人群体脂含量与分布对胰岛素抵抗的影响

目的研究不同体脂含量与分布对胰岛素抵抗(IR)的影响。方法7 917例受试者根据体重指数(BM I)和腰围分成4组:观察指标包括血压、空腹血糖、餐后2 h血糖、血脂、空腹胰岛素和血尿酸,并计算胰岛素抵抗指数(HOMA-IR)。按美国ATP III标准计算代谢综合征(MS)患病率。结果(1)IR和MS患病按高低依次排列为腹型肥胖、MONW、外周型肥胖和正常对照组;(2)在肥胖或腰围增加的人群中血糖、胰岛素、HOMA-IR明显升高,伴高血压、高甘油三酯血症、高胆固醇血症及高尿酸血症;(3)MONW与外周型肥胖患者比较,反映IR的一些指标如FIns、HOMA-IR、TG和UA均差异无统计学意义。(4)多变量分析显示,腰围和BM I是互相独立的两个IR危险因素,且腰围对IR的影响程度超过BM I;(5)决定HOMA-IR的主要变量是葡萄糖调节受损、甘油三酯、BM I、腰围和血压。结论无论是脂肪组织增加或脂肪组织的中心型分布,都可影响IR,其中以脂肪中心型分布的作用更加显著。

Study on effects of fat content and fat distribution on insulin resistance

Objective To study effects of fat content and fat distribution on insulin resistance(IR).Method 7917 cases were divided into four groups by body weight index(BMI) and waistline.Below variables were observed:blood pressure(SBP and DBP)、fasting blood glucose(FBG)、postprandial blood glucose(PBG)、fasting insulin(FIns)、triglyceride(TG)、cholesterol(TC) and uric acid were measured.HOMA-IR was calculated.Metabolic syndrome(MS) was diagnosed by ATP III criteria.Results 1.The rank of the prevalence of IR and MS were abdominal obesity,metabolic obese normal weight,peripheral obesity and normal control.2.In obese people or those with increasing waistline,there was a significant increase in blood glucose,blood pressure,fasting insulin,HOMA-IR,TG,TC,and UA.3.There was not significant difference in FIns,HOMA-IR,TG and UA,between MONW and peripheral obesity groups.4.Multivariable analysis showed that BMI and waistline were two independent risks of IR,with waistline over than BMI.5.HOMA-IR depended mainly on IGR,TC,BMI and blood pressure.Conclusion Fat content and fat distribution all contribute to IR,and effects of fat content distribution over does that of BMI.