单纯性肥胖人群血管内皮功能与糖代谢异常的相关因素研究

Prospective Investigation on the Relationship of Endothelial Function and Impaired Glucose Regulation in Obese Subjects

【目的】探讨肥胖人群血管内皮功能与高血糖发生的相关因素。【方法】研究对象来自2000-2001年筛查出的383例单纯性肥胖者（体重指数≥25kg／m2），测定体重、腰臀比、血压、空腹血糖、空腹胰岛素、餐后血糖、HOMR-IR、血管内皮依赖性舒张功能（EDD）等，根据血管内皮功能进行分组，7年后对此人群进行随访调查，并复查上述指标。【结果】共随访到346例。单纯肥胖者合并血管功能异常者，基线时空腹血糖（FPG）、空腹胰岛素（Fins）、HOMA—IR显著升高（均P〈0．05），而EDD较前显著减低（Pd0．05），7年随访糖代谢异常累积发生率48％，显著高于血管内皮功能正常者，Logistic回归分析显示，EDD与HOMR—IR、WHR、FBG、SBP、HDL-C均显著相关。【结论】血管内皮功能不全可能是肥胖高血糖早期原发表现，在糖尿病发生、发展过程中起重要作用。

[Objective]To investigate the relationship of endothelial function and impaired glucose regulation （IGR） in obese subjects. [Methods] A seven-year follow-up study was conducted in 383 simple obese subjects（BMI ≥25kg/m2）who were chosen in 2000-2001. All of them were divided into two groups relying on endothelium dependent dilatation（EDD）. Before and after follow-up adiposity, weight, waist-hip ratio （WHR）, blood pressure, lipid profile, fasting plasma glucose （FPG）, fasting insulin （Fins） and 2h blood glucose（2hPG） after glucose loading were measured, while insulin resistance index （HOMA-IR） and EDD were calculated. [Results] A total of 346 sub- jects were followed up in 2007. Seven-year cumulative incidence of IGR was 48%, while the incidence of diabetes mellitus（DM） was 16.8% in obese subjects with EDD, which was obviously higher compared with obese subjects without EDD. The FPG, Fins and HOMA-IR were significantly increased （all P〈0.05） and EDD was decreased （ P 〈0.05 ） in obese subjects with EDD compared with obese subjects without EDD. Logistic analysis showed that EDD was closely related to HOMR-IR, WHR, FBG, SBP and HDL-C. [Conclusion]EDD may play an important role in the genesis and development of DM in obese subjects.