内皮功能障碍与胰岛素抵抗和肥胖关系研究的7年随诊观察

目的观察血管内皮功能、胰岛素抵抗（IR）和肥胖之间的动态关系。方法对583例单纯性肥胖者进行7年随访，共计431例纳入随访分析。按照初访时内皮依赖性血管舒张功能（EDD）、胰岛素抵抗指数（HOMA-IR）以及随访时减重与否分组，对各组随访前后EDD、HOMA-IR和体脂进行比较分析。结果（1）与初访时比较内皮功能异常组7年后腰臀比和HOMA—IR明显升高（P〈0．05），EDD显著降低（P〈O．05），内皮功能正常组体重指数较前降低（P〈O．05），HOMA—IR和EDD无显著变化。（2）无论初访或随访IR组腰围和HOMA—IR均明显高于非IR组（P〈0．05或P〈0．01），但EDD在初访时两组无显著差异，随访时前者明显低于后者以及本组初访时（均P〈0．05）。（3）初访时，未减重组HOMA_IR高于减重组（P〈0．05），EDD低于减重组（P〈0．01）。7年后未减重组体重指数、腰围和HO-MA—IR均明显高于减重组（P〈0．05或P〈0．01），EDD明显低于减重组（P〈0．01）。且与初访时比较，随访时未减重组HOMA-IR显著升高（P〈O．05），EDD显著降低（P〈0．05）。减重组HOMA-IR、EDD无明显变化。结论内皮功能障碍可能是导致超重和肥胖相关的IR的病因，两者也是影响减重效果的原因之一，但前者可能与减重关系更密切。

A seven-year follow-up study of the relationship of endothelial function with insulin resistance and obese

Objective To investigate the relationships of endothelial function with insulin resistance and the body fat in overweight and obese subjects. Methods A seven-year follow-up study was conducted in 583 overweight and obese subjects who were chosen in 2000. Before and after follow-up, endothelium-dependent dilatation （EDD）, insulin resistance index （HOMA-IR） and body fat parameters were measured. Results Compared with the original survey, the waist-hip ratio and HOMA-IR were increased and EDD was decreased in the impaired EDD group after seven years （all P〈0.05）, and the body mass index was decreased （P〈0. 05） and HOMA-IR and EDD were not changed in the normal EDD group. No matter the original survey or followed-up, the waist circumference and HOMA-IR were higher in insulin resistance group than in non-insulin resistance group （P〈0. 05 or P〈0.01）. EDD showed no difference between the two groups in the original survey, but in followed-up it was decreased in insulin resistance group than in non-insulin resistance group （all P〈0. 05）. In the original survey, HOMA-IR was higher and EDD was lower in non-weight reduction group than weight reduction group （P〈0. 05 or P 〈0.01）. After seven years the body mass index, waist circumference and HOMA-IR were significantly increased and EDD was significantly decreased in non-weight reduction group than weight reduction group （P〈0.05 or P〈0. 01）. And compared with the original survey, HOMA-IR was significantly increased and EDD was significantly decreased in the non-weight reduction group （all P〈0. 05）, and there were no differences in HOMA-IR and EDD in weight reduction group. Conclusions Endothelial dysfunction may be one of etiological factors for overweight-related insulin resistance. The above two factors affect the validity of weight reduction.