CT测量腹内脂肪面积／皮下脂肪面积在评价胰岛素抵抗中的价值

Value of the ratio of the area of intraabdominai adipose to that of subcutaneous adipose measured by CT in evaluating insulin resistance

目的探讨CT测量腹内脂肪而积／皮下脂肪而积在评价胰岛素抵抗中的价值。方法选择以腹型肥胖为特征的血糖正常者35例（A组），糖耐量异常或空腹血糖受损及空腹血糖〈10mmol／L的糖尿病患者65例（B组），测量或计算两组患者腰围、臀围、腰臀比、体重指数（BMI），采用螺旋CT取仰卧位屏气状态下在脐平面进行扫描，测量腹内脂肪面积和皮下脂肪面积，并计算二者的比值；采空腹血测定空腹血糖、空腹胰岛素（FINS）、空腹C肽、三酰甘油（TG）、高密度脂蛋白-胆固醇（HDL-C）、低密度脂蛋白-胆固醇（LDL-C），用稳态模型评估2法计算胰岛素抵抗指数（HOMA2-IRI）。结果腹内脂肪面积和腹内脂肪面积／皮下脂肪面积在B组[（130．30±43．79）cm^2和0．98±0．36]均明显高于A组[（101．90±44．45）cm^2和0．60±0．32]，差异有统计学意义。当腹内脂肪面积／皮下脂肪面积≥0．60时，采用Pearson相关分析，lnHOMA2-IRI与腹内脂肪面积／皮下脂肪面积的相关系数为0．802（P〈0．01）。结论腹内脂肪过度堆积是胰岛素抵抗的重要标志之一，腹内脂肪面积／皮下脂肪面积≥0．60则提示存在明显的胰岛素抵抗，但〈0．60不能说明无胰岛素抵抗。

Objective To study the value of the ratio of the area of intraabdominal adipose to that of subcutaneous adipose （I/S ratio） measured by CT in evaluating insulin resistance. Methods Thirty-five cases with normal glucose tolerance which characterized in abdominal obesity （group A ）, and 65 cases with impaired glucose tolerance, impaired fasting blood glucose （FBG） or diabetic state with FBG 〈 10 mmol/L （group B ） were selected. The facility index of obesity was measured, which included waistline, hip circumference,waist-to-hip ratio （WHR） and body mass index （BMI）. Spiral CT was used to scan the vertebral body of umbilical plane in breathholding state, measured the area of intraabdominal and subcutaneous adipose,and applied professional software to calculate I/S ratio. Blood samples were collected to test the FBG, fasting insulin （FINS）,fasting C peptide,triacylglycerol （TG）,high density lipoprotein-cholesterol （HDL-C）and low density lipoprotein-cholesterol （LDL-C）. HOMA2 was applied to calculate the index of insulin resistance （HOMA2-1RI）. Result The area of intraabdominal adipose and US ratio of group B [ （ 130.30 ± 43.79 ）cm^2 and 0.98± 0.36 ] increased significantly, compared with that of group A [ （ 101.90 ± 44.45 ）cm^2 and 0.60 ± 0.32]. The correlation coefficient of lnHOMA2-1RI and I/S ratio by Pearson correlation analysis was 0.802（P 〈 0.01 ）,when I/S ratio 〉10.60. Conchtsion The overloaded stacking of intraabdominal adipose is an important mark of insulin resistance. When I/S ratio ≥0.60,it indicates an evident insulin resistance. But US ratio 〈 0.60 dose not denote no insulin resistance.