女性绝经前后内脏脂肪面积与代谢综合征及其组分的关系研究

Association of visceral fat area with metabolic syndrome and components in pre-and post-menopausal women

目的探讨女性绝经前和绝经后内脏脂肪面积(VFA)与代谢综合征(MS)及其组分的关系,并确定VFA诊断绝经前后女性MS高危人群的最佳切点值,为探讨VFA能否作为一种新兴指标判别MS高危人群提供科学依据。方法选取2015年12月至2016年4月在天津市和平区健康教育指导中心体检的20~70岁女性848名作为研究对象,其中绝经前女性613人(72.3%),绝经后女性235人(27.7%)。采用国际糖尿病联盟标准诊断MS,采用生物电阻抗法检测VFA,并进行体格检查和生化指标测定。采用SPSS 19.0进行t检验、Mann-Whitney检验和χ~2检验,用Spearman相关分析女性绝经前和绝经后VFA与MS组分的关系,用受试者工作特征曲线确定VFA诊断绝经前和绝经后女性MS组分的最佳切点值。结果绝经后女性VFA、空腹血糖(FPG)、甘油三酯(TG)及血压均高于绝经前女性;绝经前及绝经后女性VFA与腰围、FPG、TG、收缩压和舒张压均呈正相关(绝经前rs分别为0.813、0.259、0.424、0.281和0.260,绝经后rs分别为0.864、0.268、0.370、0.239和0.200),与高密度脂蛋白胆固醇(HDL-C)呈负相关(绝经前rs=-0.275,绝经后rs=-0.273),均有统计学意义(P<0.05,P<0.01)。与正常组相比,绝经前和绝经后女性内脏型肥胖组的高血糖、高甘油三酯血症及低HDL-C的患病率均较高。VFA判别绝经后女性高甘油三酯血症的曲线下面积(0.700)高于体质指数(0.631),差异有统计学意义(P<0.05);未发现VFA判别绝经前后女性MS及其组分的曲线下面积高于传统肥胖测量指标。结论绝经前后女性VFA增加会增加MS及其组分的患病风险。与传统肥胖测量指标比较,VFA判别绝经后女性高甘油三酯血症的能力高于体质指数。

Objective To explore the relationship between visceral fat area（VFA） and metabolic syndrome（MS） or components among pre-and post-menopausal women, and to determine the cut-off point of VFA to predict MS and its components in pre-and post-menopausal women for providing the scientific basis of VFA as a new indicator in people with high risk of MS. Methods Totally 848 cases from Health Education Guidance Center in Heping District of Tianjin during December of 2015 to April of 2016 were served as the subjects（613 pre-menopausal females, 72.3%; 235 post-menopausal females, 27.7%）. The diagnosis for MS was based on the International Diabetes Federation（IDF） criteria. The investigation was performed with physical examination,blood biochemical indicators and VFA measure by bioelectrical impedance analysis（BIA） for each subject. The t test, χ~2 test and Mann-Whitney test were used to analyze the data, the receiver operating characteristic（ROC） curve was used to determine the cutoff point for diagnosis of MS and components. Spearman correlation analysis was used to evaluate the relationship between VFA and MS and components in pre-and post-menopausal women. The used software was SPSS 19.0. Results VFA, fasting plasma glucose（FPG）, triglyceride（TG） and blood pressure（BP） in post-menopausal women were higher than those in pre-menopausal women. In pre and post-menopausal women, VFA correlated positively to WC, FPG, TG, SBP and DBP（in pre-menopausal women rs values were 0.813, 0.259, 0.424, 0.281 and 0.260, respectively; in post-menopausal women rsvalues were 0.864, 0.268, 0.370,0.239 and 0.200, respectively） and correlated negatively to high-density lipoprotein cholesterol（HDL-C）（in pre-menopausal women rs=-0.275; in post-menopausal women rs=-0.273）, P〈0.05 or P〈0.01. As compared with normal group, the rates of hyperglycemia, hypertriglyceridemia and low HDL-C visceral fat obesity groups in pre-and post-menopausal women increased significantly. The area（0.700） under VFA curve to discriminate hypertriglyceridemia was significantly higher than BMI（0.631）in post-menopausal women, P〈0.05. It was not found that the area under VFA to discriminate the MS in pre and post-menopausal women was higher than traditional obesity indicators. Conclusion The higher VFA could increase the risk of MS and components in pre-and post-menopausal women. As compared to the traditional obesity indicators, the efficiency of VFA was higher than that of BMI for discriminating hypertriglyceridemia in post-menopausal women.