2型糖尿病合并超重及肥胖的绝经前女性患者腹部脂肪分布与胰岛素抵抗及骨矿物质密度的关系

Relationship between the distribution of abdominal adipose tissue,insulin resistance and bone mineral density for the premenopausal women with obesity or overweight and type 2 diabetes mellitus

目的探讨2型糖尿病(type 2 diabetes mellitus,T2DM)合并超重及肥胖的绝经前女性患者腹部脂肪分布与胰岛素抵抗及骨矿物质密度的关系。方法选取2016年1月至2017年10月于北京积水潭医院住院的新发T2DM合并超重或肥胖的绝经前女性患者28例作为T2DM组,以同期住院的口服糖耐量试验正常的超重或肥胖绝经前女性30例作为对照组。对所有患者应用定量CT技术测量第2、3、4腰椎的平均骨矿物质密度,腹部总脂肪体积,皮下脂肪体积,内脏脂肪体积,同时测量患者腹围、体重指数、血尿酸、总胆固醇、甘油三酯、高密度脂蛋白、低密度脂蛋白、同型半胱氨酸、空腹血糖及空腹血胰岛素水平。比较两组间各参数的差别,并分析平均骨矿物质密度、稳态胰岛素抵抗指数(homeostasis model assessment for insulin resistance,HOMA-RI)及稳态胰岛β细胞功能指数(homeostasis model assessment forβcell,HOMA-β)的自然对数ln(HOMA-RI)及ln(HOMA-R)与腹部总脂肪体积、皮下脂肪体积、内脏脂肪体积的关系。结果T2DM组平均骨矿物质密度、皮下脂肪体积低于对照组,内脏脂肪体积、内脏脂肪体积/皮下脂肪体积比值高于对照组,差异有显著性(P<0.05);两组腹部总脂肪体积比较差异无显著性(P>0.05)。多重线性回归分析显示,年龄及内脏脂肪体积/皮下脂肪体积比值与平均骨矿物质密度呈负相关关系(P<0.05),内脏脂肪体积与ln(HOMA-RI)呈正相关关系(P<0.05)。结论2型糖尿病合并超重及肥胖的绝经前女性患者会出现骨矿物质密度下降,其平均骨矿物质密度与年龄、内脏脂肪体积/皮下脂肪体积比值呈负相关关系,内脏脂肪含量对胰岛素抵抗程度有较大影响,但胰岛素抵抗并不是造成该类骨矿物质密度下降的原因。

Objective To investigate the relationship between bone mineral density(BMD)together with insulin resistance(IR)and the distribution of abdominal adipose tissue in premenopausal women with type 2 diabetes mellitus(T2DM)and obesity or overweight.Method A total of 28 cases of premenopausal women newly-diagnosed type 2 diabetes mellitus(T2DM)with obesity or overweight were enrolled in T2DM group,and 30 cases of obesity or overweight premenopausal women with normal oral tolerance were selected as the control group.The average bone mineral density(avgBMD)of L2,L3,L4,total abdominal adipose tissue volume(TAV),subcutaneous adipose tissue volume(SAV),visceral adipose tissue volume(VAV)were detected in all patients by QCT.The waist circumference,body mass index,blood uric acid,total cholesterol,triglycerides,high-density lipoprotein cholesterol,low density lipoprotein cholesterol,homocysteine,fasting plasma glucose and fasting blood insulin levels were also measured.The differences between the two groups were compared,and the relationship between avgBMD and TAV,SAV and VAV was analyzed.Result The level of avgBMD and SAV in T2DM group was lower than that in control group(P<0.05).The levels of VAV and VAV/SAV were higher in the T2DM group than that in the control group(P<0.05).There was no significant difference in the levels of TAV between the two groups(P>0.05).Multiple linear regression analysis showed that age and VAV/SAV were associated with avgBMD(P<0.05).lnsulin resistance(HOMA-RI)was associated with VAV.Conclusion The premenopausal type 2 diabetes mellitus women with obesity or overweight appeared with decreased bone density,and the age and VAV/SAV were the negative factors.The visceral adipose tissue volume influences insulin resistance,but the insulin resistance is not the cause of this decline in bone mineral density.