肥胖患者脂联素与胰岛素抵抗、内皮依赖性舒张功能相关性研究

目的：探讨肥胖患者脂联素变化及与胰岛素抵抗、内皮依赖性舒张功能之间的关系。方法：采用彩色多普勒超声检测仪检测肥胖组（O）53例和正常对照组（C）24例右肱动脉内皮依赖性舒张功能、颈总动脉内膜-中层厚度（IMT），并测定血脂、血糖、空腹胰岛素（HNS）、血管性血友病因子（vWF）、纤溶酶原激活剂抑制物-1（PAI-1）和脂联素（adiponectin）。采用稳态模式（HOMA-IR）评价胰岛素抵抗。结果：O组腰臀比（WHR）、体重指数（BMI）、体内脂肪含量（BF）、收缩压（SBP）、舒张压（DBP）、载脂蛋白B（ApoB）、空腹血糖（FBG）、FINS和HOMA-IR高于C组（P〈0．05），脂联素明显低于C组（P〈0．05）。脂联素与性别（男=1，女=2）、高密度脂蛋白-胆固醇（HDL-C）呈正相关（r分别为0．354、0．438，P值分别为0．027、0．005）；与体重、腰围（W）、甘油三酯（TG）、WHR、F1NS和HOMA-IR呈负相关（r分别为-0．358、-0．359、-0．449、-0．375、-0．363、-0．319，P值分别为0．025、0．025、0．004、0、019、0．027、0．054）。多元逐步回归分析显示，BMI和BF是影响脂联素独立的危险因素。结论：肥胖患者脂联素降低，并且与胰岛素抵抗密切相关。

Study on the Relationship between Adiponectin and Insulin Resistance, Endothelium-dependent Vasodilatation in Obese Patients

Objective: To investigate the relevance of adiponectin to insulin resistance and the endothelium-dependent vasodilatation in obese patients. Methods:The endothelium-dependent relaxing function of right brachial artery and intima-media thickness(IMT) of common carotid arteries were detected by high resolution ultrasound and serum lipids, serum glucose, fasting insulin(FINS), von Willebrand factor (vWF), plasminogen activator inhibitor-1(PAI-1) and adiponectin were measured in 53 obese patients and 24 control subjects. Homeostasis model assessment(HOMA) was applied to assess the status of insulin resistance. Results: Waist-hip-rate(WHR), body mass index(BMI), body fat content(BF), systolic blood pressure(SBP), diastolic blood pressure (DBP), apolipoprotein B(ApoB), fasting blood glucose (FBG), fasting insulin(FINS) and HOMA-IR in obese patients were significantly higher than those in control subjects(P<0. 05). Adiponectin were remarkably decreased in obese patients compared with that in control subjects. In all subjects,spearman correlation analysis showed that adiponectin was positively correlated to sex(male=l, female=2), high density lipoprotein-cholesterol(HDL-C)(r=-0.354 and 0.438 respectively, P = 0.027 and 0.005 respectively) and negatively correlated to weight, waist(W), triglyceride(TG), WHR, FINS and HOMA-IR(r= -0.358, -0.359, -0.449, -0.375, -0.363 and -0.319 respectively, P=0.025, 0.025, 0.004, 0.019, 0.027 and 0.054 respectively). Multiple stepwise regression analysis showed BMI and BF were the independent risk factors affected the adiponectin. Conclusion: There was decreased serum adiponectin in obese patients and probably related to insulin resistance.