腹型肥胖患者体脂分布与代谢综合征及冠状动脉病变的关系

Fat distribution in abdominal obesity and its relationship to metabolic syndrome and coronary artery disease

目的探讨腹型肥胖患者各部位脂肪分布与代谢综合征(MS)和冠状动脉病变(CAD)的关系。方法 57例腹型肥胖患者,采用GE64层螺旋CT评估腹部、心脏及冠脉周围脂肪分布情况,超声评估肾脏周围脂肪分布情况,同时测量血生化指标、体质量指数和腰臀比等。结果 (1)MS组VAT、肾短轴脂肪面积及Gessini积分显著高于单纯肥胖组[分别为(2290±601)cc vs.(3024±792)cc;(13.4±1.1)mm2vs.(18.8±2.2)mm2;(20±3)vs.(46±6);P<0.05,P<0.01];多因素Logistic回归分析显示VAT是MS的独立危险因素(OR=1.002,95%CI 1.000-1.003,P<0.05);(2)Gessini评分>80分组WHR、MS异常代谢组分个数、糖尿病比例、CYS-C、EAT、冠脉周围脂肪厚度均显著高于Gessini评分40~80分组及Gessini评分<40分组[分别为(1.10±0.01)vs.(0.96±0.01)、(0.96±0.01);(4.38±0.38)vs.(3.35±0.27)、(2.71±0.27);71%vs.17%、6%;(1.33±0.21)mg/L vs.(1.03±0.07)mg/L、(0.86±0.04)mg/L;(217±58)cc vs.(201±18)cc、(129±18)cc;(17.0±1.2)mm vs.(14.3±0.6)mm、(10.4±0.6)mm;P<0.05,P<0.01]。多因素逐步回归分析显示,MS异常代谢组分个数、CYS-C、冠脉周围脂肪厚度是影响冠脉病变程度的危险因素。结论肥胖患者体内不同部位的脂肪沉积对其代谢、心血管疾病的作用具有差异性;在明显肥胖患者中,心脏及冠脉周围脂肪分布可能是更重要的心血管危险因子。

AIM To describe the characteristics of fat distribution in obesity and to explore its relationship to the occurrence and severity of metabolic disorder and coronary artery diseases. METHODS Fifty-seven patients （43 males and 14 females） with definite abdominal obesity, mean age of 52.44±11.47 yeas were included in this study. Fat accumulation in heart, aorta and abdominal viscera were quantified by 64-slice computer tomography. Peri-renal fat accumulation was measured by ultrasound. Traditional cardiovascular risk factors and metabolic risk factors were also examined. RESULTS VAT, peri-renal fat and Gessini score were significantly larger in patients with metabolic syndrome （MS） than those without [（2290±601） cc versus.（3024±792） cc; （13.4±1.1） mm2 vs.（18.8±2.2） mm2; （20±3） vs.（46±6）; P〈0.05, P〈0.01]. VAT was significantly associated with the pressence of MS by multivariate logistic regression （OR=1.002, 95%CI 1.000-1.003, P〈0.05）. WHR, number of MS components, diabetes mellitus, CYS-C, EAT and pericoronary adipose tissue in Gessini score〉80 group were significantly higher than those in Gessini score 40~80 group and Gessini score〈40 group [（1.10±0.01） vs.（0.96±0.01）, （0.96±0.01）;（4.38±0.38） vs.（3.35±0.27）, （2.71±0.27）; 71% vs. 17%, 6%; （1.33±0.21） mg/L vs.（1.03±0.07 ） mg/L, （0.86±0.04） mg/L; （217±58） cc vs.（201±18） cc, （129±18） cc; （17.0±1.2） mm vs.（14.3±0.6） mm, （10.4±0.6） mm; P〈0.05, P〈0.01]. Multivariate stepwise regression analysis showed a significant relationship between Gessini score and MS, pericoronary adipose tissue thickness and cystatin. CONCLUSION Varying locations of body fat distribution play different roles in obesity-related metabolic cardiovascular disease in abdominal obesity.