中年人肥胖、胰岛素抵抗与血管内皮功能的关系研究

Relationship between obesity, insulin resistance and endothelial function in m iddle-aged persons

目的:对中年人体脂含量、分布及胰岛素抵抗(IR)与血管内皮功能的关系进行研究。方法:35～55岁无心血管疾病和代谢性疾病的健康体检者共609例,按照体重指数(BMI)分为超重组、肥胖组和正常体重组。应用血管外超声法监测肱动脉血管内皮功能,并测定体脂含量犤BMI、脂肪百分比(Fat%)和腰围(W)犦、分布,W与臀围比值(WHR)及HOMA胰岛素抵抗指数(HOMA-IR)。结果:中年肥胖者男性多为W和WHR增加,女性则多为Fat%增加。与正常体重组比较,超重和肥胖组血流介导的血管内皮依赖性舒张功能明显降低,HOMA-IR明显升高,男女之间差异无显著性。超重和肥胖者血流介导的血管扩张在男性中与Fat%(r=-0.221,P<0.001),W(r=-0.195,P<0.001)、WHR(r=-0.148,P<0.01)和HOMA-IR(r=-0.211,P<0.001)呈负相关;在女性中与BMI(r=-0.192,P<0.01)、Fat%(r=-0.287,P<0.001)和HOMA-IR(r=-0.236,P<0.01)呈负相关。硝酸甘油引起的血管扩张与上述指标无显著相关性(P均>0.05)。结论:血管内皮功能受损与男性体脂分布、女性体脂含量及IR密切相关。

Objective To study the impacts of adipose tissue depots and distribution, insulin resistance （IR） on endothelial function in the middle-aged. Methods Six hundred nine subjects, aged 35 ～ 55 years （male 328 and female 199）, with normal clinical and laboratory parameters were included in this study and divided into three groups, including overweight group, obese group and normal weight group. The flow-mediated endothelium-dependent dilation, body mass index （BMI）, waist circumference （W）, waist hip ratio （WHR） and IR index （HOMA-IR） were measured. The relationship of adipose tissue depots and IR with endothelial dysfunction was studied. Results The significant increase of W and WHR occurred in the male obese middle-aged, while he significant increase of fat percentage did in the female obese middle-aged. compared with normal weight group, flow-mediated dilatation was significantly impaired and HOMA-IR was increased in the overweight group and obese group. There was no significant difference between male and female. The flow-mediated dilatation in overweight or obese group were negatively correlated with Fat% （ r = - 0. 221, P 〈 0. 001 ）, W（r = - 0. 195, P 〈0. 001 ）, WHR（ r = - 0. 148, P 〈 0. 01 ） and HOMA-IR（ r = - 0.21 I, P 〈 0. 001 ） in male, and with BMI（ r = - 0. 192, P 〈 0. 01 ）, Fat % （ r = - 0. 287, P 〈 0. 001 ） and HOMA-IR（ r = - 0. 236, P 〈 0. 01 ） in female, nitroglycerin-induced dilatation was not correlated with parameters mentioned above. Conclusions Endothelial dyfunetion is cosely correlated with adipose tissue distribution in male and adipose tissue depots in female and IR.