随访肥胖人群中代谢综合征发生的相关因素分析

Analysis of risk factors of metabolic syndrome in obese subjects： a follow-up study

目的探讨影响随访肥胖人群代谢综合征（MS）发生的相关因素。方法研究对象来自2000年筛查出的413例单纯肥胖者（体重指数≥25kg/m^2）及196名正常体重的健康人，7年后对此人群的体脂、血压、血脂、血糖情况进行随访调查。并测定随访前后胰岛素抵抗指数和血管内皮功能。结果共随访到553例，其中单纯肥胖者381例（单纯肥胖组），正常体重者172名（正常体重组）。单纯肥胖组MS累积发生率35．17％，正常体重组MS累积发生率8．14％。单纯肥胖组有MS者与无MS者比较，基线时的腰围、腰臀比、甘油三酯、空腹血糖、空腹胰岛素、稳态模型评估的胰岛素抵抗指数（HOMA-IR）显著升高（均P〈0．05），内皮依赖性舒张功能（EDD）明显降低（P〈0．01）。正常体重组发生MS者的腰围、腰臀比、空腹胰岛素也高于未发生MS者（均P〈0．05），而EDD低于未发生者（P〈0．05）。Logistic回归分析显示，男性性别、腰围、腰臀比、空腹血糖、HOMA-IR和EDD是发生MS的危险因素。结论腹型肥胖、胰岛素抵抗和内皮功能障碍是MS发生的基本病因。

Objective To investigate the risk factors of metabolic syndrome （ MS ） in obese subjects. Methods A seven-year follow-up study was conducted in 413 simple obese subjects and 196 subjects with normal body weight who were recruited from community residents during physical examination in 2000. There was a 7 years follow-up. Antbropometrics, blood pressure, lipid profile, fasting blood glucose, and 2 h blood glucose after glucose loading were measured. Endothelium-dependent dilatation （ EDD ） test was also performed. Results Among 553 of 609 subjects who were followed up in 2007, there were 381 simple obese subjects（ simple obese group） and 172 normal weight subjects（ normal weight group）. Seven-year cumulative incidence of MS was 35.17% in simple obese group and 8. 14% in normal weight group. In simple obese group, subjects with MS showed greater or higher levels of waist circumference（WC）, waist-hip ratio （WHR）, triglyceride （TG）, fasting plasma glucose （FPG）, fasting insulin （FINS） ,and homeostasis model assessment for insulin resistance index （HOMA-IR） （all P 〈 0. 05 ）, and also decreased EDD（ P〈0. 05 ） as compared with those without MS. WC, WHR, and FINS were higher（ all P〈0. 05 ） and EDD was lower（ P〈0. 05 ） in subjects with MS of normal weight group than those without MS. Logistic analysis showed that the male gender, WC, WHR, FPG, HOMA-IR, and EDD were major risk factors of MS. Conclusion Central obesity, insulin resistance, and endothelial dysfunction are important independent risk factors for development of MS.