Abstract: Background　Childhood obesity has become a worldwide public health problem.Clinical treatment is mainly based on dietary and exercise intervention，while drug or surgical treatment is not recommended.But children showed poor compliance with dietary and exercise intervention caused by severe hunger ect..Intestinal microecological disorder is considered to be a key factor leading to simple obesity and metabolic disorder in children.Objective　To study the effect of the combination treatment of intestinal microecological preparations and modified low-carbonhydrate diet on children appetite，body fat metabolism and gastrointestinal reactions.Methods　74 overweight or simple obese children admitted to Shenzhen Hospital of Southern Medical University from January 2017 to September 2019 were selected as study objects.The samples were divided into intervention group（n=36） and control group（n=38） according to random assignment.Behavioral intervention was used in both groups.The intervention group was treated with combination of compound intestinal microecological preparation and modified low-carbonhydrate diet，supplemented with bifidobacterium triplets + compound glutamine enteric capsule + calcium carbonate + multidimensional element tablets to basic treatment，while the control group was simply treated with calorie restrict balanced diet.Intervention lasted for 6 weeks for both groups.The indicator of blood lipid〔serum triglyceride（TG），total serum cholesterol（TC），high-density lipoprotein（HDL），low density lipoprotein（LDL）〕，leptin（LP），adiponectin（ADPN），body mass index（BMI），body fat mass，muscle mass，degree of hunger，and the incidence of gastrointestinal reactions were compared between the two groups.Results　The results of TC，HDL，LDL at post-intervention between the two groups were not statistically significant（P>0.05）.TG in the intervention group was lower than in control group after intervention（P<0.05）.LP level，BMI，and body fat mass were lower in the intervention group than in control group after intervention，while ADPN was higher than in controls（P<0.05）.There was no statistically significant difference in muscle mass between the two groups after intervention（P>0.05）.LP，BMI，body fat mass at post-intervention in both groups were lower than those at pre-intervention，while ADPN was higher than pre-intervention（P<0.05）.There was statistical evidence for difference in degree of hunger between the two groups at post-intervention（P<0.05）.The incidence of constipation in the intervention group at post-intervention was lower than in controls（P<0.05），while there was no statistically significant difference in the incidence of diarrhea and abdominal pain between the two groups at post-intervention （P>0.05）.The incidence of constipation at the end of intervention was lower than pre-intervention （P<0.05）.Conclusion　Combination of compound intestinal microecological preparation and modified low-carbonhydrate diet could promote the body fat metabolism in children and reduce the incidence of gastrointestinal reactions such as constipation by regulating the LP level and ADPN.It could also increase the sense of satiety and reduce degree of hunger in children by blocking the possible mechanism of gut-cerebral axis-anorexia peptide.Further research on its mechanism shall provide basis and ideas for the intervention treatment of simple childhood obesity with the combination of intestinal microecological preparation and diet regulation.

Key words: Overweight；Obesity；Child；Compound intestinal microecological preparation；Diet, carbohydrate-restricted；Leptin；Adiponectin；Appetite

摘要： 背景　儿童肥胖症已成为世界性公共卫生难题，临床治疗以饮食、运动干预为主，不建议药物或手术治疗，但是严重饥饿感等导致患儿对单纯饮食和运动干预依从性很差。肠道微生态失调被认为是导致儿童单纯性肥胖及代谢失调的关键因素。目的　探讨复合肠道微生态制剂联合改良低碳饮食对超重或单纯性肥胖儿童食欲及体脂代谢和胃肠道反应的影响。方法　选取南方医科大学深圳医院2017年1月—2019年9月收治的74例超重或单纯性肥胖患儿为研究对象，按照随机分配表分为干预组（n=36）和对照组（n=38）。两组均给予行为方式干预，干预组给予复合肠道微生态制剂联合改良低碳饮食，在此基础上增加双歧杆菌三联活菌片+复方谷氨酰胺肠溶胶囊+碳酸钙+多维元素片治疗；对照组给予单纯限能量均衡饮食，均干预6周。比较干预前后两组血脂指标〔三酰甘油（TG）、总胆固醇（TC）、高密度脂蛋白（HDL）、低密度脂蛋白（LDL）〕、瘦素（LP）、脂联素（ADPN）、体质指数（BMI）、体脂量、肌肉量、饥饿感程度和胃肠道反应发生率。结果　干预后两组TC、HDL、LDL比较，差异无统计学意义（P>0.05）；干预后干预组TG低于对照组（P<0.05）。干预后干预组LP、BMI、体脂量低于对照组，ADPN高于对照组（P<0.05）；干预后两组肌肉量比较，差异无统计学意义（P>0.05）。干预后两组LP、BMI、体脂量低于干预前，ADPN高于干预前（P<0.05）。干预期间两组饥饿感程度比较，差异有统计学意义（P<0.05）。干预期间干预组便秘发生率低于对照组（P<0.05）；干预期间两组腹泻、腹痛发生率比较，差异无统计学意义（P>0.05）;干预期间干预组便秘发生率低于干预前（P<0.05）。结论　复合肠道微生态制剂联合改良低碳饮食可通过调控LP和ADPN促进患儿的体脂代谢、降低便秘等胃肠道反应发生率，还能通过阻断肠-脑轴-食欲肽增加患儿的饱腹感，减低饥饿感，对其作用机制的进一步研究将为肠道微生态制剂联合饮食调控干预治疗儿童单纯性肥胖提供依据和思路。

关键词: 超重；肥胖症；儿童；复合肠道微生态制剂；膳食, 低碳水化合物；瘦素；脂联素；食欲