소아청소년 비만에서 흑색가시세포증의 정도와 위치에 따른 고인슐린혈증 및 인슐린저항성과의 상관관계

Abstract

ABSTRACT Relation of acanthosis nigricans scales and locations to hyperinsulinemia and insulin resistance in obese children

Kim Ho Young Advisor : Prof. Moon Kyung Rye, M.D. Ph.D. Department of Medicine, Graduate School of Chosun University

Objectives: This study investigated the clinical significance of acanthosis nigricans scales and locations to validate a relation of hyperinsulinemia and insulin resistance in obese children.

Methods: We conducted a retrospective analysis of clinical records of obese children who were visited to evaluate of obesity at Chosun university hospital between January 2013 and February 2014. Five anatomical sites were examined to evaluate acanthosis nigricans; the neck, axilla, elbow, knuckle, and knee. The neck and axilla were graded for severity on a scale from 0 to 4. The knuckle, elbow, and knee were graded present or absent. The neck texture measured additionally on a scale from 0 to 3. Clinical characteristics, such as age, gender, blood pressure, height, weight, BMI, waist/hip circumference ratio, fasting plasma glucose and insulin level, lipid profile, liver function test, HbA1C, c-peptide, HOMA-IR were compared according to the presence and severity of acanthosis nigricans. Pearson correlation coefficient were calculated to determine relation in fasting insulin, HOMA-IR and AN total score. And also locations of acanthosis nigricans were evaluated.

Results: 57 children were identified, 24 boys and 31 girls with a mean age of 12 years (ragne 5-19 years) and 37(70.9%) children had acanthocis nigricans. A consensus score of acanthosis nigricans was calculated by summing the scores of five locations. The diagnostic categories were; No acanthosis nigricans group (n=16, 29.1%), mild group (n=18, 32.7%), moderate group (n=11, 20.0%), severe group (10, 18.2%). Elevated acanthosis nigricans total score was strongly associated with elevated BMI, triglyceride, c-peptide in all groups. Elevated acanthosis nigricans total score was also strongly associated with elevated fasting insulin and HOMA-IR. And in this study, we also found the frequency of the neck for identifying presence of acanthosis nigricans appears to be high. But acanthosis nigricans on axilla was strongly associated with elevated fasting insulin and HOMA-IR .

Conclusion: To estimate scales and locations of acanthosis nigricans could be useful as a clinical surrogate of hyperinsulinemia and insulin resistance in obese children.

Key words : Acanthosis nigricans, Hyperinsulinemia, Insulin resistance, Obese children