肥胖伴高胆固醇血症患者胰岛素抵抗代谢指标的变化  

Insulin resistance in obese accompanying hypercholesterolemia patients

作　　者：何凌[1] 王燕[1] 梁伟[1] 陈定宇[1] 

机构地区：[1]广州市第一人民医院内分泌科,广东广州510180

出　　处：《解剖学研究》2010年第3期193-195,199,共4页Anatomy Research

基　　金：广州市医药卫生科技项目(2008-YB-002;2009-YB-001;2005-YB-008);广东省医学科研课题(B2006125)

摘　　要：目的观察肥胖伴高胆固醇血症患者胰岛素抵抗的程度。方法将2007年度门诊体检人群中体重指数(BMI)>28kg/m2者96例纳入本研究,测量血压、身高、体重、腰围、臀围、体脂含量及重量,并抽血检测空腹及口服75g葡萄糖后2h血糖(FBS,2hPBS)、胰岛素水平(FIns,2hIns),采用稳态模型评估法(HOMA)中的HOMA-IR公式评价胰岛素抵抗程度;空腹检测血脂、尿酸及糖化血红蛋白(HbA1c)水平。结果①本组肥胖症患者中,高胆固醇血症、高TG血症、混合型高脂血症及血脂水平正常者分别占37.5%,7.3%,31.2%及24%;②高Cho血症组WHR,HOMA-IR大于胆固醇正常组(0.92vs0.89,P=0.037;4.42vs3.56,P=0.032);③胰岛素抵抗组体重、腰围、臀围、WHR、BMI、脂含量、脂重量、胆固醇、FBS、UA高于非胰岛素抵抗组(73.04vs67.78,P=0.026;94.49vs87.83,P=0.001;105.14vs100.97,P=0.009;0.90vs0.87,P=0.049;29.74vs27.44,P=0.002;34.63vs32.25,P=0.049;25.11vs21.24,P=0.003;5.74vs5.44,P=0.041;5.40vs4.45,P=0.006;440.52vs355.86,P=0.017);④HOMA-IR与体脂重量、Cho、TG、WHR及BMI水平分别呈正相关(r=0.260,P=0.03,N=70;r=0.636,P=0.023,N=87;r=0.228,P=0.033,N=87;r=0.306,P=0.04,N=87;r=0.344,P=0.001,N=87)。结论②本研究所观察到的肥胖伴高胆固醇血症患者存在胰岛素抵抗,对于肥胖患者应尽早进行相关代谢指标的筛查。Objective To investigate insulin resistance level in obese accompanying hypercholesterolemia patients.Methods Ninety six out-patient clinic subjects receiving health examination in 2007 with BMI （body mass index） over 28 kg/m^2 were enrolled.Blood pressure, height, weight, waistline, hip circumference, body lipid proportion, body lipid mass, blood lipid, blood uric acid, glycosylated hemoglobin （HbA1c）, blood glucose and insulin level at fasting and 2 hours after taking 75 g glucose were measured and homeostasis model assessment （HOMA） were chosen to evaluate insulin resistance level （HOMA-IR）.Results ① The prevalence of hypercholesterolemia, hypertriacylglycemia, combined hyperlipidemia and ortholiposis in this obese group were 37.5%, 7.3%, 31.2% and 24%, respectively.②Levels of WHR and HOMA-IR were higher in patients with hypercholesterolemia than in normal cholesterol ones （0.92 vs 0.89, P=0.037; 4.42 vs 3.56, P=0.032）; ③Weight, waistline, hip circumference, waist/hip ratio, BMI, body lipid proportion, body lipid mass, cholesterol, FBS and blood uric acid were higher in insulin resistance group than those without insulin resistance （73.04 vs 67.78, P=0.026; 94.49 vs 87.83, P=0.001; 105.14 vs 100.97, P=0.009; 0.90 vs 0.87, P=0.049;29.74 vs 27.44, P=0.002;34.63 vs 32.25, P=0.049;25.11 vs 21.24, P=0.003;5.74 vs 5.44, P=0.041;5.40 vs 4.45, P=0.006; 440.52 vs 355.86, P=0.017）.④HOMA-IR index was positively correlated with body lipid mass, cholesterol, triglyceride level, WHR and BMI, respectively （r=0.260,P=0.03,N=70;r=0.636,P=0.023,N=87;r=0.228,P=0.033,N=87;r=0.306,P=0.04,N= 87;r=0.344,P=0.001,N=87）.Conclusion ② Insulin resistance exist in these obese accompanying hypercholesterolemia subjects and screening for these disorders is necessary in obese patients.

关 键 词：肥胖 高胆固醇血症 胰岛素抵抗 

分 类 号：R589.2[医药卫生—内分泌]