脾虚痰湿型、气滞痰阻型肥胖女性体脂与β细胞功能变化的关系

Relationship between Body Fat and β-cell Function in Obesity Women of Pi-deficiency with Phlegm-dampness Type and Qi-stagnancy with Phlegm-blocking Type

目的了解无糖尿病家族史、糖代谢正常的脾虚痰湿型、气滞痰阻型肥胖女性体脂改变及β细胞功能变化,分析两者之间的关系。方法60例入选对象按体重指数(BMI)分为非肥胖者和肥胖者,肥胖者按中医辨证分为脾虚痰湿型、气滞痰阻型。采用双能X线骨密度仪(DEXA)检测体脂,通过静脉葡萄糖耐量试验(IVGTT)评估急性相胰岛素分泌(AIR)、胰岛素曲线下面积(AUCins)、胰岛素曲线下面积/血糖曲线下面积(AUCins/AUCglu)等β细胞功能指标。结果与非肥胖者比较,脾虚痰湿型、气滞痰阻型肥胖者BMI、腰围(W)、脂肪含量增加,但两种证型肥胖者间BMI、W差异无统计学意义。与脾虚痰湿型肥胖者比较,气滞痰阻型肥胖者躯干、总体脂肪含量、躯干脂肪质量/总质量比增加,AIR、AUCins、AUCins/AUCglu亦明显增加。AIR、AUCins、AUCins/AUCglu与BMI、W、躯干和总体脂肪含量呈良好相关。多元线性回归分析显示躯干脂肪含量是影响AIR的重要因素。结论气滞痰阻型肥胖者具有更高的体脂(尤其是躯干脂肪)含量和伴胰岛素抵抗的AIR增加,该人群是临床干预的重点对象。

Objective To analyze the relationship between body fat and β-cell function in obesity women of Pi-deficiency with phlegm-dampness type（PDPD） and qi-stagnancy with phlegm-blcking type（QSPB）.Methods Sixty women,who had normal blood glucose level and without family history of diabetes,were enrolled.They were classified into non-obesity group and obesity group depending on their body mass index（BMI）,and subjects of obesity group were differentiated into the PDPD type and QSPB type according to Chinese medicine syndrome differentiation.The body fat was detected using double energy X-ray absorptiometry,and the β-cell function was assessed by measuring the acute insulin response（AIR）,the under insulin curve area（AUCins）,the under glucose curve area（AUCglu）,and their ratio（AUCins/AUCglu）,through intravenous glucose tolerance test（IVGTT）.Results BMI,body fat and waist circumference（Wf） were higher in obesity subjects than those in non-obesity subjects,but showed no significant difference between the two obesity types.Comparisons between obesity women of different types showed that the fat content of trunk and total body,the ratio of trunk fat/total mass,AIR,AUCins,and AUCins/AUCglu were all higher in QSPB than those in PDPD.AIR,AUCins,AUCins/AUCglu showed good correlation with BMI,Wf,trunk fat and total body fat contents.Multiple linear regression analysis demonstrated the increasing of trunk fat content was an influencing factor of AIR.Conclusion Obesity women of QSPB type possess higher body fat（especially the trunk fat） content and insulin resistance with high acute insulin response,so clinical intervention should dominantly pay attention to subjects with QSPB type of obesity.