肥胖患者体脂分布与肾脏损害的关系

Relationship between body fat distribution and obesity-related glomerulopahty

目的:探讨肥胖患者体脂分布特点与肥胖相关性肾病(ORG)的发生及其进展中的关系。方法:对照研究30例经肾穿刺活检明确诊断的ORG患者和19例无肾脏损伤的单纯性肥胖患者,借助CT测量两组患者腹部脂肪的面积;采用B超测量肾周脂肪厚度,检测、记录胰岛素抵抗水平和肾小球滤过率以及体重指数、血脂等相关指标。并根据CT测定的内脏脂肪面积,将ORG患者分为3组,分别比较各组临床、病理和代谢异常的指标。结果:ORG患者全部(100%)表现为腹型肥胖,单纯肥胖患者中腹型肥胖仅占78·9%;前者内脏脂肪的面积约为后者的1·3倍。腹型肥胖导致ORG发生的风险是外周型肥胖患者的8·0倍。ORG空腹血糖(P<0·05)、胰岛素水平(P<0·05)和胰岛素抵抗水平(P<0·01)明显高于单纯肥胖患者。ORG总胆固醇水平高于单纯肥胖患者(P<0·05),但三酰甘油及高/低密度脂蛋白水平彼此间无明显差异。随着内脏脂肪面积的增大,ORG三组患者尿蛋白排泄量[(0·89±0·41),(1·47±0·69)和(2·25±1·23)g/24h]、局灶节段性肾小球硬化(40%,50%和100%)的比例明显增加(P<0·05,ANOVA)。与之相对应的是,肾小球滤过率、胰岛素抵抗程度亦随着内脏脂肪面积的增大而增加(P<0·05,ANOVA),脂质代谢差异不显著。C反应蛋白水平随内脏脂肪面积的增加有升高的趋势(P>0·05,ANOVA);而肾周脂肪厚度间无明显差别。结论:腹部脂肪的堆积不仅与ORG的发生,还与该病的进展密切相关。其中血流动力学异常和胰岛素抵抗可能起主要的作用。

Objective：To investigate the relationship between body fat distribution and renal function in patients with obesity-related glomerulopathy （ORG）. Methodology：This study included 30 renal biopsy-proven ORG patients and 19 controls （obese people with normal urinalysis）. Anthropometric parameters, serum insulin levels and lipids were determined,and all subjects were evaluated with abdominal uhrasonagraphy （US） and computed tomography （CT）. The ORG patients were subdivided into 3 groups according to the body fat patterns evaluated in CT scan. Central fat distribution pattern was defined as visceral fat area in CT scan ≥120 cm^2. Results：We found that all the ORG patients showed central fat distribution pattern as compared with 78.9% in obese subjects in the control group （ P 〈 0. 05 ）. The relative risk of ORG was 8.0 times greater in subjects with central pattern of obesity than in subjects with peripheral pattern of obesity. Meanwhile, patients with ORG had higher levels of fasting glucose （ P 〈 0. 05 ） , insulin （ P 〈 0. 05 ） and insulin resistance （P 〈0. 01 ） than the control. And the levels of total cholesterol in patients with ORG were higher that controls （P 〈 0. 05 ）, while the levels of triglyceride, high density lipoprotein and low density lipoprotein had no difference between two groups. Furthermore, ORG patients showed increased levels of proteinuria [ （0. 89 ± 0. 41 ） , （ 1.47 ± 0. 69 ） ＆ （ 2. 24 ± 1.22）g/24h] , more percentage of focal segmental glomerulosclerosis （40% , 50% ＆ 100% ） with an increase in visceral fat area（P 〈 0.05, ANOVA）. Meanwhile, glomerular filtration rate and insulin resistance increased（ P 〈 0. 05, ANOVA）,whereas lipid dysmetabolism did not, as the visceral fat area increased. Serum level of C reactive protein showed an upward increasing trend with the increment of visceral fat area, but without statistic significance. Conclusion：Central pattern of fat distribution is a risk factor for obese patients to develop renal impairment, and may contributes to further progression of ORG.