定量计算机断层扫描探讨肥胖及超重患者不同糖代谢水平下腹腔内脂肪与骨密度相关性

Quantitative CT was used to investigate the correlation between intraperitoneal fat and bone mineral density in obese and overweight patients with different levels of glucose metabolism

目的探讨肥胖及超重患者不同糖代谢水平下腹腔内脂肪与骨密度相关性。方法选择年龄≤60岁、体质量指数≥25kg/m2未经治疗的肥胖及超重患者86例,根据糖代谢状态分为糖耐量正常(normal glucose tolerance,NGT)组(NGT组,30例)、糖耐量受损(impaired glucose tolerance,IGT)组(IGT组,31例)及糖尿病(diabetes mellitus,DM)组(DM组,25例)。采用定量计算机断层扫描(computed tomography,CT)测量腹部脂肪及L1~L3椎体骨密度。收集患者相关的临床数据,包括患者性别、年龄、体质量指数、腹部总脂肪面积、内脏脂肪面积、皮下脂肪面积、肝脏脂肪含量平均值、胰腺脂肪含量平均值、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、空腹血糖等。分别分析三组的腹腔内脂肪面积与骨密度相关性及三组间骨密度的差异,分析骨密度与各临床指标的相关性。结果NGT组、IGT组、DM组腹部内脏脂肪面积与骨密度均呈负相关(P均<0.05),NGT组相关性更高(r=-0.525,P<0.05)。NGT组、IGT组骨密度较DM组升高,差异均有显著性(P<0.05)。NGT组、IGT组之间骨密度比较,差异无显著性(P>0.05)。多因素回归分析结果显示,内脏脂肪面积是骨密度的影响因素(P<0.05)。结论无论糖代谢是否异常,肥胖及超重人群内脏脂肪面积与骨密度均呈负相关。腹部脂肪与骨密度关系复杂,腹部脂肪可能是影响肥胖患者骨密度的因素。

Objective To investigate the correlation between abdominal fat and bone mineral density in obese and overweight patients with different levels of glucose metabolism.Method A total of 86 untreated obese and overweight patients with age≤60 years and body mass index(BMI)≥25kg/m2 were selected and divided into normal glucose tolerance group(NGT group,30 cases),impaired glucose tolerance group(IGT group,31 cases)and diabetes mellitus group(DM group,25 cases)according to their glucose metabolism status.Abdominal fat and L1~L3 vertebral bone mineral density(BMD)were measured by quantitative CT.Clinical data related to patients were collected,including patients'age,BMI,total abdominal fat area,visceral fat area,subcutaneous fat area,mean liver fat content,mean pancreas fat content,total cholesterol,triglyceride,low density lipoprotein,high density lipoprotein,fasting,fasting blood glucose,etc.The correlation between intraperitoneal fat area and bone mineral density and the difference of bone mineral density among the three groups were analyzed respectively,and the correlation between bone mineral density and various clinical indicators was analyzed.Result There was a negative correlation between intraperitoneal fat area and bone mineral density in NGT group,IGT group and DM group(all P<0.05),and the correlation between intraperitoneal fat area and bone mineral density in NGT group was higher(r=-0.525,P<0.05).BMD of NGT group and IGT group was higher than that of DM group,respectively,with statistical significance(P<0.05).There was no significant difference in bone mineral density between the NGT group and the IGT group(P>0.05).The results of multivariate regression analysis showed that the intraperitoneal fat area was influence factor of bone mineral density(P<0.05).Conclusion Intraperitoneal fat area was negatively correlated with bone mineral density in both obese and overweight people regardless of abnormal glucose metabolism.The relationship between abdominal fat and BMD is complex,and abdominal fat may be a factor affecting bone mineral density in obese patients.