肥胖人群血管内皮功能与心血管危险因素的关系研究

Seven-year follow-up study of relationship between endothelial function and risk factors of cardiovascular diseases in obese subjects

目的探讨血管内皮功能障碍与单纯肥胖人群心血管危险因素的关系。方法2000年对筛查出的单纯肥胖者(体质指数≥25kg/m2)进行内皮依赖性血管舒张(EDD)功能以及体质指数(BMI)、腰围、腰臀比、血压、血脂、空腹血糖、空腹胰岛素、胰岛素抵抗指数(HOMA-IR)等测定。7年后对上述人群进行随访,共随访到524例,其中男性356例,女性168例。结果EDD正常组基线时腰围、腰臀比、HOMA-IR高于EDD异常组(P<0.05或P<0.01),其余指标均差异无统计学意义。7年后随访,EDD正常组血压高于本组基线资料(P<0.05),其余指标差异无统计学意义。EDD异常组与本组基线时比较以及与EDD正常组随访时资料比较,腰臀比、收缩压、舒张压、胆固醇、甘油三酯、低密度脂蛋白胆固醇、空腹血糖、空腹胰岛素、HOMA-IR均显著升高(P<0.05或P<0.01),EDD显著降低(P<0.05)。多元逐步回归显示,腰臀比、收缩压、HOMA-IR与EDD关系最密切。结论本研究表明,血管内皮功能障碍是导致肥胖相关的心血管危险因素发生和聚集的重要原因,早期干预可能预防和延缓心血管疾病的发生。

Objective To investigate the relationship between endothelial function and risk factors of cardiovascular diseases in obese subjects. Methods A seven-year follow-up study was conducted in 524 subjects with simple obesity （ body mass index≥25 kg/m^2） in 2000. Before follow-up, the flow-mediated endothelium-dependent dilatation （EDD） function and other clinical metabolic parameters, such as body mass index （BMI）, waist circumference, waist-hip ratio, blood pressure, lipid pro- file, fasting blood glucose, fasting insulin and insulin resistance index （HOMA-IR） were measured. Results Waist circumference, waist-hip ratio and HOMA-IR were higher in normal EDD group than those in impaired EDD group （ P 〈 0.05 or P 〈0. 01 ）. No significant differences were seen in other parameters. After seven years, the blood pressure was increased from baseline in normal EDD group （ P 〈 0.05 ） , and there were no changes in other measured parameters. Waist-hip ratio, blood pressure, lipid profile （not including HDL-C ） , fasting blood glucose, fasting insulin and HOMA-IR were significantly increased （P 〈 0. 05 or P 〈0.01 ） and EDD was decreased （P 〈 0. 05 ） in impaired EDD group compared with baseline and follow-up values in normal EDD group. Multiple stepwise linear regression analysis indicated that waist-hip ratio, systolic blood pressure, and HOMA-IR were closely associated with EDD. Conclusion Endothelial dysfunction may be an important cause of obesity-related cardiovascular risk factors and early intervention of endothelial dysfunction may prevent or postpone the development of obesity-related cardiovascular diseases.