血清游离脂肪酸水平在不同体重指数及糖耐量个体中与胰岛素敏感性及相关指标的关系  

Fasting serum free fatty acid , insulin sensitivity index and serum lipid levels in individuals with different body mass index and glucose tolerance

作　　者：张翼飞[1] 洪洁[1] 顾卫琼[1] 孙首悦[1] 唐金凤[1] 江凌[1] 戴蒙[1] 赵咏桔[1] 宁光[1] 

机构地区：[1]上海第二医科大学附属瑞金医院内分泌科上海市内分泌代谢病临床医学中心,200025

出　　处：《中华内科杂志》2003年第11期793-796,共4页Chinese Journal of Internal Medicine

基　　金：上海市教育发展基金会;上海市教育委员会曙光计划项目 ( 0 1SG48)

摘　　要：目的　运用Bergman的最小模型技术研究不同体重指数 (BMI)及糖耐量个体血清空腹游离脂肪酸水平与胰岛素敏感性之间的关系。方法　用放射免疫分析法检测 2 6例正常人 (正常BMI及糖耐量 )、39例糖耐量正常单纯性肥胖者、新近诊断的 2 5例糖耐量异常 (IGT)患者及 2 1例 2型糖尿病患者的血清空腹游离脂肪酸 (FFA)水平 ,测定空腹血清甘油三酯 (TG)、血清总胆固醇 (TC)水平 ,并利用Bergman最小模型技术计算胰岛素敏感性指数 (ISI)。结果　 (1)正常对照组血清FFA值显著低于单纯肥胖组、IGT组及 2型糖尿病组 ,但FFA值在后 3组之间差异无显著性。 (2 )正常对照组ISI值显著高于单纯肥胖组、IGT组及 2型糖尿病组 ,但ISI值在后 3组之间差异无显著性。 (3)在校正了BMI因素影响后 ,正常对照组血清FFA值仍显著低于其他各组。 (4 )相关性研究显示 ,血清FFA值与ISI值呈明显负相关 ,与简易胰岛素敏感性指数HOMAIR以及BMI、腰臀围比 (WHR)、TG值呈明显正相关 (r值分别为 - 0 4 5 4、0 2 13、0 2 4 1、0 336、0 4 14 ,P值分别 <0 0 1、<0 0 5、<0 0 5、<0 0 1、<0 0 1) ,而与年龄、性别及TC值无相关性 ;(5 )以FFA为应变量 ,ISI、HOMAIR、BMI、WHR、TG为自变量进行多元逐步回归分析显示 ,ISI、BMI、TG为影响空腹血?Objective To investigate the relationship among fasting serum free fatty acid(FFA), insulin sensitivity index(ISI), serum triglyceride(TG) and total cholesterol(TC) levels in subjects with different body mass index(BMI) and glucose tolerance by using Bergman′s minimodel method. Methods 26 normal control subjects, 39 obese subjects, 25 impaired glucose tolerance(IGT) subjects and 21 patients with newly diagnosed type 2 diabetes mellitus (DM) were recruited into this study. Serum FFA level was mearsured with radioimmunoassay and ISI was obtained by using Bergman′s minimal model method. Results(1) In the four groups, serum FFA concentration of the control group was significantly lower than that of the other three groups, although there was no difference among the latter three. (2) ISI level of the control group was significantly higher than that of other three groups, while there was no difference among the latter three. (3) After adjusting with BMI, there was still significant difference in serum FFA levels between the control and the other three groups. (4) ISI, HOMAIR,BMI, waist hip ratio(WHR) and TG were all related to the concentration of serum FFA (r=-0.454,0.213,0.241,0.336 and 0.414 respectively, P<0.01, <0.05,<0.05,<0.01and <0.01 respectively), while age,sex and serum TC levels were not related with serum FFA. (5) According to multivariate stepwise regression, ISI, BMI and TG were the major determinant factors for FFA(R2 = 0.109、0.212、0.156,P<0.001). Conclusions Besides BMI, ISI and serum TG level are the major determinant factors that affect the concentration of serum FFA. As compared with the simple index HOMAIR, ISI level was more significantly related with serum FFA concentration. FFA levels are significantly different in various glucose tolerant states even after adjusting with BMI. FFA levels were obviously higher in subjects with IGT or type 2 diabetes mellitus.

关 键 词：血清游离脂肪酸 体重指数 糖耐量个体 胰岛素敏感性 2型糖尿病 

分 类 号：R587.1[医药卫生—内分泌]