不同糖代谢状态肥胖女性体脂对胰岛素敏感性的影响  

Effects of Body Fat on Insulin Sensitivity in Obese Females under Different Glycometabolism Conditions

作　　者：严孙杰[1] 沈喜妹[1] 杨立勇[1] 张松菁[1] 易如海[1] 顔晓芳 

机构地区：[1]福建医科大学附属第一医院内分泌科,福州350005

出　　处：《福建医科大学学报》2009年第6期479-482,共4页Journal of Fujian Medical University

基　　金：福建省教育厅科技项目(JA05263)

摘　　要：目的了解不同糖代谢状态肥胖女性体成分及胰岛素敏感性变化,并分析两者之间的关系。方法70例肥胖女性按口服葡萄糖耐量试验结果分为3组,采用双能X线骨密度仪测定体成分,并行静脉葡萄糖耐量试验等。计算早期胰岛素分泌功能指标胰岛素急性分泌时相(AIR)、胰岛素曲线下面积(AUCins),以稳态模型胰岛素敏感指数(HOMA2-%S)评估胰岛素敏感性,稳态模型胰岛素抵抗指数(HOMA2-IR)估测胰岛素抵抗。结果糖耐量正常组、糖调节受损组、糖尿病组体质量指数(BMI)、腰围、总体、四肢脂肪含量及总体、四肢、躯干瘦组织含量均无差异。随糖代谢恶化,躯干脂肪含量、HOMA2-IR递增;AIR、AUCins、HOMA2-%S递减。躯干脂肪含量始终与HOMA2-%S、HOMA2-IR呈独立相关,具有良好线性关系;与AIR呈线性相关为空腹血糖、年龄。结论在BMI、腰围匹配的情况下,糖代谢异常程度与躯干脂肪增加平行。体脂增加尤其分布的异常是导致不同糖代谢状态肥胖患者胰岛素敏感性下降重要的决定因素。Objective To observe the changes of body composition and insulin sensitivity in obese females under different glycometabolism conditions, and to analyze the relationship between them. Methods 70 obese women with different levels of blood glucose were divided into three groups by glucose tolerance test （OGTT）. Body composition was measured by dual-energy X-ray absorptiometry （DEXA）, and intravenous glucose tolerance test （IVGTT） also performed. The acute insulin response （AIR） and the area under the curve of insulin （AUCins） were employed to evaluate the early insulin secretion. Homeostasis model insulin sensitivity index （HOMA2-%S） was adopted to evaluate insulin sensitivity and the homeostasis model insulin resistance index （HOMA2-IR） used to assess insulin resistance. Results Obese females had no difference in body mass index（BMI）, waist circumference, total body fat（lean） content, limbs fat （lean） content and trunk lean content among the group with normal glucose tolerance （NGT）, group with impaired gucose regulation （IGR） and group with diabetes mellitus （DM）. With the deterioration of glucose metabolism women appeared to have more trunk fat content and HOMA2-IR. The opposite distribution was found in other parameters, including AIR, AUCins and HOMA2-%S. Trunk fat content was independently associated with HOMA2-%S and HOMA2-IR, and they had a good linear relationship. Age and FPG showed a linear relationship with AIR in stepwise multiple linear regression analyses. Conclusion The present data show that obese females with the same BMI and waist circumference prove to have simultaneously increases of trunk fat content and level of abnormal glucose metabolism. Increased body fat, especially abnormal distribution of body fat, plays an important role in the decrease of insulin sensitivity of obese females under different glycometabolism conditions.

关 键 词：肥胖症 葡糖耐量试验 脂肪类 胰岛 胰岛素 

分 类 号：R589.2[医药卫生—内分泌] R587.1[医药卫生—内科学]