肥胖2型糖尿病患者腹腔内脂肪面积与胰岛素抵抗的相关性

Correlation between visceral fat area with insulin resistance in obese patients with type 2 diabetes mellitus

目的观察肥胖2型糖尿病患者腹腔内脂肪面积与胰岛素抵抗的相关性。方法 170例新诊断的肥胖2型糖尿病患者采用螺旋CT于空腹状态下行腹部扫描,扫描相当于腰椎4-5水平,选定脂肪组织CT值范围为(-250)-(-50)Hu,测定该横断面腹腔内上述CT值范围的像素面积和为腹腔内脂肪面积(VA),按腹腔内脂肪面积分为皮下脂肪型肥胖组(DM1:腹腔内脂肪面积<100 cm2,n=68,男性/女性=29/39),内脏脂肪型肥胖组(DM2:腹腔内脂肪面积≥100 cm2,n=102,男性/女性=41/61),收集患者体重、身高、腰围、血压、血脂、糖化血红蛋白、空腹血糖、空腹胰岛素、腹腔内脂肪面积、皮下脂肪面积等指标,计算稳态模型评估胰岛素抵抗指数、体重指数,比较两组间差异,并将腔内脂肪面积与HOMA-IR进行双变量分析及偏相关分析。结果 DM2组的体质量指数、腰围、收缩压、舒张压、糖化血红蛋白、稳态模型评估的胰岛素抵抗指数、总胆固醇、低密度脂蛋白胆固醇均高于DM1组,差异有统计学意义(P<0.05),双变量及偏相关分析显示腹腔内脂肪面积与HOMA-IR显著相关,且呈正相关(P<0.05),而与皮下脂肪面积无关。结论肥胖2型糖尿病胰岛素抵抗与腹腔内脂肪面积呈正相关,而与皮下脂肪面积无显著相关性。

Objective To explore the association of visceral fat area with insulin resistance in obese type 2 diabetic patients. Methods The abdominals of 170 newly diagnosed obese type 2 diabetic patients under fasting state were scanned by spiral CT at lumbar4- 5 level and in the range of fat area（- 250）-（- 50） Hu. The patients were divided into subcutaneous lard type obesity group（ DM1： visceral fat area 100 cm2,n = 68,the ratio of male to female of 29∶ 39） and visceral obesity group（ DM2： visceral fat area≥100 cm2,n = 68,the ratio of male to female of 41∶ 61） according to visceral fat area. The weight,height,waist circumference,blood pressure,blood lipids,glycosylated hemoglobin,fasting glucose,fasting insulin,abdominal fat area,subcutaneous fat area（ SA） were collected. The homeostasis model assessment insulin resistance index and body mass index were calculated and compared between two groups,and double variables analysis and partial correlation were applied to analyze the visceral fat area and HOMA-IR. Results The body mass index,waist circumference,systolic pressure,diastolic pressure,glycosylated hemoglobin,homeostasis model assessment insulin resistance index,cholesterol,low density lipoprotein in DM2 group were significantly higher than in DM1 group. Double variables analysis and the partial correlation showed that visceral fat area was positively correlated with HOMA-IR（ P〈0. 05）,but not with SA. Conclusion Insulin resistance in obese type 2 diabetes mellitus patients is positively correlated with visceral fat area but not with the subcutaneous fat area.