单纯肥胖者与代谢综合征患者血管内皮功能的比较

Comparison of vascular endothelial function in simple obesity and metabolic syndrome patients

目的:比较单纯肥胖者与代谢综合征患者的血管内皮功能。方法:观察对象来自石家庄市2000-09/2001-06参加社区健康体检者。①体质量指数≥25kg/m2的超重/肥胖者中,单纯肥胖组295例,代谢综合征组219例,另选172例体质量指数<25kg/m2的健康人作为对照。②将肥胖者按体质量指数分为轻度肥胖(25～29.9kg/m2)和重度肥胖(≥30kg/m2),按腰围分为腹部脂肪轻度堆积(男<104cm,女<88cm)和重度堆积(男≥104cm,女≥88cm)。③血管内皮舒张功能测定:所有受试者采用NAS-1000HF彩超诊断系统测定反应性充血时及含服硝酸甘油后肱动脉内径的变化。结果:686例受试者全部进入结果分析。①单纯肥胖组和代谢综合征组体质量指数、腰围、臀围和腰臀比均高于对照组(P<0.01～0.001),其中体质量指数和臀围在男女间比较差异不显著,腰围和腰臀比男性高于女性(P<0.05),而男性代谢综合征组又高于男性单纯肥胖组(P<0.05)。②血管内皮舒张功能检测显示,反应性充血时,单纯肥胖组和代谢综合征组相对于基础血管内径变化的百分率均低于对照组[(7.79±3.93)%,(5.54±4.46)%,(11.25±3.98)%,P<0.05～0.01];代谢综合征组男性低于单纯肥胖组男性(P<0.05);男性代谢综合征组重度肥胖者低于轻度肥胖者(P<0.05);单纯肥胖组男性重度脂肪堆积低于男性轻度脂肪堆积者(P<0.05),代谢综合征组无论男女,重度脂肪堆积均低于轻度脂肪堆积者(P<0.05)。结论:①单纯肥胖者已存在血管内皮功能异常,而代谢综合征患者中内皮功能损伤程度更显著,并且与腹部脂肪堆积密切相关。②代谢综合征患者中男性血管内皮功能损伤较女性更明显。

AIM： To compare the vascular endothelial function in the patients with simple obesity （SO） and metabolic syndrome （MS）. METHODS： The trail enrolled the healthy examiners from the community of Shijiazhuang between September 2000 and June 2001. （1）There were 295 subjects with SO and 219 subjects with MS, which were stratified by body mass index （BMI） as light obesity group （BMI 25-29.9 kg/m^2） and serious obesity group （BMI ≥ 30 kg/m^2） and by mean of waist circumference （W） as abdominal adipose tissue light depot group （W 〈 104 cm in male and W 〈 88 cm in female） and serious depot group （W≥ 104 cm in male and W ≥ 88 cm in female）, and 172 health non-obesity subjects （BMI 〈 25 kg/m^2） were selected as controls.（2）Evaluation on vascular endothelial diastolic function： The caliber of brachial artery was measured during reactive hyperemia and after sublingual nitroglycerin by using NAS-1000HF color ultrasound system. RESULTS： Totally 686 testees were involved in the result analysis. （1）BMI, W, hip circumference and waist-hip ratio （WHR） were all higher in SO group and MS group than in control group （P 〈 0.01-0.001）. There were no significant difference in BMI and hip circumstance between male and female, but W and WHR were increased in male compared with female （P 〈 0.05）, and W and WHR of the male in MS group were higher than those in SO group （P 〈 0.05）.（2） Vascular endothelium diastolic function： The flow-mediated dilatation during reactive hyperemia was significantly impaired in the groups of SO and MS compared with control group [（7.79±3.93）%, （5.54±4.46）%, （11.25±3.98）%, P 〈 0.05-0.01], especially in male of MS group compared with SO group （P 〈 0.05）. The flow-mediated dilatation was decreased in serious obesity compared with light obesity （P 〈 0.05） in MS group, and in the male of abdominal adipose tissue serious depot compared with light depot （P 〈 0.05） in SO group. No matter male or female in MS group it was decreased in adipose tissue serious depot than in light depot （P 〈 0.05）. CONCLUSION： （1）Vascular endothelial function is abnormal in SO patients and significantly injured in MS patients, which is correlated with abdominal adipose tissue depots. （2）The vascular endothelial function is more obvious in MS male than in MS female.