经超声测量的内脏脂肪及心外膜脂肪组织厚度对代谢综合征的诊断预测价值

目的评价内脏脂肪厚度(VAT)和心外膜脂肪组织厚度(EAT)对代谢综合征(MS)的诊断预测价值。方法对210例符合入选标准的健康体检对象进行腰围、空腹血生化测定并用超声测量VAT、EAT。根据国际糖尿病联盟MS标准,分为MS组和非MS组,用SPSS12.0软件进行比较分析。结果男女VAT在MS组均高于非MS组(P<0.01),而EAT在男性MS组高于非MS组(P<0.05),女性则两组之间无显著差异;无论男女VAT和EAT均和腰围成正相关。经年龄、性别、腰围调整后,VAT和收缩压、舒张压、甘油三酯、载脂蛋白B、空腹胰岛素、胰岛素抵抗指数成正相关,和胰岛素敏感指数成负相关;EAT和空腹胰岛素、胰岛素抵抗指数成正相关,和胰岛素敏感指数成负相关。经超声测量的VAT、EAT诊断MS的ROC曲线下面积分别为男性为0.74、0.73,女性为0.79、0.63,诊断切点值分别为男性为43.5mm、5.53mm,女性为23.8mm、7.95mm。两种方法ROC曲线下面积比较,无论男女均无显著差异。结论由超声测量的VAT、EAT均可作为内脏型肥胖简便、可靠和实用的评价指标,和MS关系密切,可作为MS患者无创的协同诊断方法之一。     

超声测量内脏脂肪和心外膜脂肪组织厚度对代谢综合征的诊断预测价值

目的 超声测量内脏脂肪厚度(VAT)和心外膜脂肪组织厚度(EAT),评价其对代谢综合征(MS)的诊断预测价值.方法 对210例人选的健康体检者进行腰围、空腹血生化测定和经超声测量VAT、EAT.根据国际糖尿病联盟MS标准,分为MS组和非MS组,用SPSS 12.0软件进行统计学分析.结果 男女VAT在MS组均高于非MS组(P<0.01),而EAT在男性MS组高于非MS组(P<0.05),女性两组比较无差异;无论男女VAT和EAT均和腰围成正相关;经年龄、性别、腰围调整后,VAT和收缩压、舒张压、甘油三酯、载脂蛋白B、空腹胰岛素、胰岛素抵抗指数成正相关,胰岛素敏感指数成负相关;EAT和空腹胰岛素、胰岛素抵抗指数成正相关,胰岛素敏感指数成负相关.经超声测量的VAT、EAT诊断Ms的ROC曲线下面积分别为男性0.74、0.73,女性为0.79、0.63,诊断切点值分别为男性43.5mm、5.53mm,女性23.8mm、7.95mm.两种方法ROC曲线下面积比较,无论男女均无显著性差异.结论 由超声测量的VAT和EAT指标均可作为内脏型肥胖简便、可靠和实用的评价指标,与MS关系密切,可作为MS患者无创的协同诊断方法之一.     

超声测量心外膜脂肪组织厚度对冠心病的诊断预测价值

目的评价经超声测量的心外膜脂肪组织厚度(visceral adipose thickness,EAT)对冠状动脉狭窄程度的预测价值。方法共有147例接受冠状动脉造影患者入选本研究,根据造影结果,分为冠状动脉粥样硬化性心脏病(冠心病)(coronary artery disease,CAD)组101例和非CAD组46例。对所有患者采集病史,体检并进行实验室检查,超声测量EAT。对各组之间的EAT值进行比较,将患者的冠状动脉病变积分(coronary artery core,CAS)值与EAT进行相关性分析。结果 CAD组的EAT显著高于非CAD组,差异有统计学意义[(7.41±1.63)mm vs.(4.41±1.60)mm,P0.01]。严重冠状动脉病变组EAT较轻度冠状动脉病变组EAT明显升高[(8.53±1.00)mm vs.(7.16±1.73)mm,P0.01]。相关分析显示,CAS与EAT呈正相关(r=0.71,P0.001)。以EAT值≥5.35mm诊断CAD,诊断敏感性87.13%,特异性80.43%,ROC曲线下面积为89%(95%可信区间0.84～0.95;P=0.01)。结论由超声测量的EAT可作为评价冠状动脉病变程度简便、可靠和实用的评价指标,和CAD关系密切,可作为CAD患者无创的协同诊断方法之一,用于对CAD患者的筛查。     

心外膜脂肪组织与心血管疾病和代谢性疾病

内脏脂肪组织(visceral adipose tissue,VAT)增加是心血管疾病和代谢性疾病的独立危险因素.心外膜脂肪组织(epicardial adipose tissue,EAT)也是 VAT 的一种,主要起源于中胚层,位于心包膜脏层和心肌之间,沿着冠状动脉(冠脉)的主要分支走行.近年来,EAT 受到越来越多...     

脂肪组织的分泌功能与代谢综合征

表达谱研究首次发现60种食欲调节、免疫及生殖相关基因和88种受体基因在内脏脂肪组织表达，并首次鉴定出脂肪组织内的8个自分泌或旁分泌系统。脂肪组织不仅通过内分泌的方式，还通过自分泌或旁分泌的方式参与食欲调节。减少样本数的Bergman微小模型技术分析显示脂联素、瘦素和游离脂肪酸等脂肪细胞因子与代谢综合征的发生密切相关。     

心外膜脂肪组织的临床研究进展

人类心外膜脂肪组织(epicardial adipose tissue,EAT)是一种覆盖在心脏表面及大血管表面的内在脂肪组织,它不仅仅是贮存过分能量的场所,而且还是一个具有内分泌功能的器官。近年来,关于EAT在心血管疾病、动脉硬化、代谢综合征等方面的研究不断取得新进展,该文就其研究进展作一综述。     

超声测量的内脏脂肪厚度和代谢综合征的关系

目的探讨由超声测量的内脏脂肪厚度(VFT)评价内脏性肥胖的价值及其和代谢综合征(MS)的关系。方法收集了2005-03-12在我院体检中心符合入选标准的可用资料210份,测定MS相关的人体指标测量、空腹血生化检查和经超声测量内脏脂肪厚度。根据国际糖尿病联盟(IDF)MS标准,分成MS组及非MS组。结果VFT和腰围(WC)呈正相关(男r=0·61,P=0·01;女r=0·60,P=0·01),MS组VFT明显大于非MS组,男性MS组为(49·4±14·6)mm与非MS组(37·1±14·9)mm比较,女性MS组(34·5±9·4)mm与非MS组(24·6±8·7)mm比较,两者差异均有非常显著性(P=0·01)。VFT与收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、甘油三酯(TG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)呈正相关(P<0·05或P<0·01),与胰岛素敏感性指数(INSI)呈负相关(男性r=-0·309,女性r=-0·433,P<0·01),男性VFT与高密度脂蛋白胆固醇(HDL-C)呈负相关(r=-0·249,P<0·01),女性VFT与胆固醇(TC)呈正相关(r=0·255,P=0·065)。逐步法多元线性回归分析显示,男性VFT和WC、SBP、载脂蛋白B(apoB)呈正相关,和HDL-C呈负相关,相关系数分别为(r=6·746,2·75,2·86,-2·03,P<0·05或P<0·01);女性VFT和体重指数(BMI)和HOMA-IR呈正相关,相关系数分别为(r=3·60,2·98,P<0·01);而无论男女,WC和皮下脂肪仅仅和BMI呈正相关。MS发病率随着VFT的增加而增加(P<0·05或P<0·01)。经超声测量的VFT诊断MS的ROC曲线下面积男性0·74,女性0·79,最佳切点值男性43·5mm,女性23·8mm。结论经超声测量的VFT是一项简便、可靠和实用的评价内脏性肥胖的指标。并认为VFT大于此切点,即可推断存在有MS。     

超声测量的内脏脂肪厚度和代谢综合征的关系

目的 探讨由超声测量的内脏脂肪厚度(VFT)评价内脏性肥胖的价值及其和代谢综合征(MS)的关系.方法 收集了2005-03-12在我院体检中心符合入选标准的可用资料210份,测定MS相关的人体指标测量、空腹血生化检查和经超声测量内脏脂肪厚度.根据国际糖尿病联盟(IDF)MS标准,分成MS组及非MS组.结果 VFT和腰围(WC)呈正相关(男r=0.61,P=0.01;女r=0.60,P=0.01),MS组VFT明显大于非MS组,男性MS组为(49.4±14.6)mm与非MS组(37.1±14.9)mm比较,女性MS组(34.5±9.4)mm与非MS组(24.6±8.7)mm比较,两者差异均有非常显著性(P=0.01).VFT与收缩压(SBP)、舒张压(DBP)、空腹血糖(FPG)、甘油三酯(TG)、空腹胰岛素(FINS)、胰岛素抵抗指数(HOMA-IR)呈正相关(P＜0.05或P＜0.01),与胰岛素敏感性指数(INSI)呈负相关(男性r=-0.309,女性r=-0.433,P＜0.01),男性VFT与高密度脂蛋白胆固醇(HDL-C)呈负相关(r=-0.249,P＜0.01),女性VFT与胆固醇(TC)呈正相关(r=0.255,P=0.065).逐步法多元线性回归分析显示,男性VFT和WC、SBP、载脂蛋白B(apoB)呈正相关,和HDL-C呈负相关,相关系数分别为(r=6.746,2.75,2.86,-2.03,P＜0.05或P＜0.01);女性VFT和体重指数(BMI)和HOMA-IR呈正相关,相关系数分别为(r=3.60,2.98,P＜0.01);而无论男女,WC和皮下脂肪仅仅和BMI呈正相关.MS发病率随着VFT的增加而增加(P＜0.05或P＜0.01).经超声测量的VFT诊断MS的ROC曲线下面积男性0.74,女性0.79,最佳切点值男性43.5 mm,女性23.8 mm.结论 经超声测量的VFT是一项简便、可靠和实用的评价内脏性肥胖的指标.并认为VFT大于此切点,即可推断存在有MS.     

人脂肪组织抵抗素mRNA的表达与代谢综合征无关

用一步法半定量RT-PCR技术检测2型糖尿病代谢综合征患者、非糖尿病代谢综合征患者以及正常对照者大网膜及腹部皮下脂肪组织抵抗素mRNA表达。结果显示脂肪组织抵抗素mRNA表达与代谢综合征无关。     

病态窦房结综合征与心外膜脂肪组织的相关性分析

目的对比病态窦房结综合征患者与正常人群不同部位心外膜脂肪体积差异,探讨心外膜脂肪组织与病态窦房结综合征的关联性。方法选择2017年1月至2018年1月于本院住院治疗的65例病态窦房结综合征患者作为研究组,同期65例在年龄、性别、体质量指数与之匹配的正常人群作为对照组。所有入选对象均记录基线资料及伴发疾病,采用冠状动脉CT测定总心外膜脂肪组织(EAT-total)体积,心室周心外膜脂肪(EAT-ventricular)体积,心房周心外膜脂肪(EAT-atrial)体积,左房周心外膜脂肪(EAT-LA)体积及右房周心外膜脂肪(EAT-RA)体积。比较2组不同部位心外膜脂肪体积差异,分析心外膜脂肪组织与病态窦房结综合征的相关性。采用SPSS统计软件进行数据分析。结果除心室周心外膜脂肪组织外,其余区域心外膜脂肪组织在病例组中均较对照组升高[EAT-atrial,(55.3±19.6)vs(68.7±29.1)cm~3,P0.05; EAT-LA,(31.9±11.9)vs(39.5±19.3)cm~3,P0.05; EAT-RA,(23.4±8.7)vs(29. 2±11.5)cm~3,P0.05; EAT-total,(130.5±42.1)vs(150.5±61.2)cm~3,P0.05]。在多因素分析中校正混杂因素后,总心房周心外膜脂肪组织体积及右心房周心外膜脂肪体积与病态窦房结综合征的发生有关(P0.05)。结论病态窦房结综合征患者心外膜脂肪集聚,增多的心外膜脂肪组织可能在病态窦房结综合征的发生及发展中发挥作用。     

Increased epicardial adipose tissue in type 1 diabetes is associated with central obesity and metabolic syndrome

Aims

The present study evaluated the relationship between metabolic syndrome (MS), body fat composition and epicardial adipose tissue (EAT) in type 1 diabetes. Epicardial adipose tissue is a new independent marker of coronary artery disease (CAD).

Methods

Forty-five type 1 diabetic women were evaluated (age 36 ± 9 years; body mass index 24.6 ± 4.4 kg/m²). Metabolic syndrome was defined by the World Health Organization criteria. Body fat composition and EAT were analyzed by dual-energy-X-ray absorptiometry and echocardiogram, respectively.

Results

Twenty patients (45%) had MS. Patients with MS had greater android (central) fat deposition than patients without MS (41.9 ± 2.0% vs. 33.7 ± 1.8%, p = 0.004). Total body fat and gynoid (peripheric) fat distribution were similar between the groups. Mean EAT was higher in patients with MS (6.15 ± 0.34 mm vs. 4.96 ± 0.25 mm; p = 0.006) and EAT was positively correlated with android (central) fat distribution (r = 0.44; p = 0.002), however no correlation was found with gynoid (peripheric) fat distribution.

Conclusions

There was a high incidence of MS in type 1 diabetes related to increased central adiposity, despite the absence of obesity. Metabolic syndrome and central obesity were associated with increased EAT. Thus, young non-obese type 1 diabetic women with central adiposity and/or MS may have increased EAT, what may predict CAD risk.     

脂肪组织局部肾素血管紧张素系统与代谢综合征

肾素-血管紧张素系统相关成分陆续在脂肪组织中发现,它们主要受能量代谢调节,与代谢综合征的发生发展有密切关系。在机体发生肥胖、高血压、高血糖和高胰岛素血症时,脂肪组织内肾素-血管紧张素系统表达增加;应用血管紧张素受体拮抗剂或血管紧张素转换酶抑制剂,通过改变脂肪细胞功能等作用,改善代谢综合征的状态。     

Adipokine dysregulation,adipose tissue inflammation and metabolic syndrome

Obesity plays a causative role in the pathogenesis of the metabolic syndrome. Adipokines may link obesity to its co-morbidities. Most adipokines with pro-inflammatory properties are overproduced with increasing adiposity, while some adipokines with anti-inflammatory or insulin-sensitizing properties, like adiponectin are decreased. This dysregulation of adipokine production may promote obesity-linked metabolic disorders and cardiovascular disease. Besides considering adipokines, this review will also highlight the cellular key players and molecular mechanisms involved in adipose inflammation. Targeting the changes in the cellular composition of adipose tissue, the underlying molecular mechanisms, and the altered production of adipokines may have therapeutic potential in the management of the metabolic syndrome.     

Increased fibrosis and angiogenesis in subcutaneous gluteal adipose tissue in nascent metabolic syndrome

AimsMetabolic syndrome (MetS) is globally a common disorder that predisposes to both diabetes and cardiovascular disease (CVD). There is a paucity of data on fibrosis and angiogenesis in adipose tissue (AT) in patients with nascent MetS uncomplicated by diabetes or CVD. Hence, we assayed various indices of fibrosis and angiogenesis in subcutaneous AT (SAT).MethodsIn both patients with MetS and matched controls, we determined fibrosis and the densities of CD31, VEGF and Angiopoietin (Angio) 2 and 1 by immunohistochemistry in gluteal SAT.ResultsThe fibrosis score was significantly increased in SAT of Met S. Also, both CD31 and VEGF densities were significantly increased. Surprisingly, Angio-2 was not increased and the ratio of Angio2:1 was decreased. Both indices of fibrosis and angiogenesis correlated with biomediators of inflammation.ConclusionsIn conclusion, we report increased fibrosis and paradoxical increased angiogenesis in gluteal SAT and speculate that the increased angiogenesis is a protective mechanism in mitigating further adipose tissue dysregulation in this depot.     

Metabolic syndrome pathophysiology: the role of adipose tissue

Several pathophysiological explanations for the metabolic syndrome have been proposed involving insulin resistance, chronic inflammation and ectopic fat accumulation following adipose tissue saturation. However, current concepts create several paradoxes, including limited cardiovascular risk reduction with intensive glucose control in diabetics, therapies that result in weight gain (PPAR agonists), and presence of some of the metabolic traits among some lipodystrophies. We propose the functional failure of an organ, in this case, the adipose tissue as a model to interpret its manifestations and to reconcile some of the apparent paradox. A cornerstone of this model is the failure of the adipose tissue to buffer postprandial lipids. In addition, homeostatic feedback loops guide physiological and pathological adipose tissue activities. Fat turnover is determined by a complex equilibrium in which insulin is a main factor but not the only one. Chronically inadequate energy balance may be a key factor, stressing the system. In this situation, an adipose tissue functional failure occurs resulting in changes in systemic energy delivery, impaired glucose consumption and activation of self-regulatory mechanisms that extend their influence to whole body homeostasis system. These include changes in adipokines secretion and vascular effects. The functional capacity of the adipose tissue varies among subjects explaining the incomplete overlapping among the metabolic syndrome and obesity. Variations at multiple gene loci will be partially responsible for these interindividual differences. Two of those candidate genes, the adiponectin (APM1) and the perilipin (PLIN) genes, are discussed in more detail.     

代谢综合征患者内脏脂肪组织蛋白酪氨酸磷酸酶1B表达增多

目的研究蛋白酪氨酸磷酸酶1B(PTP-1B)在代谢综合征(MS)发病中的作用。方法51例患者分为对照(NC)组、2型糖尿病(T2DM)组和MS组,测定FPG、FIns,Western印迹法测定内脏脂肪组织PTP-1B表达水平。结果与NC组相比,T2DM组和MS组FPG、Ln(HOMA-IR)和PTP-1B表达水平明显升高。与T2DM组相比,MS组腰围和PTP-1B显著升高。校正年龄后PTP-1B与FPG、Ln(HOMA-IR)、腰围(WC)和SBP均呈正相关。结论内脏脂肪组织PTP-1B表达升高与肥胖、糖代谢紊乱等MS危险因素明显相关,可见内脏脂肪组织PTP-1B表达异常与MS发生发展关系密切。     

Usefulness of the epicardial fat tissue thickness as a diagnostic criterion for geriatric patients with metabolic syndrome

Objective To evaluate the epicardial fat tissue thickness (EFTT) as a diagnostic criterion for geriatric patients with metabolic syndrome (MetS). Methods Sixty geriatric patients over 65 years of age were recruited for the study. Patients were divided into two groups: Group 1 (n = 30) consisted of patients with MetS; Group 2 (n = 30) consisted of patients without MetS. Echocardiography was used to measure EFTT in all patients, and blood samples were analyzed for biochemical parameters. Results Compared to Group 2, EFTT levels of Group 1 were statistically higher (P < 0.05). In a binary logistic regression analysis, EFTT levels served as the independent factor for metabolic syndrome (B = 17.35, SE = 4.93, Wald = 12.36, P < 0.001). Receivers operating characteristic Curve (ROC-curve) analysis revealed that EFTT predicted MetS with 96.7% sensitivity and 86.7% specificity above the level of 7.3 mm [area under the curve = 0.969; 95% confidence interval (CI): 0.928–1.00]. Conclusions The present study demonstrated that serum EFTT levels were higher in geriatric patients with MetS and can therefore be used as a diagnostic criterion for MetS.