肥胖和MTHFR基因多态性与老年人体检结果的关系分析

Coloration between Obesity, MTHFR Gene Polymorphisms and Physical Examination Results of Elderly People

分析体质指数(BMI)/腰围(WC)及MTHFR基因C677T多态性与血糖、血脂、B超检查结果的关系,为防控老年肥胖相关慢性病提供参考.根据知情同意原则,随机从参加健康体检的老年人群中抽取238例,经问卷调查、体格检查、B超检查、测定空腹血糖、血脂,用PCR-RFLP方法分析80例对象的亚甲基四氢叶酸还原酶(MTHFR)基因多态性,用SPSS 22.0软件进行数据分析.研究对象超重肥胖率为52.1%,中心性肥胖率为53.4%,平均BMI为25.0 kg/m2,WC为82.2 cm,男性平均BMI、WC高于女性,差异均具有统计学意义(PBMI=0.025,Pwc=0.001).平均空腹血糖FPG为6.60 mmol/L,糖尿病(DM)检出率为15.1%,糖耐量异常检出率为21.4%;血脂异常总检出率为38.2%,其中,高胆固醇(TC)、高甘油三酯(TG)、高低密度脂蛋白胆固醇(LDL-C)、低高密度脂蛋白胆固醇(HDL-C)检出率分别为13.9%、11.3%、4.2%和8.8%;B超异常检出率为35.71%;MTHFR基因677位点突变率为57.5%.超重肥胖组、中心性肥胖组FPG、TG、HDL-C水平、DM检出率、糖耐量异常检出率、高TG率、低HDL-C率、血脂异常检出率、B超异常率、MTHFR基因突变率均高于正常组.其中,DM检出率、糖耐量异常率差异具有统计学意义(χ2=6.329,4.133,P=0.012,0.042).超重肥胖组男性DM检出率高于正常组(χ2=4.137,P=0.042).女性TC和HDL-C水平、高TC率、高LDL-C率、低HDL-C率均高于男性,差异有统计学意义(t=5.162,3.724,P<0.001,P<0.001;χ2=4.226,7.488,4.649;P=0.04,0.006,0.031).体重正常组女性血脂异常检出率高于男性(χ2=3.922,P=0.048).超重肥胖组、中心性肥胖组B超异常检出率均高于相应的正常组(χ2=5.704,4.795,P=0.017,0.029),女性差异有统计学意义(χ2=4.128,P=0.042).超重肥胖组、中心性肥胖组MTHFR突变基因型CT、TT、(CT+TT)频率均高于正常组.MTHFR基因C677/T突变基因型对象的血糖、血脂TC、TG和LDL-C水平及高DM、TG检出率、高LDL-C检出率均高于野生CC型.结论表明:研究对象超重肥胖率及相关的MTHFR基因突变率、高血糖、高血脂和B超检查结果异常检出率均较高,血糖、血脂和B超异常率随BMI、WC水平的升高、基因突变频率增加而趋向恶化,一些指标有性别差异,应采取综合措施进行肥胖及相关慢性病的防控,促进老年健康.

This paper analyzes the relationship between body mass index(BMI), waist circumference(WC), methylenetetrahydrofolate reductase(MTHFR) gene C677 T polymorphisms and blood glucose, blood lipids, and B-mode ultrasonography results, and provides reference for prevention and control of obesity-related chronic diseases. According to the principle of informed consent,238 patients were randomly selected from the elderly who participated in the physical examination. Data were collected from questionnaire, physical examination, B-mode ultrasonography examination, fasting blood glucose(FPG) and blood lipids determination, analyzing MTHFR gene polymorphism of 80 subjects by PCR-RFLP, and analyzed with SPSS 22.0 software. The total overweight and obesity rate was 52.1%, the upper body obesity rate was 53.4%, the average BMI was 25.0 kg/m2, WC was 82.2 cm, those of male were statistically higher than female(PBMI=0.025,Pwc=0.001). The average fasting blood glucose level was 6.60 mmol/L, the detection rate of diabetes and abnormal glucose tolerance, dyslipidemia was 15.1%, 21.4% and 38.2% respectively. The high TC, TG and LDL-C, detection rate was 13.9% and 11.3% and 4.2%, low HDL-C detection rate was 8.8%. B-mode ultrasonography abnormality rate was 35.71%, MTHFR gene 677 C/T mutant genotype frequency was 57.5%.FPG, blood lipid TG and HDL-C level, diabetes rate, abnormal glucose tolerance rate, high TG rate, low HDL-C rate, total dyslipidemia rate, abnormal B-ultrasonography rate and MTHFR gene mutation rate in overweight and obese group were higher than those of the normal group. The difference of diabetes rate and the abnormal rate of glucose tolerance were statistically significant(χ2=6.329, 4.133,P=0.012,0.042). For men, the rate of diabetes in the overweight and obese group was higher than that in the normal group(χ2=4.137,P=0.042). The dyslipidemia rate in women with normal weight was higher than that in men(χ2=3.922, P=0.048). The abnormal rate of B-mode ultrasonography in the overweight and obese group and the upper body obesity group were higher than that in the corresponding normal weight group(χ2=5.704,4.795,P=0.017,0.029). There was a statistically significant difference between the abnormal rate of B-mode ultrasonography in upper body obese women and normal women(χ2=4.128,P=0.042). The frequency of MTHFR mutation genotypes CT, TT,(CT + TT) in overweight obesity group and upper body obesity group were higher than that in normal group. The levels of blood glucose, TC, TG and LDL-C, the detection rates of high DM, TG and LDL-C in the C677/T mutant genotype of MTHFR gene were higher than those in the wild CC genotype. In conclusion, the average BMI of the subjects has reached the overweight range. The detection rate of overweight and obesity and the mutation frequency of obesity-related genes were all high. Abnormality of blood glucose, lipid and B-mode ultrasonography all deteriorated with the increase of BMI and WC levels and the frequency of gene mutations. There are differences in some indexes between the male and female. Comprehensive measures should be taken to prevent and control the obesity and related chronic non-communicable diseases to improve older people’s health.