腹部脂肪分布与2型糖尿病合并肥胖患者胰岛素抵抗和骨密度的关系研究

目的:探讨腹部脂肪分布与2型糖尿病合并肥胖患者胰岛素抵抗和骨密度的相关性。方法:选择2017年2月至2019年7月青岛大学附属医院内分泌与代谢病科收治的159例肥胖合并2型糖尿病患者(观察组)和同期100例单纯性肥胖且口服葡萄糖糖耐量试验(OGTT)正常者(对照组)。采用多层螺旋CT(MSCT)测量腹腔内脂肪面积(VFA)、腹内脂肪体积(IAFV)、全腹脂肪体积(TAV),并计算IAFV/TAV;采用全自动生化分析仪检测受试者血脂、空腹血糖(FPG)、空腹胰岛素(FINS)水平,并计算胰岛素抵抗指数(HOMA-IR);采用骨密度仪测量腰椎骨密度、股骨骨密度、髋骨骨密度。分析VFA、IAFV、TAV、IAFV/TAV与胰岛素抵抗和骨密度之间相关性。结果:观察组VFA、IAFV、IAFV/TAV、FPG、HOMA-IR、FINS、总胆固醇(TC)、甘油三酯(TG)、低密度脂蛋白胆固醇(LDL-C)高于对照组(P0.05),高密度脂蛋白胆固醇(HDL-C)、腰椎骨密度、股骨骨密度、髋骨骨密度低于对照组(P0.05),TAV与对照组比较差异无统计学意义(P0.05)。Pearson相关分析结果示VFA、IAFV、IAFV/TAV与FPG、HOMA-IR、FINS、TC、TG、LDL-C呈正相关(P0.05),与腰椎、股骨、髋骨骨密度、HDL-C呈负相关(P0.05),偏相关分析结果显示,VFA、IAFV、IAFV/TAV与HOMA-IR呈正相关(P0.05),与腰椎、股骨、髋骨骨密度呈负相关(P0.05)。结论:腹内脂肪异常堆积与2型糖尿病合并肥胖患者胰岛素抵抗和骨密度具有显著相关性,临床可通过检测腹内脂肪分布情况预估2型糖尿病合并肥胖患者发生胰岛素抵抗和骨质疏松的风险。

Study on the Relationship between Abdominal Fat Distribution and Insulin Resistance and Bone Mineral Density in Type 2 Diabetes Mellitus Patients with Obesity

ABSTRACT Objective: To investigate the correlation between abdominal fat distribution and insulin resistance and bone mineral density in type 2 diabetic patients with obesity. Methods: 159 obese patients with type 2 diabetes (observation group) who were admitted to the department of endocrinology and metabolism, affiliated hospital of Qingdao university from February 2017 to July 2019 and 100 cases of simple obesity with normal oral glucose tolerance test (OGTT) (control group) at the same time were selected as study subjects. The visceral fat area (VFA), itra-abdominal fat volume (IAFV) and total abdominal fat volume (TAV) were obtained by multi-slice spiral CT (MSCT), the ratio of IAFV to TAV was calculated. Blood lipid, fasting plasma glucose (FPG) and fasting insulin (FINS) were measured by automatic biochemical analyzer, the insulin resistance index (HOMA-IR) was calculated. The lumbar bone mineral density, femoral bone mineral density, hip bone mineral density were measured by bone mineral density instrument, The correlation between VFA, IAFV, TAV, IAFV/TAV and insulin resistance and bone mineral density was analyzed. Results: VFA, IAFV, IAFV/TAV, FPG, HOMA-IR, FINS, total cholesterol (TC), triglycerides (TG) and low density lipoprotein cholesterol (LDL-C) in the observation group were higher than those in the control group (P<0.05), while High density lipoprotein cholesterol(HDL-C), lumbar vertebral bone mineral density, femoral bone mineral density and hip bone mineral density in the observation group were lower than those in the control group (P<0.05). There was no significant difference between TAV and control group (P>0.05). Pearson analysis showed that VFA, IAFV, IAFV/TAV were positively correlated with FPG, homa-ir, FINS, TC, TG and LDL-C (P<0.05), and they were negatively correlated with lumbar spine bone density, femu bone density, hip bone density and HDL-C (P<0.05). Partial correlation analysis showed that VFA, IAFV, IAFV/TAV were positively correlated with HOMA-IR (P<0.05), and they were negatively correlated with bone mineral density of lumbar spine, femur and hip (P<0.05). Conclusion: The abnormal accumulation of abdominal fat has a significant correlation with insulin resistance and bone mineral density in type 2 diabetic patients with obesity. The risk of insulin resistance and osteoporosis in type 2 diabetic patients with obesity can be estimated by detecting the distribution of abdominal fat.