는 인슐린 저항성이 adiponectin과 연관성이 있는지에 대하여 조사하였다. 방 법 : 2005년 2월 1일부터 2005년 8월 30일까지 7개월 동안 분당제생병원 소아과 외래로 내원 또는 입원치료 받았던 환자 38명에게서 혈액을 채취하여 혈청 adiponectin과 인슐린을 구하였고 그 외 다른 변수들을 구하여 이들을 BMI, 성별, 인슐린 저항성 그룹에 따라 나누어 비교하였다. 결 과 : BMI로 나눈 비만군(BMI 95백분위수 이상)과 대조군(정상 BMI)에서 혈청 adiponectin (대조군 12.7±10.4 vs. 비만군 6.3±3.8, P<0.05)은 비만군에서 현저하게 줄어들어 있었다. 인슐린(대조군 11.1±8.2 vs. 비만군 39.8±53.6, P<0.05)은 비만군에서 현저히 높아져 있었으며 HOMA-IR (대조군 2.4±1.8 vs. 비만군 9.8±14.7, P<0.05)도 이와 비례하여 높아져 있었다. Adiponectin은 혈중 중성지방과 HDL-콜레스테롤과 통계학적 연관성을 가지고 있었다. 그러나 인슐린 저항성과의 상관관계는 보이지 않았다. 인슐린의 경우 나이, 키, 몸무게, BMI, ALT, AST/ ALT 비, 혈당과 연관성을 보였다. 나이에서는 비만군과 대조군을 같이 표시하였는데 나이가 들어가면서 인슐린의 농도가 증가하는 양상을 보였다(P<0.05, r=0.115). 비만군(18명)에서는 adiponectin은 다른 변수들과 유의한 상관관계를 보이지 않았다. 남자는 총 19명, 여자는 총 19명이었으며 혈청 adiponectin (남자 7.3±5.1 vs. 여자 7.9±6.3, P=0.74)과 인슐린 (남자 39.8±53.6 vs. 여자11.1±8.2, P= 0.41), HOMA-IR (남자 6.8±10.3 vs. 여자5.0±11.4, P= 0.60)은 두 성별에서 뚜렷한 차이를 보이지 않았다. HOMA-IR 값이 3이상인 집단은 총16명이었으며 3이하인 집단은 22명이었다. 혈청 adiponectin은 인슐린 저항성 집단에서 감소되어 있었지만 통계학적으로 유의한 차이를 보이지 않았다(인슐린 저항성 집단 6.3±5.4 vs. 대조군 8.6±5.9, P=0.23). 결 론 : 소아청소년에서 나타나는 인슐린 저항성은 비만군에서 더 뚜렷한 양상을 보였고 혈청 adiponectin 역시 비만군에서 더 감소되어 있었으나 둘 사이의 통계학적 연관성은 없었는데 이는 소아청소년기에 성호르몬의 영향으로 나타나는 생리적인 인슐린 저항성 등의 다른 요인들이 adiponectin보다 더 큰 영향을 미치는 것으로 생각된다.
Abstract
Purpose : Currently many studies have confirmed the relationship between serum adiponectin and its influence on insulin resistance in adults. But physiologic insulin resistance due to changes in sex hormones exists during puberty, which prohibits us from knowing the influence of adiponectin to insulin resistance in this population. In this study, we investigated the influence of adiponectin on insulin resistance in children and adolescents. Methods : 18 obese children, from the OPD were selected. From All subjects, blood was sampled after overnight fasting, adiponectin, lipid profiles, AST, ALT, fasting glucose and insulin levels were measured to evaluate correlations with adiponectin. The group were divided into subgroups by BMI, sex and HOMA-IR values. All variables were compared for differences and relationships. Results : Obese groups showed decrease in adiponectin and showed increased insulin. HOMA-IR values were increased in the obese group. In all study participants, adiponectin showed significant correlation with triglyceride and HDL. But adiponectin showed no significant correlation with HOMA-IR, insulin and glucose. In the obese group adiponectin showed no correlation with HOMA-IR, insulin and glucose. HOMA-IR showed significant correlation with BMI, body weight and age. There were no sexual differences in adiponectin, insulin and HOMA-IR values. Insulin resistant group showed decrease in adiponectin but had no statistical significance. Conclusion : Decreased adiponectin levels and increased insulin resistance were observed in obese children but adiponectin showed no correlation with insulin resistance in children and adolescence. Factors other than adiponectin may play a more significant role in insulin resistance in this age group.
참고문헌 (26)
- Strauss R.S, "Epidemic increase in childhood overweight 1986-1998.", JAMA, 286, pp.2845~2848 (2001)
- 장진하, "소아비만증에서 대사 증후군의 유병률", Korean Journal of Pediatrics, 47(11), pp.1149~1156 (2004), 대한소아과학회
- Slyper A.H, "The Pediatric Obesity Epidemic. Causes and Controversies.", The J Clin Endocrinol Metab, 89, pp.2540~2547 (2004)
- Serdula M.K, "Do obese children become obese adults? A review of the literature.", Prev Med, 22, pp.167~177 (1993)
- Must A, "Long-term morbidity and mortality of overweight adolescents. A follow-up of the Harvard Growth Study of 1922 to 1935.", N Engl J Med, 327, pp.1350~1355 (1992)
- Woo J, "Adolescent sex differences in adiponectin are conditional on pubertal development and adiposity.", Obes Res, 13, pp.2095~2101 (2005)
- Scherer P.E, "A novel serum protein similar to C1q, produced exclusively in adipocytes.", J Biol Chem, 270 (1995)
- Fruebis J, "Proteolytic cleavage product of 30-kDa adipocyte complement-related protein increases fatty acid oxydation in muscle and causes weight loss in mice.", Proc Natl Acad Sci USA, 98, pp.2005~2010 (2001)
- Tomas E, "Enhanced muscle fat oxidation and glucose transport by ACRP30 globular domain: acetyl-CoA carboxylase inhibition and AMP-activated protein kinase activation.", Proc Natl Acad Sci USA, 99 (2002)
- Yamauchi T, "Adiponectin stimulated glucose utilization and fatty-acid oxidation by activating AMP-activated protein kinase.", Nat Med, 8, pp.1288~1295 (2002)
- Pajvani U.B, "Structure-function studies of the adiponectin-secreted hormone Acrp30", adiponectin. Implications for metabolic regulation and bioactivity., 2003, pp.278, 9073~9085
- Trujillo M, "Adipose tissue-derived factors: Impact on health and disease.", Endocr Rev, 27, pp.762~768 (2006)
- Mohteshamzadeh M, "Insulin resistance in men with treated hypertension at increased risk for cardiovascular disease.", AM J HTN, 18, pp.452~456 (2005)
- Hu E, "AdipoQ is a novel adipose specific gene dysregulated in obesity.", J Biol Chem, 271 (1996)
- Yamauchi T, "The fat-derived hormone adiponectin reverses insulin resistance associated with both lipoatrophy and obesity.", Nat Med, 7, pp.941~946 (2001)
- Berg A.H, "The adipocyte-secreted protein Acrp30 enhances hepatic insulin action.", Nat Med, 7, pp.947~953 (2001)
- Combs T.P, "Endogenous glucose production is inhibited by the adipose-derived protein Acrp30.", J Clin Invest, 108, pp.1875~1881 (2001)
- Livingstone C, "Sex steroids and insulin resistance.", Clin Sci, 102, pp.151~166 (2002)
- Tsou P, "Sex-related differences between adiponectin and insulin resistance in schoolchildren.", Diabetes Care, 27, pp.308~313 (2004)
- Zubin P, "Adiponectin, adiposity, and insulin resistance in children and adolescents. J. of Clin.", Endocrinology & Metabolism, 91, pp.2119~2125 (2006)
- Takashi K, "Adiponectin and Adiponectin Receptors.", Endocr Rev, 26, pp.439~451 (2005)
- Fruebis J, "Proteolytic cleavage product of 30-kDa adipocyte complement-related protein increases fatty acid oxidation in muscle and causes weight loss in mice.", Proc Natl Acad Sci USA, 98, pp.2005~2010 (2001)
- Mori Y, "Genome-wide search for type 2 diabetes in japanese affected sib-pairs confirms susceptibility genes on 3q, 15q, and 20q and identifies two new candidate loci on 7p and 11p.", Diabetes, 51, pp.1247~1255 (2002)
- Waki H, "Impaired multimerization of human adiponectin mutants associated with diabetes: Molecular structure and multimer formation of adiponectin.", J Biol Chem, 278 (2003)
- Lindsay R.S, "Adiponectin and development of type 2 diabetes in the Pima Indian population.", Lancet, 360, pp.57~58 (2002)
- Flores-Calderon J, "Frequency of increased aminotransferase levels and associated metabolic abnormalities in obese and overweight children of an elementary school in Mexico City.", Ann Hepatol, 4, pp.279~283 (2005)