2型糖尿病患者体脂分布与胰岛素抵抗及下肢血管病变的关系

Body fat distribution and its relation with insulin resistance and lower extremity vascular disease in patients with type 2 diabetes mellitus

目的应用双能x线吸收法（DEXA）测量2型糖尿病患者体脂分布情况并分析其与胰岛素抵抗、下肢血管病变的关系。方法选取2010年12月至2011年5月山西省人民医院内分泌科住院或门诊收治的2型糖尿病患者123例作为观察组，测量其腰围、身高、体重、血压，使用DEXA测量躯干脂肪比例，检测空腹胰岛素（FINS）、空腹血糖（FPG）、总胆固醇（TC）、甘油三酯（TG）、低密度脂蛋白胆固醇（LDL-C）、高密度脂蛋白胆固醇（HDL-C）、糖化血红蛋白（HbAle），并与同期健康体检的112名健康人（对照组）做横断面对照。根据是否患有糖尿病和是否肥胖将总体对象分为4组：肥胖糖尿病组（DMOB组，78例，男41例，女37例）、非肥胖糖尿病组（DMNOB组，45例，男23例，女22例）、肥胖对照组（OB组，69名，男35名，女34名）及非肥胖对照组（NOB组，43名，男21名，女22名）。计量资料比较行独立样本t检验，采用多重线性回归分析评估腰围、体质指数（BMI）、躯干脂肪比例对稳态模型胰岛素抵抗指数（HOMA-IR）的影响。结果DMOB、DMNOB、OB、NOB组躯干脂肪比例分别为38％±4％、24％±6％、38％±5％、26％±6％。DMOB组HOMA-IR均较DMNOB、OB、NOB组显著增高，差异有统计学意义（分别为2．1±1．0、1．6±0．8、1．6±0．4、1．3±0．4，F=1．518，P〈0．05）；DMOB组收缩压（SBP）、舒张压（DBP）、TC、TG均较DMNOB组增高（t=2．173～3．058，均P〈0．05）。DMNOB组DBP、HbAlc、TC、TG及LDL-C均较OB及NOB组增高（F=0．569～47．704，均P〈0．05）。多重线性回归分析发现观察组BMI、躯干脂肪比例均为HOMA-IR的影响因素（OR=1．749、1．987，均P〈0．05）。Spearman相关性分析显示躯干脂肪比例、腰围、BMI、SBP、糖尿病病程、TG、LDL-C、HbAle、FPG、FINs、HOMA-IR与糖尿病患者下肢血管病变的严重程度呈正相关（r=0．232-0．470，均P〈0．05）。结论DEXA测量的躯干脂肪比例可评价腹型肥胖，其在一定程度上影响2型糖尿病患者胰岛素抵抗的程度，且与2型糖尿病患者下肢血管病变程度相关。

Objective To explore the value of dual energy X-ray（DEXA） in detection of body fat distribution of type 2 diabetic patients and to analyze the relationships of body fat distribution with insulin resistance and lower extremity vascular disease. Methods Total of 123 patients with type-2 diabetic mellitus treated in Shanxi People＇s Hospital from December 2010 to May 2011 were enrolled in this study as investigation group. Local trunk fat content （ Trunk% ） was measured by using DEXA. One-hundred and twelve healthy subjects receiving health examination in the hospital were enrolled as controls. The waist circumference, height, weight, blood pressure were measured in the two groups. Fasting insulin （FINS）, fasting plasma glucose （FPG）, total cholesterol （TC）, triglyceride （TG）, low density lipoprotein cholesterol （ LDL-C ）, high density lipoprotein cholesterol （ HDL-C ） and glyeated hemoglobin Ale （ HbA1 e ） were detected by enzyme-linked immunosorbent assay （ELISA） and automatic biochemical analyzer. Based on the state of diabetes and obesity, the subjects were divided into 4 groups： diabetic and obese group （DMOB group, n = 78, 41 males and 37 females） , non-obese diabetic group （DMNOB group, n = 45, 23 males and 22 females）, the obese control group （OB group, n = 69, 35 males and 34 females） and non-obese control group （NOB group, n = 43, 21 males and 22 females）. Measurement data was compared with two-tailed independent-samples t test, and multiple liner regression were used to evaluate the effects of waistline, body mass index （BMI） and trunk% on homeostasis model assessment of insulin resistance （HOMA-IR）. Results The trunk% of the DMOB, DMNOB, OB and NOB group were 38% ±4%, 24% ± 6%, 38% ± 5%, 26% ± 6%, respectively （ F = 28. 704, P 〈 0. 05）. The level of HOMA-IR in DMOB group was significantly higher than those in DMNOB, OB and NOB group （2. 1 ± 1.0, 1.6 ± 0. 8, 1.6± 0. 4 and 1.3 ±0.4,respectively; F = 1. 518, P =0. 000） ; the levels of systolic blood pressure（SBP）, diastolic blood pressure（ DBP）, TC, TG in DMOB group were significantly higher than those in DMNOB group （t = 2. 173 -3. 058; all P 〈0. 05）. And the DBP, HbAlc, TC, TG and LDL-C level in DMNOB group were significantly higher than those in OB and NOB group （ F = 0. 569 - 47.704, all P 〈 0. 05 ）. The multiple liner regression analysis suggested that BMI （ OR = 1. 749, P 〈 0. 05 ） and trunk% （ OR = 1. 987, P 〈 0.05） were influential factors of HOMA-IR. The Spearman analysis showed that trunk%, waist circumference, BMI, SBP, TG, LDL-C, HbAlc, FPG, FINS and HOMA-IR were positively correlated with lower extremity vascular disease in type 2 diabetic patients （ r = 0. 232 - 0. 470, all P 〈 0. 05）. Conclusion Trunk% measured by DEXA can be used to evaluate abdominal obesity, may influence insulin resistance in a certain extent and is related to the degree of lower extremity vascular diseases in type 2 diabetic patients.