腹型肥胖内脏脂肪定量检测的评估及其临床意义

目的 分析临床常用体脂检测方法与内脏脂肪型肥胖(VFO)诊断切点的相关性,及其在判断腹型肥胖类型中的价值.方法 4301例研究对象,其中659例接受了CT、生物电阻抗(体脂仪)和B超3项检查.以CT检查确定的腹内脂肪面积(VA)≥100 cm2作为判断VFO的诊断标准,应用受试者工作特征(ROC)曲线分别分析简易体脂参数(腰围、体重指数、腰臀比),体脂仪参数(全身脂肪含量、全身脂肪重量),超声测值(腹壁脂肪厚度、腹内脂肪厚度)判断VFO的切点及其敏感性和特异性.结果 (1)腰围、脂肪重量、体重指数、腹内脂肪厚度、全身脂肪含量、腰臀比诊断VFO均有较高准确性(ROC曲线下面积为0.718～0.837),其中腰围判断VFO的诊断效率最好.(2)判断VFO的最佳切点及其敏感性和特异性在男性和女性分别是:腰围为89.5、85.5 cm;体重指数为25、26 kg/m2;腰臀比为0.97、0.95;全身脂肪含量为29%、38%;全身脂肪重量为18.6、20.4 kg;腹内脂肪厚度为38.5、34.7 mm.结论 简易体脂参数、体脂仪、超声可用于临床定量评估内脏脂肪变化.在确定腰围的前提下,结合超声或体脂仪参数可进一步判断腹型肥胖的类型.

Evaluation of visceral adipose in abdominal obesity and its clinical application

Objective To compare the values of measurements of obesity, including body mass index(BMI), waist circumference (WC), waist-w-hip ratio (WHR), bioelectrical impedance analyzer (BIA) (fat mass and FAT%), ultrasonograpby (US) ( subcutaneous fat distance and intraabdominal fat distance), and computed tomography (CT) in predicting the quantification of visceral adipose in abdominal obesity , and to evaluate the best cut-off point, sensitivity and specificity of these methods. Methods 4301 inpatients with hypertension, 2155 males and 2146 females, aged(56.4 ± 13.8) (11 - 89), all with at least 1 risk factor of cardiovascular diseases, underwent simple body fat measurement. 3458 received BIA, 2553 received B mode uhrasonography, 1039 underwent CT examination, and 659 received all kinds of examination. Abdominal visceral adipose area (VA) measured with CT ≥ 100 cm2 was the diagnostic criteria of visceral fat obesity (VFO). Receiver operating characteristic (ROC) curve was used to analyze the body fat indexes to determine the best cut-off point. Results (1) It was accurate for WC, fat mass, BMI, intraabdominal fat distance, FAT%, and WHR were all accurate in diagnosis of VFO with the values of area under ROC of 0.730 -0.867. WC was the most effective measurement. (2) The best cut-off points of these methods in predicting abdominal visceral obesity in males and females were as follows: WC : 89.5 cm and 85.5 cm for WC. 25 kg/m2 and 26 kg/m2 for BMI, 0. 97 and 0.95 for WHR, 29% and 38% for fat composition, 18.6 kg, and 20.4 kg for fat mass, and 38.5 nun and 34.7 mm for intraabdominal fat distance. Conclusions WC, fat mass, BMI, intraabdominal fat distance, simple fat parameters, and WHR all can predict visceral adipose in abdominal obesity, in which WC is the best. For a given WC, the type of obesity can be determined by BIA and US.