腹部脂肪体积与代谢综合征组分及其肾损害

The Relationship Between Volume of Abdominal Adipose and the Components of Metabolic Syndrome and Renal Damage

目的明确腹部脂肪体积与代谢综合征(MS)组分及其肾损害的关系。方法用64排CT对MS(42例)、2型糖尿病(T2DM,7例)和原发性高血压(EH,21例)患者进行腹部脂肪扫描,应用64排CT测量患者脐上下2.5cm腹部脂肪体积、内脏脂肪体积和腹壁脂肪体积,并计算二者比值(内/壁),同时检测内脏脂肪面积、腹壁脂肪面积及腰围、血压、空腹血糖、空腹胰岛素、血脂和尿微量白蛋白,分析腹部脂肪体积和面积与MS中各种代谢指标和肾损害的相关性。结果MS组腹部脂肪体积和内脏脂肪体积较EH组和T2DM组显著增高(均P<0.05),而腹壁脂肪体积仅高于EH组(P<0.05),EH组与T2DM组间无明显差异。MS组内脏脂肪面积较EH组和T2DM组显著增高(P<0.01或<0.05)。腹部和内脏脂肪体积与内脏脂肪面积、腰围、体质量指数(BMI)、腰臀比均高度相关(P<0.01或<0.05);相关程度依次为内脏脂肪面积>腰围>BMI>腰臀比。腹部脂肪体积还与游离脂肪酸(FFA)、尿酸(UA)、三酰甘油(TG)和空腹胰岛素(FINS)呈正相关(P<0.01或P<0.05),而内脏脂肪体积与FFA中度相关和TG呈微弱正相关(相关系数分别为r=0.582和r=0.271,P<0.01或P<0.05),并与高密度脂蛋白胆固醇(HDL-C)呈负相关(r=-0.267,P<0.05)。与腹部体积相比,内脏脂肪面积仅与FFA呈弱正相关(r=0.283,P<0.05),内脏脂肪面积/腹壁脂肪面积比值与TG呈弱正相关(r=0.332,P<0.05)。脂肪体积和面积均与血压无显著相关。内脏脂肪体积与24h尿微量白蛋白排泄率也只呈弱正相关(r=0.252,P<0.05)。结论腹部脂肪堆积预示心血管危险因素的积聚,与内脏脂肪面积相比,内脏脂肪体积较内脏脂肪面积与MS组分及其早期肾损害相关性更好。

Objective To evaluate the volume of abdominal adipose in relative to the components of metabolic syndrome（MS） and renal damage. Methods Forty-two cases with MS, 21 cases with essential hypertension（EH） and 7 cases with type 2 diabetes mellitus（T2DM） were enrolled. Abdominal adipose were measured with 64 slice three-dimensional computerized tomography （CT） obtianing indices： volume of abdominal adipose （VAAI, volume of visceral adipose （VVA） and volume of subcutaneous adipose （VSA）. Visceral adipose area （VA） and subcutaneous adipose area （SA} were determined. Urinary albumin excretion rate （UAE） was assessed. Results VAA and VVA ranging within 2.5 cm of the umbilicus in MS group were significantly higher compared with those in T2DM and EH groups （P〈0.05）, VSA in MS group was only significantly higher than that in EH group（P〈0.01 or P〈0.05）, there was no difference between EH and DM patients. There was a positive correlation between VAA and VA, abdominal circumference （ACI, body mass index （BMI）, and waist to hip ratio （WHR）（r=0. 859, 0. 824, 0. 782, 0. 667, 0. 494, respectively, P〈0.01）, VVA also weakly related with free fatty acid （FFA） （r=0. 283, P〈0.05） and triglyeeride （TG） （r=0. 332, P〈0.05）, but negatively with high density lipoprotein cholestrol （HDL-C） （r=-0.267, P〈0.05）. VVA weakly related with urine albumin excretion（r=0. 252,P〈0.05 ）. Conclusion Accumulation of abdominal adipose is associated with clustering of multiple cardiovascular factors. Volume of visceral abdominal adipose might be a better index than viseral area related to MS and its renal damage.