肥胖症患者血清内毒素水平与胰岛素抵抗的相关性研究

Study on the Relationship between the Level of Fasting Serum Lipopolysaccharide and Insulin Resistance in Patients with Obesity

目的:探讨肥胖人群空腹血清内毒素(LPS)水平,分析LPS的影响因素及其与体质量指数(BMI)、体脂分布、胰岛素抵抗的关系。方法:选取2018年6月—2019年7月在我院内分泌科诊治的肥胖症患者49例(BMI≥28),同时,随机选取同期健康体检者21例作为正常对照组。检测空腹血清LPS、体脂成分、糖脂代谢指标,计算稳态模型评估胰岛素抵抗指数(HOMA-IR)。采用Pearson相关分析LPS与BMI、腰臀比、HOMA-IR等指标相关性,采用多元线性回归分析LPS的影响因素。结果:肥胖组患者血清LPS水平显著高于正常对照组(P<0.01)。血清LPS水平与BMI、体脂肪含量、体脂百分比、内脏脂肪面积、腰围、臀围、腰臀比、HOMA-IR、总甘油三酯、总胆固醇、低密度脂蛋白胆固醇水平均呈正相关(P<0.05);多元逐步回归分析显示,血清LPS水平与HOMA-IR、腰臀比呈独立正相关(P<0.05)。结论:肥胖患者空腹血清LPS水平显著升高,机体处于低度炎症、代谢性内毒素血症状态。而HOMA-IR和腰臀比是影响LPS水平的两个独立因素,LPS可能在胰岛素抵抗、肥胖和糖尿病之间发挥重要作用。

Objective:To investigate the level of fasting serum lipopolysaccharide(LPS)in obese subjects,and to analyze the influencing factors of LPS and its relationship with BMI,body fat distribution and insulin resistance.Methods:49 obesity(BMI≥28)patients who were diagnosed and treated in the department of endocrinology of our hospital from June 2018 to July 2019 were selected.Meanwhile,21 healthy adults were enrolled as a normal control group.Fasting serum LPS,body fat composition and glycolipid metabolism were measured,and homeostasis model assessment of insulin resistance index(HOMA-IR)was calculated.The relationship between LPS and other variables were presented by the Pearson correlation coefficients.Stepwise regression model was used to analyze the influencing factors of LPS.Results:The level of LPS in obesity group was statistically higher than that in normal control group(P<0.01).Serum LPS level was positively correlated with BMI,body fat(BF),percent body fat(PBF),visceral Fat area(VFA),waist circumference(WC),hipline circumference(HC),waist-hip ratio(WHR),HOMA-IR,TG,TC and LDL-C(all P<0.05).Multiple linear regression analysis demonstrated that serum LPS was influenced by HOMA-IR and WHR.Conclusion:Serum LPS was significantly higher in obese patients,which may make human body in a low-grade systemic inflammation and metabolic endotoxemia state.The HOMA-IR and WHR were independent influencing factors of serum LPS.LPS may play an important role in insulin resistance,obesity and diabetes.