腹部脂肪组织分布与2型糖尿病患者胰岛素抵抗的相关性研究

摘要

Objective To investigate correlation of abdominal adipose tissue distribution and insulin resistance in T2DM. Methods A total of 128 T2DM patients were divided into two groups :obese (OG) group (n=66) and non‐obese (NOG) group (n=62). Spiral CT was used for the measurement of adipose tissue of the total area (TA) and visceral fat area (VA) at abdominal umbilical level lumbar vertebrae 4 ,5 plane in T2DM patients. Subcutaneous fat area (SA ) was calculated. General and biochemical characteristics were measured in both groups. Results WC [male(73.52 ± 0.88) vs (70.66 ± 0.92)cm ;female(83.22 ± 0.96) vs (78.98 ± 0.98)cm] ,BMI [male(28.85 ± 3.45) vs (25.11 ± 4.36)kg/m2 ;female (28.23 ± 3.48) vs (25.05 ± 3.89)kg/m2 ] ,SBP [male(158.23 ± 8.25) vs (112.25 ± 7.25)mmHg ;female (154.25 ± 6.32) vs (109.68 ± 8.02)mmHg] ,DBP [male(95.36 ± 5.26) vs (80.69 ± 7.25)mmHg ;female (92.45 ± 4.36) vs (80.26 ± 6.48)mmHg] ,FPG [male(9.85 ± 2.89) vs (7.03 ± 2.88)mmol/L ;female (9.75 ± 2.65) vs (7.39 ± 2.98)mmol/L] ,FIns [male(11.25 ± 3.45) vs (7.02 ± 2.43)mIU/L ;female (11.02 ± 3.58) vs (7.18 ± 2.69)mIU/L] ,HbA1c [male(7.36 ± 1.36)% vs (5.21 ± 0.37)% ;female(7.68 ± 1.22)% vs (5.32 ± 0.42)% ] ,TG [male(5.98 ± 1.52) vs (3.02 ± 0.89)mmol/L ;female(5.78 ± 1.26) vs (2.98 ± 0.92)mmol/L] ,TC [male(8.02 ± 1.28) vs (4.39 ± 0.98)mmol/L ;female(7.98 ± 1.13) vs (4.23 ± 0.89)mmol/L] ,LDL‐C [male(9.12 ± 0.58) vs (4.21 ± 0.86)mmol/L ;female(8.96 ± 0.78) vs (4.18 ± 0.92)mmol/L] ,SUA [male(83.63 ± 21.64) vs (72.98 ± 12.25)μmol/L ;female(83.98 ± 19.78) vs (71.98 ± 11.98)μmol/L] ,C‐RP [male(5.96 ± 1.25) vs (2.32 ± 0.42)mg/L ;female(5.05 ± 1.32) vs (2.52 ± 0.56)mg/L] ,HOMA‐IR [male(4.25 ± 1.12) vs (2.25 ± 1.12);female(4.36 ± 1.42) vs (2.12 ± 1.02)] ,TA [male(50.68 ± 9.12) vs (30.96 ± 3.26)cm2 ;female(47.23 ± 4.23) vs (26.98 ± 3.02)cm2 ] , VA [male(19.78 ± 5.42) vs (10.59 ± 4.69)cm2 ;female(17.02 ± 3.96) vs (8.45 ± 3.78)cm2 ] ,SA [male (30.91 ± 6.02) vs (18.96 ± 5.78)mm2 ;female(28.25 ± 4.23) vs (17.25 ± 4.62)mm2 ]and VA/SA [male (0.72 ± 0.22)% vs (0.42 ± 0.18)% ;female(0.58 ± 0.17)% vs (0.32 ± 0.12)% ] were significantly higher in OG group than in NOG group. T2DM course [male(2.36 ± 0.58) vs (2.62 ± 0.78)years ;female (2.38 ± 0.62) vs (2.82 ± 0.82)years] ,HDL‐C [male(0.98 ± 0.21) vs (2.28 ± 0.78)mmol/L ;female(0.96 ± 0.32) vs (2.19 ± 0.82)mmol/L] and HOMA‐β[male(28.22 ± 9.34) vs (82.22 ± 31.25);female(28.02 ±8.02) vs (81.36 ± 28.36)] were lower in OG group than in NOG group(P< 0.05). Spearson correlation analysis showed that HOMA‐IR was positively associated with TG ,SUA ,TA ,VA ,SA ,VA/TA ,SA/TA and VA/SA. Logistic multiple regression analysis showed that TG ,SA ,TA and VA/TA were risk factors for insulin resistance in T2DM patients. Conclusion Abdominal fat distribution is closely related to IR in T2DM patients.%目的：探讨腹部脂肪分布与T2DM 患者IR的相关性。方法将128例 T2DM 患者根据BMI分为肥胖（OG）组66例和非肥胖（NOG）组62例，采用螺旋CT测量T2DM患者腹部平脐腰4、5椎体平面脂肪组织总面积（TA）和内脏脂肪面积（VA），计算皮下脂肪面积（SA）。检测各组一般资料及生化指标。结果 OG组 WC[男（73.52±0.88） vs （70.66±0.92）cm ；女（83.22±0.96） vs （78.98±0.98）cm]、BMI[男（28.85±3.45） vs （25.11±4.36）kg／m2；女（28.23±3.48） vs （25.05±3.89）kg／m2]、SBP[男（158.23±8.25） vs （112.25±7.25）mmHg ；女（154.25±6.32） vs （109.68±8.02）mmHg]、DBP [男（95.36±5.26） vs （80.69±7.25）mmHg ；女（92.45±4.36） vs （80.26±6.48）mmHg]、FPG[男（9.85±2.89） vs （7.03±2.88）mmol／L ；女（9.75±2.65） vs （7.39±2.98）mmol／L]、FIns[男（11.25±3.45） vs （7.02±2.43）mIU／L ；女（11.02±3.58） vs （7.18±2.69）mIU／L]、HbA1c[男（7.36±1.36）％ vs （5.21±0.37）％；女（7.68±1.22）％ vs （5.32±0.42）％]、TG [男（5.98±1.52） vs （3.02±0.89）mmol／L ；女（5.78±1.26） vs （2.98±0.92）mmol／L]、TC[男（8.02±1.28） vs （4.39±0.98）mmol／L ；女（7.98±1.13） vs （4.23±0.89）mmol／L]、LDL‐C[男（9.12±0.58） vs （4.21±0.86）mmol／L ；女（8.96±0.78） vs （4.18±0.92）mmol／L]、SUA [男（83.63±21.64） vs （72.98±12.25）μmol／L ；女（83.98±19.78） vs （71.98±11.98）μmol／L]、C‐RP[男（5.96±1.25） vs （2.32±0.42）mg／L ；女（5.05±1.32） vs （2.52±0.56）mg／L]、HOMA‐IR[男（4.25±1.12） vs （2.25±1.12）；女（4.36±1.42） vs （2.12±1.02）]、TA[男（50.68±9.12） vs （30.96±3.26）cm2；女（47.23±4.23） vs （26.98±3.02）cm2]、VA[男（19.78±5.42） vs （10.59±4.69）cm2；女（17.02±3.96） vs （8.45±3.78）cm2]、SA[男（30.91±6.02） vs （18.96±5.78） mm2；女（28.25±4.23） vs （17.25±4.62）mm2]和 VA／SA [男（0.72±0.22）％ vs （0.42±0.18）％；女（0.58±0.17）％ vs （0.32±0.12）％]高于NOG组，T2DM病程[男（2.36±0.58） vs （2.62±0.78）年；女（2.38±0.62） vs （2.82±0.82）年]、HDL‐C[男（0.98±0.21） vs （2.28±0.78）mmol／L ；女（0.96±0.32） vs （2.19±0.82）mmol／L]和 HOMA‐β[男（28.22±9.34） vs （82.22±31.25）；女（28.02±8.02） vs （81.36±28.36）]低于 NOG组（P＜0.05）。Spearman相关性分析结果显示，HOMA‐IR与 TG、SUA、TA、VA、SA、VA／TA、SA／TA和 VA／SA呈正相关。Logistic回归分析结果显示，TG、SA、TA和 VA／TA是T2DM患者HOMA‐IR的危险因素。结论腹部脂肪分布与T2DM患者IR关系密切。