腹部脂肪分布与代谢综合征组分关系的研究

Relationships between the distribution of abdominal adipose tissue and the components of metabolic syndrome

目的探讨代谢综合征(MS)中各种代谢异常与腹部脂肪分布之间的关系.方法用螺旋CT 对MS(70例)、2型糖尿病(T2DM,16例)和高血压病(EH,22例)患者进行腹部脂肪扫描,测量患者腹内脂肪、腹壁脂肪含量,并计算二者比值(内/壁比),分析腹部脂肪与代谢综合征中各种代谢指标的相关关系.结果 MS组患者较EH组和T2DM组腹内脂肪面积(VA)显著增高(115.69±48.72cm2 vs 69.96±25.41cm2、55.96±29.75cm2,P均＜0.01).腹内脂肪含量与腹围、体重指数(BMI)、腰臀比、体脂比等均有相关关系,相关程度依次为腹围＞BMI＞腰臀比＞体脂比.不论是根据NCEP-ATPⅢ,还是亚太地区界定腹型肥胖的标准,腹型肥胖患者腹内脂肪面积均高于非腹型肥胖患者.腹内脂肪含量与血糖、总胆固醇、甘油三酯无显著相关,而与HDL-C呈负相关(r＝-0.202,P＝0.036),与LDL-C呈正相关(r＝0.297,P＝0.002);与收缩压及舒张压均有显著相关.腹内脂肪面积与胰岛素水平呈正相关,同时胰岛素抵抗患者的腹内脂肪面积和内/壁比均显著高于非胰岛素抵抗患者.腹内脂肪增加与其他心血管危险因素如C反应蛋白(CRP)、血清尿酸及血液流变学指标异常等均有显著相关性.结论腹内脂肪含量增加与代谢综合征及其各单一成分疾病密切相关,腹部脂肪堆积预示了心血管危险因素的增加.NCEP-ATPⅢ界定腹型肥胖的标准同样适用于中国重庆本地人群.

Objective To investigate the relationship between the distribution of abdominal adipose tissue and metabolic abnormality in the patients with metabolic syndrome （MS）. Methods 108 patients （MS 70 cases, essential hypertension （EH） 22 cases and type Ⅱ diabetes mellitus （T2DM） 16 cases） were enrolled in this study. The visceral adipose （VA） and subcutaneous adipose （SA） were measured with computerized tomography （CT）, the ratio of VA/SA was calculated and the correlation between them was analyzed. Results （1） The VA value in MS group was significantly higher compared to both T2DM and EH groups （P〈0. 01）. （2） There was a positive correlation between the area of VA and the abdominal circumference （AC）, BMI, waist-to-hip ratio （WHR） and the body fat ratio （BFR）, and the correlation coefficient were 0. 734, 0. 632, 0. 578 and 0. 323, respectively （P〈0. 05）. The area of VA in patients with abdominal obesity was greater than that of the patients without abdominal obesity （P〈0.05）. （3） The content of VA showed a positive correlation with LDL-C, systolic blood pressure and diastolic pressure, and a negative correlation with HDL-C （P〈0. 05）. No obvious correlation was found between VA and blood glucose, TC and TG. （4） The VA area correlated positively with the serum insulin level, and these patients showed higher insulin resistance;their VA/SA ratio was higher compared with patients without resistance （P〈0. 05）. （5） The increase in VA was remarkably correlated to the level of serum C reactive protein （s-CRP）, and also to serum uric acid. Conclusion VA accumulation is closely related to MS and diseases related with single MS component, and it is a risk factor of cardiovascular disease. The diagnostic criteria of NECP-ATP Ⅲ for abdominal obesity can also be adopted for Chongqing population.