体脂分布与代谢综合征、颈动脉内膜中层厚度及尿白蛋白排泄率

Body Fat Distribution and Metabolic Syndrome,Carotid Arterial Intima-media Thickness,Urinary Albumin Excretion Rate

目的探讨体脂分布特点与代谢综合征(MS)、颈动脉内膜中层厚度(IMT)及尿白蛋白排泄率(UAER)的关系。方法2006-2008年于我院行健康体检者182例为研究对象,未经降血糖、降血脂、利尿、降压、抗尿酸药物治疗。在脐水平测定腰围和CT测定内脏脂肪面积及体脂分布,多普勒超声心动仪测量颈动脉IMT,散射比浊法测定UAER。将研究对象分组为内脏型肥胖组[腰围≥90(男)或≥85cm(女),内脏脂肪面积≥100cm2,n=71)、皮下型肥胖组[腰围≥90(男)或≥85cm(女),内脏脂肪面积<100cm2,n=80]及正常对照组[腰围<90(男)或<85cm(女),n=31]。结果内脏型肥胖组MS发生率高于皮下型肥胖组(63.7%比31.9%,P<0.01)。内脏型肥胖组IMT高于皮下型肥胖组[(0.95±0.14)比(0.77±0.12)mm,P<0.05]与正常对照组[(0.71±0.13)mm,P<0.05]。内脏型肥胖组UAER高于皮下型肥胖组[(31.05±19.87)比(22.75±9.32)mg/24h,P<0.01]与正常对照组[(9.95±6.23)mg/24h,P<0.01]。皮下型肥胖组UAER高于正常对照组(P<0.05)。Spearman秩相关分析显示内脏脂肪蓄积随代谢综合征组分增加而增加(r=0.65,P<0.01)。Pearson直线相关分析显示内脏脂肪蓄积与IMT、UAER呈正相关(r=0.59,P<0.01;r=0.61,P<0.01);皮下脂肪蓄积与UAER呈正相关(r=0.53,P<0.05)。多元逐步线性回归分析显示内脏脂肪面积、高密度脂蛋白胆固醇(HDL-C)、收缩压及低密度脂蛋白胆固醇可用作IMT的解释变量;内脏脂肪面积、空腹血糖及HDL-C可作为UAER的解释变量。结论内脏型肥胖MS发生率高于皮下型肥胖,颈动脉IMT主要受内脏脂肪蓄积影响,UAER既受内脏脂肪影响也受皮下脂肪影响。

Objective To study the relationship between body fat distribution and metabolic syndrome （MS）, carotid arterial intima-media thickness （IMT）, urinary albumin excretion rate （UAER）. Methods A cohort of one hundred eighty-two subjects underwent annual health check-up and without any medication were enroIled. Waist circumference （WC） were measured and body fat distribution was measured by computed tomography （CT） scanning at umbilical level. Carotid artery IMT was measured by eehocardiography, and UAER was measured using nephe- [ometry. The suhiects were classified as visceral obesity （mate WC ≥90 cm and that of females ≥85 cm, and visceral fat area ≥100 cm2 , n=71）, subcutaneous obesity （male WC ≥90cm and that of females ≥85 cm, and visceral fat area 〈100 cm2 , n=80） and normal （male WC〈90 cm and that of females〈85 cm, n=31）. Results The incidence of MS in visceral obesity was significantly higher than that in subcutaneous obesity （63.7% vs 31.9%, P〈0.01）. Carotid artery IMT was higher in visceral obesity, compared with that in subcutaneous obesity [ （0.95±0.14） vs （0. 77±0.12） mm, P〈0.05] vs normal [（0.71±0.13） mm, P〈0.05]. UAER was higher in visceral obesity, compared with that in subcutaneous obesity [（31.05±19.87） vs （22.75± 9.32） mg/24 h, P〈0.0.1-1 vs normal I-（9.95±6.23） rag/24 h,. P%0.01]. UAER was higher in subcutaneous obesity, compared with that in normal （P^0.05）. Spearman＇s rank correlation analysis showed, the accumulatiom of visceral fat was elevated with increasing metabolic syndrome components （r= 0.65, P〈0.01）. Pearson linear correlation analysis showed that the accumulatiom of visceral fat was positively correlated with IMT and UAER （r= 0.59, P〈0.01; r=0.61, P〈0.01 ; respectively）, and subcutaneous fat also positively correlated with UAER （r=0.53, P〈0.05）. Stepwise multiple regression analysis showed that visceral fat area, HDL-C, SBP, LDL-C were predisposing risk factors fdr IMT, and visceral fat area, FBG, HDL-C for UAER. Conclusion Visceral obesity was associated with higher incidence rate of MS than that of subcutaneous obesity. Carotid artery IMT are more likely related to viscer- al obesity than that subcutaneous obesity. UAER were influenced concomitantly both by visceral and subcutaneous obesity.