单纯性肥胖者减重效果与血管内皮功能和胰岛素抵抗的关系

RELATIONSHIP OF WEIGHT REDUCTION WITH ENDOTHELIUM-DEPENDENT DILATATION AND INSULIN RESISTANCE IN OBESE PEOPLE

[目的]探讨血管内皮功能和胰岛素抵抗对减重效果的影响。[方法]274例单纯肥胖者经过12个月的强化生活方式减重干预,按照减重程度分为理想达标组(99例),一般达标组(128例)和未达标组(47例)。测量血管内皮依赖性舒张功能(EDD)、胰岛素抵抗指数(HOMA-IR)、体重指数、腰围、腰臀比、血压、血脂及空腹血糖。[结果]减重未达标组HOMA-IR和腰围、腰臀比高于减重达标两组(均P﹤0.05),而一般达标组又高于理想达标组(P﹤0.05)。EDD在3组无显著差异。减重干预后,减重达标两组EDD显著增加(均P﹤0.01),HOMA-IR明显降低(均P﹤0.05),体重指数、腰围、腰臀比、血压、总胆固醇、甘油三酯、空腹血糖也较减重前降低(P﹤0.05或P﹤0.01),上述指标在未达标组减重干预前后无差异。多因素Logistic回归分析结果显示HOMA-IR(OR=2.35)、腰围(OR=1.33)、腰臀比(OR=0.936)与减重效果相关。EDD对体重达标的影响低于前者。[结论]减重干预可显著改善血管内皮功能和胰岛素抵抗及各项代谢指标。胰岛素抵抗和腹部脂肪增多是影响减重效果的不利因素。

[Objective] To explore the effect of weight reduction on the endothelium-dependent dilatation （EDD）, insulin resistance （IR） in obese people. [Methods] 274 obese people received 12-week intense lifestyle intervention for weight reduction, and they were divided into achieving the opthnal criteria group （99 subjects）, the basic criteria group （128 subjects） and the no achieving criteria group （47 subjects） according to weight loss. EDD, HOMA-IR and other clinical metabolic parameters, such as body mass index, waist circumference, waist-hip ratio, blood pressure, lipid profile, fasting blood glucose were measured. [Results] HOMA-IR, waist circumference and waist-hip ratio of the no achieving criteria group were significantly higher than those of the two groups that achieving criteria in weight loss （ all P 〈 0.05 ）. and those indexes of the basic criteria group were significantly higher than that of the optimal criteria group （P 〈 0.05）. The EDD had no significant difference in three groups. After intense lifestyle intervention, the EDD was increased （all P 〈 0.01 ）, HOMA-IR was decreased （all P 〈 0.05）, and body mass index, waist circumference, waist-hip ratio, blood pressure, total cholesterol, triglyceride, fasting blood glucose in the two groups that achieving criteria of weight loss were significantly decreased （P 〈 0.05 or P 〈 0.01 ）, but the above parameters did not found significant different in the no achieving criteria group before and after weight loss. Logistic regression analysis showed that HOMA-IR （OR = 2.35）, waist circumference （OR = 1.33） and waist-hip ratio （OR = 0.936） were correlation with weight loss. But the EDD had smaller effect on the weight loss than the former indexes. [Conclusion] The intense lifestyle intervention for weight reduction can improve endothelial function and IR and many metabolic parameters in obese people. IR and visceral fat accumulation are disadvantage factors for weight reduction.