2型糖尿病体脂分布与臂踝脉搏波传导速度相关性研究

Association between body composition and brachial-ankle pulse wave velocity in type 2 diabetes mellitus patients

目的探讨2型糖尿病(T2DM)患者内脏脂肪及其他体成分与臂踝脉搏波传导速度(ba PWV)的关系。方法纳入于重庆医科大学附属第一医院内分泌科2013年7月至2014年12月资料完整的住院T2DM患者377例进行横断面分析,采用全自动动脉硬化检测仪测定ba PWV评估动脉僵硬度,采用双能X线吸收测量法(DEXA)进行人体成分测量。结果 ba PWV高值组(≥1800 cm/s)较低值组(<1800 cm/s)体脂率(P=0.014)、躯干/四肢脂肪百分比(P=0.047)、腹部脂肪面积(P=0.015)及内脏脂肪面积(P<0.001)更高,腿部瘦组织更低(P<0.001)。单纯内脏型肥胖组(体重指数<25,内脏脂肪面积≥100 cm^2)及超重或肥胖伴内脏型肥胖组(体重指数≥25,内脏脂肪面积≥100 cm^2)ba PWV水平均较对照组(BMI<25,内脏脂肪面积<100 cm^2)显著增高(P均<0.05)。多元线性回归在校正年龄、性别、糖尿病病程、高血压史、血脂、肾小球滤过率、高敏C反应蛋白后,腹部内脏脂肪面积(β=0.293,P<0.001)与ba PWV正相关,腹部皮下脂肪面积(β=-0.193,P=0.012)和腿部瘦组织(β=-0.219,P=0.002)与ba PWV负相关,其线性关系在校正收缩压和心率后减弱。结论 T2DM患者内脏脂肪蓄积与ba PWV增加相关,腹部皮下脂肪和腿部瘦组织增加可能是动脉弹性的保护因素,但年龄、收缩压及心率是ba PWV的独立影响因素。

Objective To investigate the association between brachial-ankle pulse wave velocity （baPWV） and body composition in patients with type 2 diabetes meUitus （T2DM）. Methods Totally 377 T2DM inpatients were recruited in this cross-sectional study. baPWV was detected by using an automatic device. Body composition was measured by using dual energy x-ray absorptiometry （DEXA）. Results Compared to the group with baPWV〈 1800cm/s, the group with baPWV≥1800cm/s had significantly higher total percent fat （P=0.014）, trunk limb fat mass ratio （P=0.047）, abdominal fat area（P=0.015）, visceral fat （P〈0.001） and significantly lower leg lean mass （P〈0.001）. Higher baPWV was found in simple visceral obesity group （BMI〈25, visceral fat≥100cm2） and overweight or obesity ＋ visceral obesity group （BMI≥25, visceral fat ≥ 100cm2） in comparison with the control group （BMI〈25 visceral fat 〈 100cm2） （P〈0.05）. After adjustment for age, gender, duration of diabetes, hypertension, lipid profile, eGFR and hsCRP in multiple linear regression analysis, visceral fat area（13=0.293, P〈0.001） was positively related to baPWV, subcutaneous fat area （β=-0.193, P=0.012） and leg lean mass （β=-0.219, P=0.002） were negatively related to baPWV, but the correlation between baPWV and body composition disappeared after adjustment for SBP and heart rate. Conclusion baPWV is associated with visceral fat accumulation in T2DM patients. Abdominal subcutaneous fat and leg lean mass may be protective factors for arterial elasticity. Age, SBP and heart rate are the independent factors for baPWV.