内脏脂肪指数对成人生长激素缺乏症患者代谢综合征的评估作用研究

Value of Visceral Adiposity Index in Predicting Metabolic Syndrome in Adult Growth Hormone Deficiency

目的探讨内脏脂肪指数(VAI)对成人生长激素缺乏症(AGHD)患者代谢综合征(MS)的评估作用。方法选取2015年1月—2016年1月在重庆医科大学附属第一医院确诊2年及以上的AGHD患者66例为AGHD组;选取同期在本院体检中心进行体检的健康人群66例为对照组。并根据VAI三分位数将AGHD患者分为3组:低VAI组(n=22)、中VAI组(n=22)、高VAI组(n=22)。测量所有受试者身高、体质量、腰围(WC)、臀围(HC)、血压〔收缩压(SBP)、舒张压(DBP)〕等;测定空腹血糖(FPG)、空腹胰岛素(FINS)、血脂〔包括总胆固醇(TC)、三酰甘油(TG)、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)〕水平;计算BMI、腰臀比(WHR)、稳态模型评价的胰岛素抵抗指数(HOMA-IR)及VAI。通过绘制受试者工作特征(ROC)曲线,计算ROC曲线下面积(AUC),分析VAI的评估作用。结果 AGHD组中男21例,女45例;对照组中,男21例,女45例。两组受试者年龄、身高、SBP、DBP、FPG、TC、LDL-C间差异无统计学意义(P>0.05),而体质量、BMI、WC、HC、WHR、FINS、TG、LDL-C、HDL-C、VAI、HOMA-IR间差异有统计学意义(P<0.05)。不同VAI患者性别、年龄、身高、WHR、FINS、TC、LDL-C间差异无统计学意义(P>0.05);而体质量、BMI、WC、HC、SBP、DBP、FPG、TG、HDL-C、HOMA-IR及MS发生率间差异有统计学意义(P<0.05)。年龄调整前后,VAI与WC、DBP、FPG、TG均呈正相关(P<0.05),与HDL-C呈负相关(P<0.05),与SBP无相关性(P>0.05)。VAI评估AGHD患者MS的AUC为0.871〔95%CI(0.788,0.954),P<0.001〕,最佳临界值为1.9,灵敏度为0.960,特异度为0.610。结论 VAI可作为AGHD患者MS的筛查与评估手段。

Objective To investigate the value of visceral adiposity index（VAI） in predicting metabolic syndrome（MS） in adult growth hormone deficiency（AGHD）. Methods From January 2015 to January 2016,we selected 66 patients diagnosed with AGHD 2 or over 2 years ago in the First Affiliated Hospital of Chongqing Medical University,and 66 controls underwent physical examination in Medical Examination Center in the hospital during the same period as the AGHD group and the control group,respectively. The AGHD group was further assigned to 3 groups,low-VAI subgroup,middle-VAI subgroup and upper-VAI subgroup with 22 patients in each based on the VAI tertile value. We measured all the subjects＇ height,weight,waist circumference（WC）,hip circumference（HC）,blood pressure 〔systolic blood pressure（SBP） and diastolic blood pressure（DBP） 〕, fasting plasma glucose（FPG）, fasting insulin（FINS）, blood lipid 〔total cholesterol（TC）,triacylglycerol（TG）,low-density lipoprotein cholesterol（LDL-C） and high-density lipoprotein cholesterol（HDL-C） 〕.Body mass index（BMI）,waist-hip ratio（WHR）,homeostasis model assessment of insulin resistance（HOMA-IR） and VAI were calculated. The value of VAI in the prediciton of MS in AGHD was explored by analyzing the calculated area under curve（AUC） of receiver operating characteristic（ROC） curve. Results Both the AGHD group and the control group had the same number of males（21） and females（45）. The differences in terms of age,height,SBP,DBP,FPG and TC between the AGHD group and the control group were not statistically significant（P〈0. 05）. Compared with those in control group,weight,BMI,WC,HC,WHR,FINS,TG,LDL-C,VAI,and HOMA-IR were increased in AGHD group,while HDL-C was lower in AGHD group（P〈0. 05）. There were no prominently statistical differences in sex,age,height,WHR,FINS,TC and LDL-C between the low-VAI subgroup, middle-VAI subgroup and upper-VAI subgroup（P〈0. 05）, while notable differences were observed in weight, BMI, WC, HC, SBP, DBP, FPG, TG, HDL-C, HOMA-IR and incidence of MS between the 3 subgroups（P〈0. 05）. VAI was positively correlated with WC, DBP, FPG, and TG（P〈0. 05）, but negatively associated with HDL-C（P〈0. 05）,and it had no relation with SBP（P〈0. 05） no matter adjusting for age or not. Results of ROC curve analysis showed that VAI was a significant discriminator for MS in AGHD patients,the AUC of VAI was 0. 871 〔95% CI（0. 788,0. 954）,P〈0. 001 〕,the optimal critical value was 1. 9,the sensitivity was 0. 960,and the specificity was 0. 610. Conclusion VAI is significantly correlated with MS in AGHD patients,which can be a reliable diagnostic method for MS in AGHD patients.