腹内脂肪面积切点与代谢综合征临床检出率的关系

Relationship between visceral adipose tissue and prevalence of metabolic syndrome (MS ) in patients with MS, and hypertension and/or diabetes

目的探讨估测代谢综合征(MS)的腹内脂肪面积(VA)的切点,以及VA与代谢综合征检出率的关系。方法应用螺旋CT检测了564例代谢综合征、糖尿病和高血压病病人的腹内脂肪面积;分别应用ROC工作曲线和四分位法分析估测代谢综合征及其组分的VA临界点和该临界点所对应的简易体脂参数包括,体重指数(BMI)、腹围(WC)和腰臀比(WHR),以及不同VA面积下的代谢综合征的检出率。结果(1)女性病人出现血脂紊乱、腹型肥胖和代谢综合征时VA集中在70- 72 cm2之间,而男性病人出现以上代谢紊乱时VA多在91-107 cm2之间,未找到高血糖和高血压相应的VA切点。(2)罹患代谢紊乱时,女性腹围在82-84 cm之间,BMI在24-25 kg/m2之间;男性腹围在89 cm左右,BMI在25 kg／m2左右。(3)男性VA在70 cm2、71-101 cm2、102-133 cm2、≥134 cm2时代谢综合征检出率分别为16．9％、49．4％、72．7％和87．5％,VA≥70 cm2时代谢综合征检出率显著增高(P<0．01);女性VA在<55 cm2、55-84 cm2、85-104cm2、≥105 cm2时代谢综合征检出率分别为7．7％、44．0％、67．2％和87．5％,VA≥55 cm2时代谢综合征检出率显著增高(P<0．01)。结论代谢综合征病人腹内脂肪的堆积有性别差异;在临界超重或超重阶段,即已出现腹内脂肪堆积及各种代谢紊乱的聚集;随着腹内脂肪含量的增加,代谢综合征的临床检出率显著升高。

Objective To investigate the relationship between the visceral adipose （VA） accumulation and the prevalence of metabolic syndrome （MS） in patients with MS, and hypertension and/or diabetes. Methods VA area was measured by computed tomography （CT） in 564 patients with with MS, and hypertension and/or diabetes, 308 males and 256 females. Body mass index （BMI） , waist circumference （WC） and waist-to-hip ratio （WHR） were assessed. Receiver operating characteristic （ROC） curve was used as index for analysis. Results （ 1 ） The VA of the patients with MS was 116 cm^2 ± 38 cm^2 , significantly higher than those of the patients with hypertension and diabetes （72 cm^2 ± 34 cm^2 and 64 cm^2±34 cm^2 respectively, both P 〈0.01 ）. ROC curve analysis showed that the optimal cut-off points of VA for hypertriglyeeridemia, hypo-high density lipoproteinemia, abdominal obesity and MS was 91 ～ 107 cm^2 for men ; and 70 ～ 72 cm^2 for women. （2） The anthropometric parameters to the corresponding optimal cut-off points of VA were as follow： BMI, WC, and WHP were 25 kg/ m^2 , 89 cm , and 0.95 ～ 0.96 for men; and 24 ～ 25 kg/ m^2, 82 ～ 84 cm, and 0.91 for women. Both the cut-off points of VA in assessing hyperglycemia and in assessing hypertension could not be found out. （3） The prevalence of MS was significantly increased when VA ≥55 cm^2 in women and when VA ≥70 cm^2 in men respectively. Conclusion There is a gender difference in the accumulation of the VA tissue. Even in the subjects with overweight, abdominal obesity and dysmetabolism have appeared in patients . The prevalence of MS is significantly increased with the intra-abdominal fat accumulation.