脂代谢紊乱对肥胖人群胰岛素抵抗的影响

Effect of Lipotoxicity on Insulin Resistance in Obese Population

目的探讨脂代谢紊乱对肥胖人群胰岛素抵抗（IR）的影响。方法将106例入选者按照体质指数（BMI）的不同分为体重正常组（BMI 18．5—24．9kg／m^2）、超重组（BMI25．0—27．0kg／m^2）和肥胖组（BMI〉27．0kg／m^2），做口服葡萄糖耐量试验（OGTT），测定空腹及服糖后2h血糖（FBG、2hBG），同时测定空腹及服糖后2h真胰岛素（FTI、2hTI）、空腹胆固醇（TC）、三酰甘油（TG）、高密度皮脂蛋白（HDL）、低密度脂蛋白（LDL）、游离脂肪酸（FFA）、瘦素（Lep）、肿瘤坏死因子-α（TNF-α），计算胰岛素抵抗指数（HOMA—IR），并对有些数据做相关分析。结果超重组TG、FFA、Lep、TNF-α、FTI、2hBG水平及HOMA—IR高于体重正常组但低于肥胖组（P〈0．05）；超重组与肥胖组之间TC、LDL水平差异无显著性意义（P〉0．05），但均高于正常组（P〈0．05）；正常组FBG、HDL水平分别低于和高于肥胖组（P〈0．05），但与超重组差异无显著性意义（P〉0．05）；TG与FFA、Lep与FFA、Lep与TNFα、TNFα与FFA之间均呈正相关（r=0．62、0．49、0．41、0．54，P〈0．01）；FFA、Lep、TNFα、腰臀围比值（WHR）与HOMA—IR独立相关（F=242．1，偏回归系数分别为1、55、1.69、1．02、0．03。P〈0．05）。结论脂代谢紊乱是引起肥胖人群IR的重要因素之一。

Objective To investigate the effect of lipotoxicity on insulin resistance in Obese Population. Methods 106 examinees were divided into normal weight group, overweight group and obese group according to their body mass index （BMI） , plasma glucose and insulin were determined in the fasting and 2 hours blood samples during oral glucose tolerance test （ OGTT）, Total cholesterol （TC） triglyceride （TG） high density lipoprotein （ HDL）, low ensity lipoprotein （LDL）, free fatty acid （FFA）, leptin （Lep） and tumor necrosis factor alpha （TNF -α） were also determined in the fasting status. Homeostasis model assessment was applied to estimate insulin resistance （ HOMA - IR）, correlation analysis was performed between HOMA - IR and other related parameters. Results The levels of TG, FFA, Lep, TNF -α, fasting true insulin （ FT1）, 2 hour true insulin and blood glucose after glucose intake （2hTI, 2hBG） and HOMA - IR in overweight group were higher than those in normal weight group but lower than those in obese group （ P 〈0. 05） ; There were no significant difference in the levels of TC and LDL between overweight group and obese group （ P 〉 0. 05 ）, but the levels of these indicators in these two groups were higher than those in normal weight group （ P 〈 0. 05） ; The levels of FBG and HDL in normal weight group were lower and higher than those in obese group respectively （ P 〈 0. 05 ）, but there were no marked difference as compared with overweight group （ P 〉 0. 05） ; Positive correlation was found between the levels of TG and FFA, Lep and FFA, Lep and TNF -α, TNF -α andFFA （r =0.62, 0.49, 0.41 and 0.54,P 〈0.01）; The FFA, Lep, TNF-αandwaist/hipratio （WHR）wereindependently correlated with HOMA - IR. Conclusion Lipotoxieity is one of the important, factor resulting in IR in obese population.