代谢综合征与自由脂肪酸的关系

Association between the metabolic syndrome and free fatty acid

目的探讨代谢综合征及其不同组分与自由脂肪酸(free fatty acid, FFA)的关系.方法 1999年9月至10月,在北京市自然人群中采用分层随机抽样方法进行危险因素的横断面调查.分析了997名35～64岁男女两性的血浆FFA浓度与代谢综合征及其组分的关系.结果 (1)代谢综合征的患病率随着FFA的升高而升高.(2)采用多因素logistic回归调整了年龄、性别、吸烟、饮酒、体重指数(BMI)和胰岛素抵抗后,FFA四分位分层的第二、三、四层的OR值分别为3.1、3.1和4.1,均有统计学意义(P<0.01).(3)在相关分析中,FFA与甘油三酯(TG)、血糖、收缩压、舒张压和腰围的相关均有统计学意义(P<0.01),其中与TG的相关性最强,与血糖的相关性其次.FFA与高密度脂蛋白胆固醇(HDL-C)的相关无统计学意义.(4)用多因素logistic分析调整了BMI和胰岛素抵抗等因素后,FFA仍与代谢综合征5个组分中的腹部肥胖、高TG血症、高血压、高血糖4个组分相关,与低HDL-C血症的关系无统计学意义.(5)调整了FFA和BMI等因素的作用后,胰岛素抵抗也与代谢综合征及其5个组分中的腹部肥胖、高TG血症、高血糖和低HDL-C血症相关,而与高血压的关系无统计学意义.结论 FFA 与代谢综合征和代谢综合征5个组分中的腹部肥胖、高TG血症、高血压、高血糖4个组分均相关,提示FFA是代谢综合征的发病基础或危险因素之一.FFA和胰岛素抵抗可能通过不同的机制共同导致代谢综合征.

Objective To explore the association of free fatty acid （FFA） with the metabolic syndrome （MS） and its components. Methods A cross-sectional study on cardiovascular risk factors was carried out in a natural population of Beijing in 1999, recruited by a stratified-random sampling method. The association of FFA with MS and its components was analyzed in a sample of 997 subjects aged 35-64 years. Results （1） The prevalence of MS increased with FFA level. （2） After adjustment for age, sex, smoking, alcohol consumption, body mass index （BMI） and insulin resistance index using a multi-variable logistic regression, FFA was significantly associated with MS. The odds ratio （OR） for the second, third, and fourth quartiles of FFA was 3. 1, 3. 1 and 4. 1, respectively （ all P 〈 O. 001 ）. （3） FFA correlated significantly with triglycerides （TG）, glucose, systolic blood pressure, diastolic blood pressure, and waist circumference in the correlation analysis （all P 〈0. 001 ）. The strongest correlation was found between FFA and TG, but no significant correlation was found between FFA and high-density lipoprotein cholesterol （HDL-C）. （4） After adjustment for other factors in the logistic regression, FFA was significantly associated with central obesity, hypertriglyceridemia, hypertension, and hyperglycemia, but not with low HDL-C. （5） After adjustment for FFA, BMI and other factors, insulin resistance was also associated with central obesity, hypertriglyceridemia, low HDL-C, and hyperglycemia, but not hypertension. Conclusion FFA was associated with MS and four of the five components of MS, i.e. central obesity, hypertriglyceridemia, hypertension, and hyperglycemia. It is suggested that FFA be one of the underlying pathogenic factors or risk factors for MS. FFA and insulin resistance may lead to MS through different but synergetic mechanisms.