男性腹型肥胖患者腹部脂肪面积与胰岛素抵抗的相关性分析

目的：探讨男性腹型肥胖患者腹部脂肪面积与糖代谢指标的关系。方法选择21～62岁肥胖男性94例，其中腹围≥90 cm（腹型肥胖组）70例，＜90 cm（均匀肥胖组）24例，登记两组患者的一般资料，测量身高、体质量、腹围、臀围，计算体质量指数（BMI）；受试者空腹行口服葡萄糖耐量试验，检测血糖（0、1、2 h）及胰岛素（0、1、2 h），计算胰岛素抵抗指数；应用 MRI 测量腹部内脏脂肪面积；比较两组患者血糖、胰岛素及胰岛素抵抗指数的差异，并分析腹型肥胖患者糖代谢相关指标与腹部脂肪面积的相关性。结果腹型肥胖组 BMI、腰围、臀围、胰岛素抵抗指数及腹部脂肪面积均高于均匀肥胖组[（28.67±4.20）、（21.80±1.97）kg/ m2，（99.75±4.07）、（79.50±10.05）cm，（104.42±7.62）、（91.86±4.49）cm，2.60±1.80、1.52±0.73，（153.06±53.23）、（71.78±25.48）cm2]，差异均有统计学意义（t值分别为-7.704、-9.583、-7.618、-2.877、-7.184，P 均＜0.05）；腹型肥胖组0、1、2 h 血糖和胰岛素高于均匀肥胖组[（5.89±1.36）、（5.29±0.53）mmol/ L，（10.55±3.07）、（8.76±1.96）mmol/ L，（8.41±3.63）、（6.54±1.50）mmol/ L，（9.71±5.05）、（6.42±2.96）mU/ L，（83.29±64.51）、（33.00±19.82） mU/ L，（27.93±14.98）、（63.56±21.09）mU/ L]，差异均有统计学意义（t 值分别为-2.098、-2.671、-2.447，-3.010、-3.784、-3.089，P 均＜0.05）；腹型肥胖患者腹部脂肪面积与年龄、BMI、腹围、臀围、血糖（0、1、2 h）、胰岛素（0、2 h）及胰岛素抵抗指数均呈正相关（ r 值分别为0.254、0.533、0.521、0.615、0.245、0.315、0.294、0.273、0.249、0.225，P 均＜0.05），校正混杂因素后，年龄（x1）、腹围（x2）及胰岛素抵抗指数（x 3）与腹部内脏脂肪面积成正相关相关（y =1.369x1＋4.472x2＋25.072x3-333.626）。结论与均匀肥胖相比较，腹型肥胖患者的腹部脂肪面积大小与胰岛素抵抗相关。

The correlation of intra-abdominal fat area with insulin resistance in male with abdominal obesity

Objective To investigate the relationship between intra-abdominal fat area（IAFA）in male with abdominal obesity and glycometabolism related indicators. Methods Ninety-four obesity males,aged from 21 to 62 years old,were selected as our subjects. They were divided into abdominal obesity group（n = 70）and non-abdominal obesity group（ n = 24）. The general information of all subjects was recorded. The indexes of height,weight,waist circumference,hip circumference,body mass index（BMI）were measured. The fasting oral glucose tolerance test was performed. The levels of blood glucose（0,1,2 h）and insulin（0,1,2 h）were measured,and insulin resistance index was calculated. MRI measurement was applied to calculate the IAFA. Compared the difference between the two groups in term of the level of blood glucose,insulin and insulin resistance index,and analyzed the correlation between glycometabolism related indicators and IAFA. Results BMI,waist circumference,hip circumference,insulin resistance index and IAFA in abdominal obesity group were （28. 67 ± 4. 20）kg/ m2 ,（99. 75 ± 4. 07）cm,（104. 42 ± 7. 62）cm,2. 60 ± 1. 80,（153. 06 ± 53. 23）cm2 respectively,higher than those in non-abdominal obesity group（（21. 80 ± 1. 97）kg/ m2 ,（79. 50 ± 10. 05）cm, （91. 86 ± 4. 49）cm,1. 52 ± 0. 73,（71. 78 ± 25. 48）cm2 ）,and the differences were statistically significant（t= - 7. 704,- 9. 583,- 7. 618,- 2. 877,- 7. 184,P 〈 0. 05）. The level of blood glucose at 0,1,2 h of patient in abdominal obesity group were（5. 89 ± 1. 36）mmol/ L,（10. 55 ± 3. 07）mmol/ L,and（8. 41 ± 3. 63） mmol/ L,higher than that in non-abdominal obesity group（（5. 29 ± 0. 53）mmol/ L,（8. 76 ± 1. 96）mmol/ L, （6. 54 ± 1. 50）mmol/ L）. Meanwhile,The insulin at 0,1,2 h of man in abdominal obesity group were（9. 71 ± 5. 05）mU/ L,（83. 29 ± 64. 51）mU/ L,（63. 56 ± 21. 09）mU/ L）,significantly higher than those in non-abdominal obesity group（（6. 42 ± 2. 96）mU/ L,（33. 00 ± 19. 82）mU/ L,（63. 56 ± 21. 09）mU/ L）,and the differences were significant（ t = - 2. 098,- 2. 671;- 2. 447,- 3. 010;- 3. 784,- 3. 089;P 〈 0. 05）. The IAFA in abdominal obesity was positively correlated with age,BMI,waist circumference,hip circumference,blood glucose（0,1,2 h）insulin（0,2 h）and insulin resistance index（r = 0. 254,0. 533,0. 521,0. 615,0. 245,0. 315, 0. 294,0273,0. 249,0. 225,P 〈 0. 05 ）. After adjustment for confounding factors,age（ x1 ）,abdominal circumference（x2）and insulin resistance index（x3）were related to IAFA（y = 1. 369x1 ＋ 4. 472x2 ＋ 25. 072x3- 333. 626）. Conclusion Compared with patients with non-abdominal obesity,the IAFA of patient with abdominal obesity with abdominal fat area size is associated with insulin resistance.