空腹胰岛素21.93，需要用药吗？男，29岁，偏胖。
\u80f0\u5c9b\u7d20\u7a7a\u8179\u67e5\u662f\uff0c21.69\uff1b\u4e8c\u5c0f\u65f6\u80f0\u5c9b\u7d20\u662f\uff0c19.69.\u4f60\u597d\uff01\u6b63\u5e38\u4eba\u7a7a\u8179\u80f0\u5c9b\u7d20\u6c34\u5e73\u4e3a10~20mU/L\u3002\u6b63\u5e38\u80f0\u5c9b\u7d20\u91ca\u653e\u8bd5\u9a8c\u9ad8\u5cf0\u4e00\u822c\u5728\u534a\u5c0f\u65f6\u81f31\u5c0f\u65f6\u4e4b\u95f4\uff0c\u5cf0\u503c\u548c\u7a7a\u8179\u80f0\u5c9b\u7d20\u6bd4\u503c\u8fbe\u52305-10\u500d\u3002\u4ee5\u7a7a\u8179\u80f0\u5c9b\u7d20\u4e3a\u57fa\u7840\uff0c\u534a\u5c0f\u65f6\u548c\u4e24\u5c0f\u65f6\u53ef\u4ee5\u5206\u522b\u8fbe\u5230\u4e24\u4e2a\u5cf0\u503c\uff0c\u5982\u679c\u5cf0\u503c\u4e0d\u591f\uff0c\u5c31\u8bf4\u660e\u80f0\u5c9b\u7d20\u91ca\u653e\u4e0d\u8db3\uff0c\u6240\u4ee5\u5c31\u8981\u8865\u5145\u80f0\u5c9b\u7d20\u3002
\u89c2\u5bdf\u9752\u5c11\u5e74\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u4e0e\u80a5\u80d6\u7a0b\u5ea6\u3001\u7cd6\u3001\u80f0\u5c9b\u7d20\u53ca\u8102\u4ee3\u8c22\u53d8\u5316\u7684\u5173\u7cfb\u3002\u65b9\u6cd5 \u5bf9194\u540d\u5b66\u751f\u8fdb\u884c\u4e86OGTT(75g\u8461\u8404\u7cd6)\u53ca\u80f0\u5c9b\u7d20\u91ca\u653e\u5b9e\u9a8c\uff0c\u6d4b\u5b9a\u7626\u7d20\u3001\u8840\u8102\u3001\u7a7a\u8179\u548c\u9910\u540e2h\u8840\u7cd6\u3001\u80f0\u5c9b\u7d20\u6c34\u5e73\u5e76\u8ba1\u7b97Homa\u80f0\u5c9b\u7d20\u62b5\u6297\u6307\u6570\u3002\u7ed3\u679c \u5973\u6027\u8840\u7a7a\u8179\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u660e\u663e\u9ad8\u4e8e\u7537\u6027\uff0c\u4e14\u6309\u4f53\u91cd\u5206\u7ec4\u540e\uff0c\u65e0\u8bba\u5728\u80a5\u80d6\u7ec4\u548c\u6b63\u5e38\u4f53\u91cd\u7ec4\uff0c\u5973\u6027\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u4ecd\u660e\u663e\u9ad8\u4e8e\u7537\u6027\u3002\u80a5\u80d6\u7ec4\u8840\u4e2d\u8840\u6e05\u7626\u7d20\u660e\u663e\u9ad8\u4e8e\u6b63\u5e38\u4f53\u91cd\u7ec4\u3002\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u4e0eBMI\u3001FIns\u3001 PIns2h\u548cHoma\u80f0\u5c9b\u7d20\u62b5\u6297\u6307\u6570\u5448\u6b63\u76f8\u5173\u3002\u800c\u4e0eFPG\u3001PG2h\u65e0\u76f8\u5173\u6027\u3002\u5728\u6b63\u5e38\u4f53\u91cd\u7ec4\uff0c\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u5c1a\u4e0eTG\u5448\u6b63\u76f8\u5173\u3002\u5728\u7537\u6027\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u8fd8\u4e0eTC\u3001TG\u3001LDL\u5448\u6b63\u76f8\u5173\u3002\u7ed3\u8bba \u80a5\u80d6\u9752\u5c11\u5e74\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u5347\u9ad8\uff0c\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u4e0e\u8840\u8102\u3001\u8840\u538b\u4e4b\u95f4\u6709\u590d\u6742\u7684\u76f8\u4e92\u5173\u7cfb\uff0c\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u4e0e\u7a7a\u8179\u3001\u9910\u540e\u80f0\u5c9b\u7d20\u6c34\u5e73\u548c\u80f0\u5c9b\u7d20\u62b5\u6297\u6307\u6570\u6709\u76f8\u5173\u5173\u7cfb\uff0c\u8bf4\u660e\u7626\u7d20\u5728\u80a5\u80d6\u76f8\u5173\u7684\u9ad8\u80f0\u5c9b\u7d20\u8840\u75c7\u548c\u80f0\u5c9b\u7d20\u62b5\u6297\u53d1\u751f\u4e2d\u53ef\u80fd\u8d77\u4f5c\u7528\u3002
\u5173\u952e\u8bcd\uff1a\u9752\u5c11\u5e74\uff1b\u7626\u7d20\uff1b\u80a5\u80d6\uff1b\u80f0\u5c9b\u7d20\u62b5\u6297
The relationship between juvenile serum leptin levels and obesity, serum glucose as well as insulin concentrations
ABSTRACT: Objective To investigae the relationship between plasma leptin levels and obesity, plasma glucose, lipid as well as insulin concentration. Methods 194 students aged from 12-18 were selected. The assessments included serum leptin and lipid concentration, a 75g OGTT and insulin releasing test. Blood leptin, glucose, insulin and the blood lipids were measured. Results As compared with the control group, serum leptin, Fins(fasting insulin), Pins2h (2hour postprandial insulin) and insulin resistance index (IR) in the obesity group were highly elevated and statistically distinguished by the ttest (P<0.05). Serum leptin levels were positively correlated with Fins, Pins2h and IR. Conclusion Serum leptin levels in juvenile obesity is high. The correlation between hyperleptinemia and hyperinsulinemia suggests a possible role for leptin in obesityrelated insulin resistance pathogenesis.
KEY WORDS: juvenile; leptin; obesity; insulin resistance
\u7626\u7d20(leptin, LP)\u662f\u8102\u80aa\u7ec6\u80de\u5206\u6ccc\u7684\u4e00\u79cd\u6fc0\u7d20\u3002\u76ee\u524d\u8ba4\u4e3a\u5176\u9664\u5177\u6709\u6291\u5236\u98df\u6b32\u3001\u51cf\u5c11\u6444\u98df\u3001\u589e\u52a0\u80fd\u91cf\u6d88\u8017\u3001\u6291\u5236\u8102\u80aa\u5408\u6210\u7b49\u4f5c\u7528\u5916\uff0c\u5c1a\u4e0e\u80f0\u5c9b\u7d20\u62b5\u6297\u53d1\u751f\u6709\u5173\u3002\u800c\u80f0\u5c9b\u7d20\u62b5\u6297\u53c8\u4e0e\u8840\u8102\u7d0a\u4e71\u3001\u8840\u538b\u5f02\u5e38\u3001\u7cd6\u4ee3\u8c22\u7d0a\u4e71\u5bc6\u5207\u76f8\u5173\u3002\u672c\u7814\u7a76\u5bf9194\u540d\u5b66\u751f\u8fdb\u884c\u4e86\u8840\u7626\u7d20\u6c34\u5e73\u3001\u7cd6\u3001\u8102\u4ee3\u8c22\u65b9\u9762\u7684\u7814\u7a76\uff0c\u4ee5\u4e86\u89e3\u9752\u5c11\u5e74\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u4e0e\u80a5\u80d6\u7a0b\u5ea6\u3001\u7cd6\u3001\u80f0\u5c9b\u7d20\u53ca\u8102\u4ee3\u8c22\u53d8\u5316\u7684\u5173\u7cfb\uff0c\u4ee5\u63a2\u8ba8\u8840\u6e05\u7626\u7d20\u5728\u80f0\u5c9b\u7d20\u62b5\u6297\u53d1\u751f\u4e2d\u7684\u4f5c\u7528\u3002
1 \u5bf9\u8c61\u4e0e\u65b9\u6cd5
1.1 \u5bf9\u8c61 \u5e74\u9f84\u4e3a12-18\u5c81\u7684194\u540d\u5b66\u751f\uff0c\u80a5\u80d6\u7ec4(Ob)98\u540d\uff0cBMI=26.22\uff0c\u7537\u602763\u4f8b\uff0c\u5973\u602735\u4f8b\uff0c\u5e73\u5747\u5e74\u9f8414.96\u5c81\uff1b\u6b63\u5e38\u7ec4(Nor)96\u540d\uff0cBMI=21.59\uff0c\u7537\u602755\u4f8b\uff0c\u5973\u602741\u4f8b\uff0c\u5e73\u5747\u5e74\u9f8415.03\u5c81\u3002\u4e24\u7ec4\u5747\u5254\u9664\u7ee7\u53d1\u6027\u80a5\u80d6\u3002\u80a5\u80d6\u7684\u8bca\u65ad\u6807\u51c6\u4e3a\u5927\u4e8e\u6216\u7b49\u4e8e\u540c\u5e74\u9f84\u3001\u540c\u6027\u522b\u7ec4BMI\u7684\u7b2c85\u767e\u5206\u4f4d\u6570\u3002
1.2 \u65b9\u6cd5 \u5168\u90e8\u53d7\u8bd5\u8005\u4e8e\u6e05\u6668\u7a7a\u8179\u8098\u524d\u9759\u8109\u53d6\u8840\uff0c\u6d4b\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u3001\u8840\u8102\uff0c\u884c\u53e3\u670d\u8461\u8404\u7cd6\u8010\u91cf\u8bd5\u9a8c(OGTT)\u52a0\u80f0\u5c9b\u7d20\u91ca\u653e\u8bd5\u9a8c\uff0c\u6d4b\u5b9a\u7a7a\u8179\u8840\u7cd6( FPG)\u3001\u7a7a\u8179\u80f0\u5c9b\u7d20(FIns)\u3001\u670d\u7cd6\u540e2h\u8840\u7cd6(PG2h)\u3001\u670d\u7cd6\u540e2h\u80f0\u5c9b\u7d20(PIns2h)\u6c34\u5e73\uff0c\u5e76\u8ba1\u7b97Homa\u80f0\u5c9b\u7d20\u62b5\u6297\u6307\u6570(HomaIR=\u7a7a\u8179\u8840\u80f0\u5c9b\u7d20\u4e58\u7a7a\u8179\u8840\u7cd6\u503c\u966422.5\u540e\uff0c\u53d6\u81ea\u7136\u5bf9\u6570)\u3002\u8840\u7cd6\u91c7\u7528\u9759\u8109\u8840\uff0c\u7f8e\u56fd\u5f3a\u751f\u8840\u7cd6\u4eea\u6d4b\u5b9a\u3002\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u7528\u7f8e\u56fdLinco\u516c\u53f8\u63d0\u4f9b\u7684\u653e\u5c04\u514d\u75ab\u836f\u76d2\u6d4b\u5b9a\uff0c\u8840\u8102\u91c7\u7528\u9176\u6cd5\u75287170A\u5168\u81ea\u52a8\u751f\u5316\u5206\u6790\u4eea\u6d4b\u5b9a\u3002OGTT\u752875g\u8461\u8404\u7cd6\u6807\u51c6\u6cd5\u3002
1.3 \u7edf\u8ba1\u5b66\u5904\u7406 \u7ed3\u679c\u5747\u4ee5\u5747\u6570\u00b1\u6807\u51c6\u5dee(\u00b1s)\u8868\u793a\uff0c\u6570\u636e\u7528SPSS\u7edf\u8ba1\u8f6f\u4ef6\u8fdb\u884c\u5206\u6790\u3002\u5404\u9879\u6307\u6807\u663e\u8457\u6027\u68c0\u9a8c\u4f7f\u7528\u5b8c\u5168\u968f\u673a\u8bbe\u8ba1\u6210\u7ec4\u8d44\u6599t\u68c0\u9a8c\uff0c\u591a\u56e0\u7d20\u76f8\u5173\u5206\u6790\u91c7\u7528\u9010\u6b65\u56de\u5f52\u6cd5\u3002
2 \u7ed3\u679c
2.1 \u8840\u6e05\u7626\u7d20\u3001\u8840\u8102\u3001\u8840\u7cd6\u53ca\u80f0\u5c9b\u7d20\u6d4b\u5b9a \u5973\u6027\u8840\u6e05\u7a7a\u8179\u7626\u7d20\u6c34\u5e73\u4e3a(12.88\u00b15.57)\u03bcg/L\uff0c\u7537\u6027\u4e3a(8.35\u00b14.79)\u03bcg/L\uff0c\u5973\u6027\u660e\u663e\u9ad8\u4e8e\u7537\u6027(P<0.001)\u3002\u6309\u4f53\u91cd\u5206\u7ec4\u540e\uff0c \u65e0\u8bba\u5728\u80a5\u80d6\u7ec4\u548c\u6b63\u5e38\u4f53\u91cd\u7ec4\uff0c\u5973\u6027\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u4ecd\u660e\u663e\u9ad8\u4e8e\u7537\u6027\u3002\u80a5\u80d6\u7ec4\u65e0\u8bba\u7537\u6027\u3001\u5973\u6027Fins\u3001PIns2h\u5747\u660e\u663e\u9ad8\u4e8e\u6b63\u5e38\u4f53\u91cd\u7ec4\uff1b\u8840\u8102\u5728\u4e0d\u540c\u6027\u522b\u7ec4\u5b58\u5728\u4e0d\u540c\u53d8\u5316\uff1b\u5728\u7537\u6027\u4e2d\uff0c\u80a5\u80d6\u7ec4HomaIR\u660e\u663e\u9ad8\u4e8e\u6b63\u5e38\u4f53\u91cd\u7ec4\uff0c\u800c\u5973\u6027\u4e2d\uff0c\u4e24\u7ec4\u65e0\u663e\u8457\u5dee\u5f02(\u88681)\u3002
\u88681 \u4e34\u5e8a\u53ca\u5b9e\u9a8c\u5ba4\u8d44\u6599\uff08\u7565\uff09
Table 1 Clinical and laboratory data
Ob: obesity group; Nor: normal group
2.2 \u8840\u6e05\u7626\u7d20\u6c34\u5e73\u4e0e\u4f53\u91cd\u3001\u8840\u538b\u3001\u7cd6\u3001\u8102\u4ee3\u8c22\u3001\u80f0\u5c9b\u7d20\u6c34\u5e73\u53ca\u80f0\u5c9b\u7d20\u62b5\u6297\u7684\u5173\u7cfb \u91c7\u7528\u76f8\u5173\u5206\u6790\uff0c\u53d1\u73b0\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u4e0eBMI\u3001FIns\u3001PIns2h\u3001HomaIR\u53caTC\u3001TG\u3001LDL\u5448\u6b63\u76f8\u5173\uff0c\u800c\u4e0eFPG\u3001PG2h\u65e0\u76f8\u5173\u6027\u3002\u5c06\u7814\u7a76\u5bf9\u8c61\u6309\u6027\u522b\u5206\u7ec4\u540e\uff0c\u7537\u6027\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u4ecd\u4e0eBMI\u3001FIns\u3001PIns2h\u3001HomaIR\u53caTC\u3001TG\u3001LDL\u5448\u6b63\u76f8\u5173\u3002\u5973\u6027\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u4e0eBMI\u3001FIns\u3001HomaIR\u53caSBP\u3001DBP\u5448\u6b63\u76f8\u5173\u5173\u7cfb(\u88682)\u3002\u5c06\u7814\u7a76\u5bf9\u8c61\u6309\u4f53\u91cd\u5206\u7ec4\u540e\uff0c\u5728\u80a5\u80d6\u7ec4\uff0c\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u4e0eFIns\u3001PIns2h\u548cHomaIR\u5448\u6b63\u76f8\u5173(\u88683)\uff1b\u5728\u6b63\u5e38\u4f53\u91cd\u7ec4\uff0c\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u4e0eTG\u548cHomaIR\u5448\u6b63\u76f8\u5173(r=0.229\uff0cP<0.05\uff1br=0.217\uff0cP<0.05)\uff0c\u4e0eSBP\u8d1f\u76f8\u5173(r=-0.257\uff0cP<0.05)\u3002
2.3 \u5404\u53d8\u91cf\u548c\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u7684\u591a\u5143\u56de\u5f52\u5206\u6790 \u4ee5\u7626\u7d20\u4e3a\u5e94\u53d8\u91cf\uff0c\u4ee5\u6027\u522b\u3001BMI\u3001FIns\u3001 PIns2h\u548cHomaIR\u4e3a\u81ea\u53d8\u91cf\uff0c\u91c7\u7528\u9010\u6b65\u591a\u5143\u7ebf\u6027\u56de\u5f52\u65b9\u6cd5\u8fdb\u884c\u5206\u6790\uff0c\u53d1\u73b0\u6027\u522b\u3001\u4f53\u91cd\u6307\u6570\u548c\u80f0\u5c9b\u7d20\u62b5\u6297\u6307\u6570\u662f\u5f71\u54cd\u8840\u6e05\u7626\u7d20\u6c34\u5e73\u7684\u4e3b\u8981\u56e0\u7d20(\u88684)\u3002
\u88682 \u7814\u7a76\u4eba\u7fa4\u7626\u7d20\u7684\u5355\u56e0\u7d20\u76f8\u5173\u5206\u6790\uff08\u7565\uff09
Table 2 Spearman correlation analysis for leptin with other variables in the whole group
*P<0.001, **P<0.01, ***P<0.05
\u88683 \u80a5\u80d6\u7ec4\u7626\u7d20\u7684\u5355\u56e0\u7d20\u76f8\u5173\u5206\u6790\uff08\u7565\uff09
Table 3 Spearman correlation analysis for leptin with other variables in the obesity group
*P<0.001, **P<0.01, ***P<0.05
\u88684 \u5404\u53d8\u91cf\u548c\u7626\u7d20\u6c34\u5e73\u7684\u591a\u5143\u56de\u5f52\u65b9\u7a0b\uff08\u7565\uff09
3 \u8ba8\u8bba
\u7626\u7d20\u662f1994\u5e74\u7528\u5b9a\u4f4d\u514b\u9686\u6280\u672f\u53d1\u73b0\u7684\u4e00\u4e2a\u8102\u80aa\u6e90\u6027\u6fc0\u7d20\uff0c\u662f\u98df\u6b32\u8c03\u63a7\u53ca\u8102\u4ee3\u8c22\u7814\u7a76\u8fc7\u7a0b\u4e2d\u7684\u4e00\u4e2a\u91cc\u7a0b\u7891\u6027\u7684\u53d1\u73b0\u3002\u7626\u7d20\u4e3b\u8981\u4f5c\u7528\u4e8e\u4e0b\u4e18\u8111\u7684\u5f13\u6838\u548c\u5ba4\u65c1\u6838\u90e8\u4f4d\u7684\u53d7\u4f53\uff0c\u5f71\u54cd\u795e\u7ecf\u80bdY\u7684\u8868\u8fbe\uff0c\u4ece\u800c\u8c03\u8282\u98df\u6b32\uff0c\u80fd\u91cf\u4ee3\u8c22\u3002\u4f46\u8fd1\u5e74\u53d1\u73b0\u7626\u7d20\u53d7\u4f53\u4e0d\u4ec5\u5206\u5e03\u4e8e\u4e0b\u4e18\u8111\uff0c\u800c\u4e14\u8fd8\u5e7f\u6cdb\u5206\u5e03\u4e8e\u5468\u56f4\u7ec4\u7ec7\u5668\u5b98\uff0c\u63d0\u793a\u5176\u5bf9\u5916\u5468\u7ec4\u7ec7\u6709\u5e7f\u6cdb\u800c\u76f4\u63a5\u7684\u751f\u7406\u4f5c\u7528\u3002
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\u603b\u4e4b\uff0c\u7626\u7d20\u5728\u80a5\u80d6\u76f8\u5173\u7684\u4ee3\u8c22\u7d0a\u4e71\u4e2d\u7684\u4f5c\u7528\u5341\u5206\u590d\u6742\uff0c\u8fdb\u4e00\u6b65\u63a2\u7d22\u5176\u673a\u5236\uff0c\u5fc5\u5c06\u4e3a\u80a5\u80d6\u76f8\u5173\u7684\u4ee3\u8c22\u7d0a\u4e71\u7684\u6cbb\u7597\u63d0\u4f9b\u65b0\u89c6\u70b9\u3002
你好；这种情况可能是胰岛素抵抗引起的，可以查查有无糖尿病。
指导意见：
一般这种情况可以查血糖确诊。确诊糖尿病可以用二甲双胍治疗，控制饮食。
绛旓細鍥炵瓟锛氱梾鎯呭垎鏋: 浣犲ソ;杩欑鎯呭喌鍙兘鏄儼宀涚礌鎶垫姉寮曡捣鐨,鍙互鏌ユ煡鏈夋棤绯栧翱鐥呫 鎸囧鎰忚: 涓鑸繖绉嶆儏鍐靛彲浠ユ煡琛绯栫‘璇娿纭瘖绯栧翱鐥呭彲浠ョ敤浜岀敳鍙岃儘娌荤枟,鎺у埗楗銆
