腹型肥胖的类型与代谢综合征发生的风险

目的 探讨不同的腹型肥胖类型与代谢综合征(MS)发生风险的关系.方法 选择至少有一项心血管代谢危险因素的患者846例,应用CT测量腹壁和腹内脂肪面积,同时测量腰围、血压、空腹血糖、空腹胰岛素和血脂谱,按照是否腰围超标和合并内脏脂肪型肥胖(VFO)分为4个亚组:非肥胖组,隐性VFO组,假性VFO组和VFO组,比较不同腹型肥胖类型患者的MS风险.结果 (1)男性隐性VFO 51例(10.9%)显著高于女性18例(4.8%).(2)男性隐性VFO组MS罹患率22例(43.1%)显著高于非肥胖组47例(25.0%),低于假性VFO组37例(78.7%)和VFO组163例(88.6%).假性VFO组MS罹患率显著高于非肥胖组和隐性VFO组.(3)女性隐性VFO组MS6例(33.3%)与非肥胖组48例(31.2%)差异无统计学意义,但显著低于假性VFO组74例(78.7%)和VFO组100例(90.9%).假性VFO组的MS罹患率高于非肥胖组和隐性VFO组,与VFO组差异无统计学意义.(4)腰围增加和腹内脂肪堆积是发生MS的独立危险因素OR 1.13(1.10～1.17),1.01(1.01～1.02),P<0.01].结论 不同腹型肥胖类型对MS危险有显著影响,隐性VFO和假性VFO患者同样有较高的心血管代谢风险.

Relationship of different types of abdominal obesity to risk of metabolic syndrome

OBJECTIVE: To explore the relationship of different types of abdominal obesity to risk of metabolic syndrome (MS). METHODS: Visceral fat area (VA) and substantial fat area (SA) were assessed by CT in 846 patients, 470 males and 376 females, aged 55 +/- 12, who suffered from at least one cardiometabolic risk factor and divided into 4 groups according to their VA and waist circumference (WC): non-obesity, masked visceral fat obesity (VFO), pseudo-VFO, and VFO groups. Blood pressure, fasting blood glucose, fasting serum insulin, and lipid profile were also measured. The MS risks of different types of abdominal obesity were compared. RESULTS: The prevalence rate of masked VFO of males was 10.9% (51/470), significantly higher than that of female (4.8%, 18/376). The prevalence rate of MS of the male patients with masked VFO was 43.1%, significantly higher than that of those in non-obesity group (25.0%), and lower than those of the males in the pseudo-VFO group (78.7%) and in the VFO group (88.6%), whereas the MS prevalence rate of the males in the pseudo-VFO group was significantly higher than those in the non-obesity and masked VFO groups. On the other hand, the MS prevalence rate of the female patients with masked VFO was 33.3%, not significantly different from that of the female patients in the non-obesity group (31.2%), but significantly lower than those of the pseudo-VFO and VFO groups (78.7% and 90.9% respectively). The MS prevalence rate of the female pseudo-VFO patients was also significantly higher than those in the non-obesity and masked VFO groups. Logistic regression analysis showed that WC and VA were independent risk factors for MS OR (95% CI) = 1.13 (1.10-1.17), 1.01 (1.01-1.02), respectively, P < 0.01). CONCLUSION: Different types of abdominal obesity have important impacts on the risk of metabolic syndrome. Masked VFO, even though with normal WC, and pseudo-VFO have considerably higher cardiometabolic risks.