男性2型糖尿病患者体脂分布与心血管危险因素的关系

Correlation between fat distribution and cardiovascular risk in Chinese type 2 diabetes

目的探讨男性2型糖尿病患者体脂分布特点及其与心血管危险因素的关系。方法横断面研究,用CT测量91例男性T2DM患者腹壁皮下脂肪面积(SA)及腹腔脏器脂肪面积(VA),计算VA/SA(VSR)以及腹部总体脂量(TAF),同时检测代谢参数,计算BMI;对体脂参数与代谢危险因素行peanson相关分析、偏相关分析及多元逐步回归分析。结果 (1)相关分析结果显示,体脂分布与年龄无相关关系;无论BMI高低,其VSR均明显高于欧美肥胖人群和我国肥胖人群;内脏型肥胖的HbA_1c、TG、FFA水平高于皮下型肥胖组,FIns、FPG水平低于皮下型肥胖组,差异有统计学意义(P<0.05);(2)在校正年龄、糖尿病病程和BMI后,VA、SA和TAF均与FFA呈正相关,VSR与HbA_1c呈正相关;(3)BMI为影响DBP、UA、FIns的独立危险因素,影响SBP、TG、HDL-C的重要因素;TAF是影响2hFFA的独立危险因素;VA为影响FFA的独立危险因素;SA是影响FPG的独立危险因素;VSR是影响HbA_1c的独立危险因素。结论男性T2DM患者体脂分布以中心性肥胖、尤其是腹部内脏脂肪增加为特点;其心血管危险因素不仅与总体脂有关,更与体脂分布(腹型肥胖)有关。

Objective To investigate the characteristics of body fat distribution and its relationship with cardiovascular risks in Chinese type 2 diabetic patients. Methods Total body fat mass was evaluated using body mass index （BMI）. The ratio of the visceral（VA）to abdominal subcutaneous（SA） adipose area（VSR）was determined using a computed tomography （CT） scans at the level of L4/L5 in 91 Chinese type 2 diabetic patients. Blood pressure （BP） and cardiometabolic parameters were also determined. Results （1） Age had no relation with the body fat distribution. The VSR was significantly higher in Chinese type 2 diabetes than in non-diabetic subjects of obese Chinese and in obese European and American. （2） HbA1 c, TG and FFA0h were higher in patients with visceral fat obesity （VFO） than in those with subcutaneous fat obesity （SFO） ; Fins and FPG was lower in patients with VFO than in those with SFO（P〈0.05）. （3） After adjustment for age and diabetes duration, BMI was positively correlated with SBP, DBP, Fins, UA, FFA and TG, and negatively correlated with HDL-C and FPG. TFA, SA and VA were negatively correlated with FPG and HDL-C, and positively correlated with Fins, FFA, 2hFFA and TG. After adjustment for age, diabetes duration and BMI, TFA,SA and VA were positively correlated with FFA,and VSR was positively correlated with HbA1 c. （4） Stepwise multiple regression analysis showed that BMI was an independent predictor for DBP, UA and Fins （P= 0. 004, 0.001,0. 000, respectively）, and was an important predictor for SBP, TG and HDL-C （all P=0. 000）. TFA was an independent predictor for 2hFFA （P= 0. 021）. VA was an independent variable associated with FFA （P=0. 000）. SA was an independent predictor for FPG （P=0. 004）; VSR was an independent predictor for HbA1 c（P=0-020）. Conclusions Chinese type 2 diabetic male patients show central obesity. The cardiovascular risk factors are associated not only with the total body fat mass but also with regional body fat distribution.