代谢正常型肥胖患者临床特点及发生糖脂代谢异常的风险分析

Clinical characteristics of metabolically healthy obese individuals and risk analysis of progression into abnormal glucose and lipid metabolism

目的分析代谢正常型肥胖患者的临床特点，并评估3年后发生糖脂代谢异常的风险。 方法回顾性分析本院于2012年2月至2015年8月对济宁市社区居民进行的流行病学调查资料，纳入数据完整者3 766人，其中筛选出代谢正常人群875人，再分为代谢正常型肥胖（MHO）组127人、代谢正常型超重（MHOW）组386人、代谢正常型体重正常（MHNW）组362人。组间比较采用t检验，率的比较采用χ2检验，多因素分析采用logistic回归分析。 结果MHO占肥胖者的11.63%（127/1 092），其中男性7.82%（32/409），女性13.91%（95/683），性别差异有统计学意义（P〈0.05）。与MHNW组相比，MHO组HbA1C、空腹胰岛素（FINS）、低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TG）、谷氨酰转肽酶（GGT）、收缩压、舒张压、腰围升高，肾小球滤过率（GFR）、高密度脂蛋白胆固醇（HDL-C）降低，差异有统计学意义（均P〈0.05）；MHOW组FINS、LDL-C、TG、GGT、收缩压、腰围升高，HDL-C降低（均P〈0.05）。与MHOW组相比，MHO组FINS、TG、收缩压、腰围升高，GFR、HDL-C降低（均P〈0.05）。随访3年后，MHNW、MHOW、MHO组分别有17.96%（65/362）、32.90%（127/386）、42.52%（54/127）发生血脂异常，3组间差异有统计学意义（P〈0.05）；3组分别有20.17%（73/362）、22.80%（88/386）、26.77%（34/127）发生糖代谢异常，3组间差异无统计学意义（P〉0.05）。校正性别、年龄、FINS、谷丙转氨酶、谷草转氨酶、GGT、肌酐等因素后，MHO组发生血脂异常的风险是MHNW组的2.193倍（95%CI 1.359~3.539，P〈0.05），MHOW组是MHNW组的1.705倍（95%CI 1.190~2.443，P〈0.05）。 结论与MHNW组相比，MHOW/MHO患者临床指标存在明显差异，且3年后发生血脂异常的风险更高。

ObjectiveTo investigate the clinical characteristics of metabolically healthy obese（MHO）individuals, and to explore the risk of progression into metabolic disorders after 3 years. MethodsA total of 3 943 residents in Jining City were evaluated twice from February 2012 to August 2015, and 3 766 individuals were enrolled excluding those with missing data. Of the subjects, 875 subjects were screened as metabolic normal population, which were divided into MHO（n=127）, metabolically healthy overweight（MHOW, n=386）, and metabolically healthy normal weight（MHNW, n=362）groups. T test, χ2 test, and logistic regression analysis were used for data analysis. ResultsThe incidence of MHO was 11.63%（127/1 092）in obesity, and the proportion of MHO in females was higher than that in males（13.91% vs 7.82%, P〈0.05）. Compared with MHNW group, the levels of HbA1C, fasting insulin, low density lipoprotein-cholesterol（LDL-C）, triglyceride（TG）, glutamyl transpeptidase（GGT）, systolic blood pressure（SBP）, diastolic blood pressure（DBP）, and waist circumference（WC）were higher in MHO while glomerular filtration rate（GFR） and high density lipoprotein-cholesterol （HDL-C） were lower（all P〈0.05）; and fasting insulin, LDL-C, TG, GGT, SBP, WC were higher in MHOW while HDL-C was lower（all P〈0.05）. The levels of fasting insulin, TG, SBP, WC were higher in MHO while GFR and HDL-C were lower compared with MHOW（all P〈0.05）. Following up for 3 years, the incidences of dyslipidemia in MHNW, MHOW, and MHO were 17.96%（65/362）, 32.90%（127/386）, 42.52%（54/127）, respectively, with significant difference among three groups（P〈0.05）. The incidences of hyperglycemia in the three groups were 20.17%（73/362）, 22.80%（88/386）, 26.77%（34/127）, respectively, without significant difference among groups（all P〉0.05）. After adjustment for some factors including sex, age, fasting insulin, glutamic pyruvic transaminase, glutamic oxaloacetic transaminase, GGT, and creatinine, the risks of dyslipidemia in MHO（OR=2.193, 95%CI 1.359-3.539, P〈0.05）and MHOW（OR=1.705, 95%CI 1.190-2.443, P〈0.05）were significantly increased as compared with MHNW. ConclusionCompared with MHNW individuals, MHOW/MHO individuals show an obviously different clinical feature as well as with higher risks of dyslipidemia after 3 years.