2型糖尿病患者腹部脂肪分布与胰岛素敏感性及血清瘦素水平的关系

目的 探讨2型糖尿病患者腹部脂肪分布与瘦素和胰岛素抵抗的关系。方法 48例2型糖尿病患者均进行高胰岛素正血糖钳夹试验，根据体重指数(BMI)和葡萄糖利用率(GIR)将患者分为非肥胖型胰岛素敏感组(NIS，16例)，非肥胖型胰岛素抵抗组(NIR，15例)和肥胖型胰岛素抵抗组(OIR，17例)，同时洲定血清瘦素，胰岛素水平和腹部脂肪面积。结果 两非肥胖组(NIS和NIR)之间的BMI相似，但NIR组的GIR要明显低于NIS组，NIR组的内脏脂肪面积比NIS组明显增高，NIR组的瘦素水平在皮下脂肪校正之后与NIS组差异无显著性。OIR组的皮下脂肪，内脏脂肪和瘦素水平比非肥胖组(NIS和NIR)明显增高，OIR的GIR明显低于NIS和NIR组。多元回归分析显示，无论肥胖组还是非肥胖组，内脏脂肪是预测胰岛素抵抗的最重要变量；皮下脂肪是血清瘦素水平的最重要变量。结论 两种代谢不同的脂肪分布是胰岛素抵抗和瘦素水平的决定因素。

Association of abdominal fat distribution with insulin sensitivity and serum leptin level in type2 diabetic patients

Objective To examine the association of abdominal fat distribution with insulin sensitivity and serum leptin level. Methods Euglycemic hyperinsulinemic clamp test was performed in 48 type 2 diabetic patients who were then divided into three groups: the nonobese insulin sensitive (NIS, n=16), the nonobese insulin resistant (NIR, n=15) and the obese insulin resistant (OIR, n=17) groups based on the body mass index (BMI) and glucose disappearance rate (GIR). GIR was measured by 2h euglycemic hyperinsulinemic clamp. Serum insulin and leptin were assayed by RIA. Abdominal fat area was measured by CT. Results BMI in two nonobese groups (NIS and NIR) did not differ, GIR in NIR group was lower than that in NIS group, the visceral fat area in NIR group was greater than that in NIS group. NIS and NIR groups had similar leptin levels after being corrected with subcutaneous fat area. In OIR group subcutaneous fat area and visceral fat area were greater and serum leptin level higher than the respective values in NIS and NIR groups. After multiple regression analysis, no matter whether the nonobese or obese group was, the visceral fat area seemed to be the best variate in predicting insulin resistance, and subcutaneous fat area was thebestvariateinconjunctionwithserum leptin levels. Conclusion The distribution of two kinds of metabolically different fat is the determinative factor in insulin resistance and serum leptin level in nonobese and obese type 2 diabetes.