腹型肥胖的类型与代谢综合征发生的风险

Relationship of different types of abdominal obesity to risk of metabolic syndrome

目的 探讨不同的腹型肥胖类型与代谢综合征（MS）发生风险的关系。方法 选择至少有一项心血管代谢危险因素的患者846例，应用CT测量腹壁和腹内脂肪面积，同时测量腰围、血压、空腹血糖、空腹胰岛素和血脂谱，按照是否腰围超标和合并内脏脂肪型肥胖（VFO）分为4个亚组：非肥胖组，隐性VFO组，假性VFO组和VFO组，比较不同腹型肥胖类型患者的MS风险。结果 （1）男性隐性VFO51例（10．9％）显著高于女性18例（4．8％）。（2）男性隐性VFO组MS罹患率22例（43．1％）显著高于非肥胖组47例（25．0％），低于假性VFO组37例（78．7％）和VFO组163例（88．6％）。假性VFO组MS罹患率显著高于非肥胖组和隐性VFO组。（3）女性隐性VFO组MS6例（33．3％）与非肥胖组48例（31．2％）差异无统计学意义，但显著低于假性VFO组74例（78．7％）和VFO组100例（90．9％）。假性VFO组的MS罹患率高于非肥胖组和隐性VFO组，与VFO组差异无统计学意义。（4）腰围增加和腹内脂肪堆积是发生MS的独立危险因素[OR1．13（1．10～1．17），1．01（1．01～1．02），P〈0．01]。结论 不同腹型肥胖类型对MS危险有显著影响，隐性VFO和假性VFO患者同样有较高的心血管代谢风险。

Objective To explore the relationship of different types of abdominal obesity to risk of metabolic syndrome （MS）. Methods Visceral fat area （VA） and substantial fat area （SA） were assessed by CT in 846 patients, 470 males and 376 females, aged 55±12, who suffered from at least one cardiometabolic risk factor and divided into 4 groups according to their VA and waist circumference （WC） ： non-obesity, masked visceral fat obesity （VFO）, pseudo-VFO, and VFO groups. Blood pressure, fasting blood glucose, fasting serum insulin, and lipid profile were also measured. The MS risks of different types of abdominal obesity were compared. Resets The prevalence rate of masked VFO of males was 10.9% （51/ 470） , significantly higher than that of female （4. 8%, 18/376）. The prevalence rate of MS of the male patients with masked VFO was 43. 1%, significantly higher than that of those in non-obesity group （25.0%）, and lower than those of the males in the pseudo-VFO group （78.7%） and in the VFO group （ 88.6% ）, whereas the MS prevalence rate of the males in the pseudo-VFO group was significantly higher than those in the non-obesity and masked VFO groups. On the other hand, the MS prevalence rate of the female patients with masked VFO was 33.3%, not significantly different from that of the female patients in the non-obesity group （ 31.2% ） , but significantly lower than those of the pseudo-VFO and VFO groups （78.7% and 90.9% respectively）. The MS prevalence rate of the female pseudo-VFO patients was also significantly higher than those in the non-obesity and masked VFO groups. Logistic regression analysis showed that WC and VA were independent risk factors for MS [ OR （95% CI） = 1.13 （ 1.10 - 1.17 ）, 1.01 （ 1.01 - 1.02）, respectively, P 〈 0.01 ）. Conclusion Different types of abdominal obesity have important impacts on the risk of metabolic syndrome. Masked VFO, even though with normal WC, and pseudo-VFO have considerably higher cardiometabolic risks.