The Relationship Between The Severity Of Acanthosis Nigricans And Insulin Resistance In Obese Children

Objectives:1.To explore the clinical characteristics and risk factors of acanthosis nigricans in obese children,and further analyze the value of acanthosis nigricans in predicting insulin resistance.2.To explore the corresponding changes of various indicators among different severity of acanthosis nigricans in obese children.Methods:1.88 obese children were divided into AN group and non AN group.The general data and laboratory indexes of the two groups were compared,and the risk factors of AN and its predictive value for insulin resistance were further analyzed.2.88 obese children were divided into non AN group,mild AN group,moderate AN group and severe AN group according to the AN severity scale developed by Burke et al.Then compare the general data and laboratory indexes of the four groups.Results:1.88 obese children were divided into two groups: AN group(44 cases,50%),male group(29 cases,65.9%),female group(15 cases,34.1%);non AN group(44 cases,50%),male group(25 cases,56.8%),female group(19 cases,43.2%);there was no significant difference in gender between the two groups.The age of AN group was higher than that of non AN Group [12.0(10.5 13.0)vs.10.8(9.3 12.0)],there was significant difference between the two groups.The body weight and BMI of AN group were higher than those of non AN group,and there was significant difference between the two groups(P < 0.05).The waist circumference of AN group was significantly higher than that of non AN group(P < 0.05),but no significant difference in waist to body ratio.In terms of blood pressure,there was a significant difference between the two groups in systolic blood pressure(P < 0.05),but no significant difference in diastolic blood pressure.There was no significant difference in the incidence of T2 DM between AN group and non AN group.The incidence of MS in AN group was significantly higher than that in non AN group(P<0.05).There was no significant difference in fasting and 30 minutes blood glucose between the two groups,but there was significant difference in 60 minutes,120 minutes and 180 minutes blood glucose(P < 0.05).There were significant differences in insulin levels at five time points(P < 0.05).The HOMA-IR of AN group was significantly higher than that of non AN group(P < 0.05),and the IAI of AN group was significantly lower than that of non AN group(P < 0.05).Hb A1 c,ALT and UA in AN group were significantly higher than those in non an group(P < 0.05).There was no significant difference in 25(OH)D/ AST/TC/TG/HDL and LDL.Further binary logistic regression analysis showed that HOMA-IR was an independent risk factor for the occurrence of acanthosis nigricans in obese children(P = 0.001).ROC analysis showed that the AUC of acanthosis nigricans for predicting insulin resistance was 0.773,the sensitivity was 63.64,the specificity was 90.91,and the 95% CI was 0.671-0.855.2.88 obese children were divided into non AN group,mild AN group,moderate AN group and severe AN group.There were 44 cases in non AN group,29 boys and 15 girls;15 cases in mild AN group,9 boys and 6 girls;10 cases in moderate AN group,6 boys and 4 girls;19 cases in severe AN group,10 boys and 9 girls;there was no significant difference in gender among obese children in four groups.There was no significant difference in diastolic blood pressure and waist body ratio among the four groups,but there were significant differences in age,BMI,waist circumference,systolic blood pressure,the incidence of T2 DM and MS(P < 0.05).We found that the indicators with differences after pairwise comparison: there was no significant difference in age and T2 DM ratio;BMI of non AN group was significantly different from that of moderate and severe AN group(P < 0.05);waist circumference and systolic blood pressure of non AN group were significantly different from those of moderate AN group(P < 0.05);the proportion of MS in non AN group was significantly different from that in moderate and severe AN group(P < 0.05).There was no significant difference in blood glucose at 0,30 and 180 minutes,25 OHD,liver function(ALT,AST)and blood lipid(TC,TG,HDL,LDL)between the four groups.There were significant differences in 60 minutes and 120 minutes blood glucose,each time point of insulin,Hb A1 c and UA between the four groups(P < 0.05).We found that the indicators with differences after pairwise comparison: there were significant differences in blood glucose of 60 minutes and 120 minutes between non AN group and a certain degree of AN group;insulin level of fasting and post test in non AN group was significantly different from that of severe AN group and other degree of AN group;Hb A1 c and UA of non AN group and moderate AN group were significantly different,that is,Hb A1 c and UA of moderate AN group were the highest.There were significant differences in HOMA-IR and IAI among the four groups of obese children(P < 0.001).HOMA-IR increased with the aggravation of acanthosis nigricans,and IAI decreased with the aggravation of acanthosis nigricans.After pairwise comparison,we found that HOMA-IR and IAI in non AN group were significantly different from those any degree of AN group(P < 0.05).All the biochemical indexes with significant difference are significant difference between non AN group and a certain degree of AN group,and there is no significant difference between the three groups with AN.conclusion1.BMI,systolic blood pressure,ALT,UA and insulin levels of obese children in AN group were significantly higher than those in non AN group,and the proportion of MS and T2 DM was also significantly increased,suggesting that when obese children develop acanthosis nigricans,they should be highly aware of metabolic syndrome and type 2 diabetes.2.Acanthosis nigricans in obese children has a good value in predicting insulin resistance,and HOMA-IR increases with the aggravation of acanthosis nigricans,IAI decreases with the aggravation of acanthosis nigricans.It is considered that acanthosis nigricans is a convenient and effective indicator for insulin resistance in obese children,and the heavier serious degree of acanthosis nigricans is,the heavier insulin resistance it is.