肥胖人群糖脂代谢、体脂水平与胰岛素抵抗的关系

RELATIONSHIP AMONG GLUCOSE METABOLISM, LIPID METABOLISM,BODY LIPID AND INSULIN RESISTANCE LEVEL IN OBESE PATIENTS

目的观察肥胖人群糖脂代谢、体脂水平与胰岛素抵抗的关系。方法将社区人群中体重指数(BMI)>25kg/m2者96例纳入本研究,测量血压、身高、体重、腰围、臀围、体脂含量及重量,并抽血检测空腹及口服75g葡萄糖2h后血糖(FBS,2hPBS)、胰岛素水平(Fins,2hIns),采用稳态模型评估法(HO-MA)中的HOMA-IR公式评价胰岛素抵抗程度;空腹检测血脂、尿酸及糖化血红蛋白(HbAlc)水平。结果①本组肥胖人群64.0%存在胰岛素抵抗,糖、脂代谢异常,高血压和高尿酸血症者分别为31.2%、74.4%、44.8%及43.2%;②存在糖代谢异常者HOMA-IR和(或)2hIns、WHR、TG高于糖代谢正常组;血脂或尿酸水平异常者WHR大于正常组;高血压组HDL水平低于血压正常组;胰岛素抵抗组WHR、体脂重量、体脂含量、FBS、TC及BMI高于非胰岛素抵抗组;③HOMA-IR指数与体脂重量和TG呈正相关(r=0.448,p=0.000;r=0.411,p=0.000)。结论本组肥胖人群存在糖脂代谢异常、体脂水平增高及胰岛素抵抗,对于肥胖患者应尽早进行相关代谢指标的筛查。

Objective To investigate the relationship among glucose metabolism, lipid metabolism, body lipid and insulin resistance level in obese patients. Methods Ninety - six community subjects with BME （ body mass index） over25kg/m^2 were enrolled. Blood pressure, height, weight, waistline, hip circumference, body lipid proportion, body lipid mass, blood lipid, blood uric acid, glyeosylated hemoglobin （HbAlc） ,blood glucose and insulin level at fasting and 2 hours after taking 75g glucose were measured and homeostasis model assessment （HOMA） were chosen to evaluate insulin resistance level （ HOMA - IR）. Results （1）The prevalence of insulin resistance, abnormal glucose metabolism （AGM）, abnormal lipid metabolism, hypertension and hyperuricacidemia in this obese group were 64. 0% ,31.2% ,74. 4% ,44. 8% ,and 43.2% ,respectively. （2）Levels of HOMA - IR and （ or）2 h Ins , WHR, TG were higher in patients with AGM than in the normal ones. Those with lipid metabolism disorder or hyperuricacidemia have higher WHR value than the normal group while HDL levels were lower in hypertension group than the normal one. As for those with insulin resistance, the WHR, body lipid proportion, body lipid mass, FBS 2h PBS, TG and BMI were elevated than those without insulin resistance. （3）HOMA -IR index was positively correlated with body lipid mass and TG level, respectively （r =0,448, p =0. 000; r =0. 411, p =0. 000） Conclusion AGM abnormal lipid metabolism, elevated body lipid and insulin resistance exist in the obese group and screening for these disorders is necessary in obese patients .