肥胖伴内皮功能异常者胰岛抵抗与胰岛β细胞功能状况的研究(英文)

Study of insulin resistance and insulin secretion function in overweight and obese subjects with endothelial dysfunction

目的 探讨内皮功能障碍对肥胖者胰岛素抵抗 (IR)及胰岛 β细胞功能的影响。 方法 2 96例单纯肥胖者被分为内皮功能异常组 (A组 )与正常组 (B组 ) ,并从无内皮功能障碍的正常体重健康人中抽取 87例作为对照 (C组 )。测定体重指数 (BMI)、腰围 (W )、腰臀比 (WHR)、收缩压 (SBP)、舒张压 (DBP)、空腹血糖(FBG)和胰岛素 (FINS)、血脂、肌酐 (Cr)、尿酸 (Ur)及服糖后 2h血糖 (PBG)和胰岛素 (PINS)。采用稳态模式评估法 (HOMA)评价IR(HOMA -IR)和胰岛β细胞分泌功能 (HOMA -β)。 结果 A组和B组BMI、W、WHR、SBP、DBP、甘油三脂 (TG)和Ur均显著高于C组 (P <0 .0 0 1) ,而A组W、WHR、DBP、TG和Ur又较B组显著升高 (P<0 .0 5～ 0 .0 1)。A组FBG、FINS、HOMA -IR和HOMA -β也显著高于B组 (P <0 .0 5～ 0 .0 0 1) ,HOMA -β在B组与C组之间无显著差异。A组反应性充血时血管内径扩张与HOMA -IR和HOMA -β呈显著负相关 (P <0 .0 5～ 0 .0 1) ,在B组和C组则未见相关性。结论 内皮功能障碍引起的IR和 β细胞功能异常可能是促使心血管危险因素发生和聚集的重要原因。

Objective: To investigate the impacts of endothelial dysfunction on insulin resistance (IR) and insulin secretion function in overweight and obese subjects.Methods: 296 overweight and obese subjects were divided into impaired and normal endothelial function (A and B group, respectively). 87 normal weight and healthy subjects without endothelial dysfunction acted as normal control (C group). The body mass index (BMI), waist circumference (W), waist-hip ratio (WHR), SBP, DBP, fasting blood glucose (FBG), and insulin (FINS), postprandial 2h blood glucose (PBG) and insulin (PINS), lipid profile, creatnine (Cr) and uric acid (Ur) were measured. Homeostasis model assessment (HOMA) was applied to calculate HOMA-IR as an index of IR and HOMA-β as an index of beta-cell function. Results: BMI, W, WHR, SBP, DBP, TG and Ur in both A and B groups were higher than in C group ( P <0.05～0.001), and compared with Group B, W, WHR, DBP, TG and Ur in group A were significantly increased ( P <0.05～0.01), FBG, FINS, HOMA-IR and GOMA-β in group A were significantly higher than in Group B was similar to Group C in HOMA-β. The flow-mediated endothelium-dependent dilation in Group A was significantly higher than that in Group B ( P <0.05～0.001). Group B was similar to Group C in HOMA-β. The flow-mediated endothelium-dependent dilatation in Group A was significantly lower than that in latter two groups. The flow-mediated dilatation was closely negatively correlated with HOMA-IR and HOMA-β(γ=-0.197, P <0.05 andγ=-0.136, P <0.01) but there were no significant correlation in B and C groups.Conclusion: Endothelial dysfunction is an important risk factor affecting the clustering of cardiovascular risk factors, the occurring and developing of IR in overweight and obese subjects.