2型糖尿病患者腹部脂肪分布与糖尿病并发症的相关性研究

Relationship between abdominal fat distribution and diabetic complications in patients with type 2 diabetes mellitus

目的探讨2型糖尿病患者腹部脂肪分布与糖脂代谢及糖尿病并发症的关系。方法选本院内分泌科住院的2型糖尿病患者357例,定量CT测量内脏脂肪(VAT)和皮下脂肪(SAT)面积,同时检查患者糖尿病肾病、视网膜病变、周围神经病变、外周动脉粥样硬化、心脑血管疾病的患病情况。根据VAT的值以三分位数法分为3组:T1组(VAT<162.0 cm^2)、T2组(162.0≤VAT<221.1 cm^2)、T3组(VAT≥221.1 cm^2)。结果T1组HbA1C水平高于T3组(P<0.05);T1组高密度脂蛋白胆固醇(HDL-C)、肾小球滤过率(eGFR)高于T2、T3组(P<0.05);T2、T3组男性比例、年龄、体重指数(BMI)、收缩压、舒张压、三酰甘油(TG)、24h尿白蛋白、糖尿病肾病和外周动脉粥样硬化的比例高于T1组(P<0.05);T3组空腹C肽(FCP)、改良稳态模型评估的胰岛素抵抗指数(HOMA-IR)高于T1、T2组(P<0.01)。Spearman相关分析显示,VAT、SAT与BMI、FCP、HOMA-IR呈正相关(P<0.01),VAT与年龄、收缩压、舒张压、TG、24h尿白蛋白、糖尿病肾病、外周动脉粥样硬化、心脑血管疾病呈正相关(P<0.05),与HbA1C、HDL-C、eGFR呈负相关(P<0.05),SAT与总胆固醇、低密度脂蛋白胆固醇呈正相关(P<0.01),与外周动脉粥样硬化呈负相关(P<0.01)。多因素相关分析显示,校正年龄、BMI、收缩压、空腹血糖等因素后,VAT仍是发生糖尿病肾病的危险因素(P=0.013)。结论VAT、SAT均与血脂和胰岛素抵抗相关,VAT可能是2型糖尿病患者发生糖尿病肾病的危险因素。

Objective To investigate the association of abdominal fat distribution with glycolipid metabolism and diabetic complications in patients with T2DM.Methods Totally 357 inpatients with T2DM were collected from the Endocrinology Department of our hospital.All patients received quantitative computed tomography to measure the visceral adipose tissue(VAT)and subcutaneous adipose tissue(SAT),and were divided into three groups depending on the tertile of VAT value:T1 group(VAT<162.0 cm^2),T2 group(162.0≤VAT<221.1 cm^2),T3 group(VAT≥221.1 cm^2).The incidences of diabetic kidney disease,diabetic retinopathy,diabetic peripheral neuropathy,peripheral atherosclerosis,and cardia-cerebrovascular disease were examined in all patients.Results HbA1C level in T1 group was higher than that in T3 group(P<0.05).High density lipoprotein-cholesterol(HDL-C)and estimated glomerular filtration rate(eGFR)in T1 group were higher compared with those in T2 and T3 groups(P<0.05).Male proportion,age,body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),triglyceride(TG),24h urinary albumin,diabetic kidney disease and peripheral atherosclerosis in T2 and T3 groups were higher than those in T1 group(P<0.05).Fasting C-peptide(FCP)and modified homeostasis model assessment for insulin resistance(HOMA-IR)in T3 group were higher than those in T1 and T2 group(P<0.01).VAT and SAT were positively correlated with BMI,FCP,and HOMA-IR(p<0.01).VAT was positively correlated with age,SBP,DBP,TG,24h urinary albumin,diabetic kidney disease,peripheral atherosclerosis,and cardia-cerebrovascular disease(P<0.05),while inversely correlated with HbA1C,HDL-C,and eGFR(P<0.05).SAT was positively correlated with total cholesterol and low density lipoprotein-cholesterol(P<0.01),while negatively correlated with peripheral atherosclerosis(P<0.01).Multivariate logistic regression analysis showed that VAT was still a risk factor for diabetic kidney disease after adjusted by age,BMI,SBP and fasting plasma glucose(P=0.013).Conclusion VAT and SAT are associated with blood lipids and insulin resistance,while VAT seems to be a risk factor for diabetic kidney disease.