代谢正常肥胖个体的临床特点及其发生代谢异常性疾病的风险

目的了解代谢正常肥胖（MHO）个体的临床特点并探讨其发生代谢异常性疾病的风险。方法回顾性分析湖南省人民医院体检中心2006年4月至2010年1月体检人群的临床资料，排除资料不全者，共有2830名人员纳入研究。其中1367名于1—3年后再次来院体检。记录受检者临床及生化指标。多组间比较进行方差分析，率的比较用χ2 检验。结果肥胖者占39．58％（1120／2830），MHO占肥胖者的23．30％（261／1120）。女性MHO的百分比明显高于男性（31．22％比21．64％，χ2=8．126，P〈0．05）。与肥胖伴代谢综合征组比较，MHO组收缩压、舒张压、空腹血糖、甘油三酯、低密度脂蛋白胆固醇（LDL-C）、谷丙转氨酶、尿酸、外周血白细胞计数较低，高密度脂蛋白胆固醇（HDL-C）较高，差异有统计学意义（t值为2．036～20．985，均P〈0．05）；与正常对照组比较，MHO组体质指数、血压、空腹血糖、甘油三酯、LDL—C、谷丙转氨酶、尿酸、外周血白细胞计数较高，HDL．c较低，差异有统计学意义（t值为3．458～10．978，均P〈0．05）。随访1—3年后，正常对照组中有17．6％（44／250）的个体出现代谢异常，而MHO组中46．8％（51／109）出现代谢异常，MHO代谢异常发生风险明显高于正常对照组（OR=4．117，95％CI：2．503—6．770，P〈0．05）。结论MHO个体临床表型介于正常对照与肥胖伴代谢综合征者之间，其发生代谢异常性疾病的风险随时间延长而增加。

Clinical characteristics and risk on metabolic abnormal diseases of metabolically healthy obese individuals

Objective To investigate the clinical characteristics of metabolically healthy obese （MHO） individuals, and to explore the risk of MHO individuals on metabolic abnormal diseases. Methods A total of 4076 subjects were evaluated for routine health examination in People＇s Hospital of Hunan Province from April 2006 to January 2010, 2830 individuals were enrolled excluding those with missing data. Of the subjects, 1367 individuals were followed up during 1 -3 years after. Data were collected of those individuals on the clinical and biochemistry parameters. Analysis of variance, χ2 test, trend test and risk analysis were used for data analysis. Results The prevalence of obesity was 39. 58% （ 1120/2830）, and MHO was 23.30% （261/1120） in obesity. The proportion of MHO in females was higher than that in males （31.22% vs 21.64%, χ2 = 8. 126, P 〈 0.05）. Parameters including systolic blood pressure （SBP）, diastolic blood pressure （ DBP）, fasting blood glucose （FBG）, triglyceride （ TG）, low density lipoprotein cholesterol（LDL-C） , aspartatetransaminase （ALT） , uric acid （UA） and white blood cell （ WBC ） count, were lower （while high density lipoprotein cholesterol（HDL-C） was higher） in MHO than those in obesity with metabolic syndrome （t value was between 2. 036 and 20. 985, all P 〈 0. 05）, and higher （ HDL-C was lower） than those in normal controls （t value was between 3.458 and 10. 978, all P 〈0. 05）. Following up for 1 to 3 years, the incidence of metabolic abnormal diseases in normal controls was 17.6% （44/250）, the incidence of metabolic abnormal diseases in MHO was 46. 8% （51/109）, the risk of metabolic abnormaldiseases in MHO was significantly higher than that in normal controls （OR =4. 117, 95% CI： 2.503 - 6. 770 ; P 〈 0. 05 ）. Conclusions MHO shows an intermediate clinical features between normal controls and obesity with MS. Over time, the risk of metabolic abnormal diseases in MHO was significantly increased.