52例肥胖患者脂肪分布与代谢综合征及糖代谢指标的相关性

目的 探讨定量CT测量的肥胖人群脂肪分布对代谢综合征及糖代谢水平的影响。 方法 选取体质量指数(BMI)≥28的肥胖患者52例,依据是否合并代谢综合征分为合并代谢综合征组(OB-MS组,n=32例)和单纯肥胖组(OB-NMS组,n=20例);根据口服75 g葡萄糖耐量试验(OGTT)结果分为肥胖糖耐量正常组(OB-NGT组,n=17例)、肥胖糖耐量受损组(OB-IGT组,n=15例)及肥胖糖尿病组(OB-DM组,n=20例)。采用螺旋CT定量测定腰2、3、4、5椎体平面脂肪组织总面积及内脏脂肪面积,双侧腰大肌、后背肌肌肉及脂肪面积,肝脏、胰腺脂肪百分比,同时检测各项代谢生化指标并计算胰岛素抵抗指数及胰岛素分泌指数,比较各组不同指标的差异。 结果 OB-MS组内脏脂肪面积(t=3.37)及胰腺脂肪百分比(t=2.05)大于OB-NMS组(P<0.05)。糖耐量不同的肥胖患者,内脏脂肪面积(F=7.63)、肝脏(F=5.93)及胰头脂肪百分比(F=3.70)差异有统计学意义(P均<0.05),OB-IGT组和OB-DM组内脏脂肪面积均大于OB-NGT组,OB-DM组肝脏及胰头脂肪百分比大于OB-NGT组,差异有统计学意义(P<0.05)。多元线性回归结果显示,调整年龄及胰岛素抵抗指数后,内脏脂肪面积(SB=-0.83,P=0.02)和胰头脂肪百分比(SB=-0.51,P=0.02)与胰岛β细胞功能指数(MBCI)对数呈负相关。 结论 肥胖患者的内脏脂肪沉积与代谢综合征的发生具有密切关系;而内脏、肝脏及胰头脂肪沉积与肥胖患者糖代谢紊乱的发生密切相关。本研究为临床肥胖患者代谢综合征及糖尿病的早期识别提供了可靠的指标。

Correlation of fat distribution with metabolic syndrome and glucose metabolism in 52 obese patients

Objective To investigate the effects of fat distribution measured by quantitative-computed tomography(Q-CT)on metabolic syndrome(MS)and glucose metabolism in obese people. Methods Totally 52 patients with body mass index(BMI)≥28 were collected and divided into two groups: obesity with MS group(OB-MS group, n=32)and obesity without MS group(OB-NMS group, n=20). According to the results of 75g oral glucose tolerance test(OGTT), the subjects were divided into three groups: obesity with normal glucose tolerance group(OB-NGT group, n=17), impaired glucose tolerance group(OB-IGT group, n=15), and obesity with diabetes mellitus group(OB-DM group, n=20). The adipose tissue area and visceral fat area of lumbar vertebras 2, 3, 4 and 5, the muscle and fat area of bilateral psoas major and back muscles, and the percentages of liver fat and pancreatic fat were quantitatively determined with spiral CT. Meanwhile, various metabolic and biochemical indexes were detected and compared. Results OB-MS group had significantly larger visceral fat area(t=3.37)and higher percentage of pancreatic fat(t=2.05)than OB-NMS group. There were statistically significant differences in visceral fat area(F=7.63), percentage of liver fat(F=5.93)and percentage of pancreatic head fat(F=3.70)among the three groups with different glucose tolerance(P<0.05). OB-IGT and OB-DM groups had larger visceral fat area than OB-NGT group, and OB-DM group had greater percentages of liver fat and pancreatic head fat than OB-NGT group(P<0.05). Multiple linear regression results showed that after age and insulin resistance index were adjusted, visceral fat area(SB=-0.83, P=0.02)and percentage of pancreatic head fat(SB=-0.51, P=0.02)were negatively correlated with modified β-cell function index(MBCI). Conclusion The accumulation of visceral fat is an important factor leading to metabolic syndrome, while visceral fat, liver fat and pancreatic head fat are important risk factors leading to abnormal glucose metabolism in obese people. These results provide clinical indicators for the early identification of metabolic syndrome and diabetes in obese patients.