脂质蓄积指数在成人生长激素缺乏症患者中对胰岛素抵抗的评估价值  

Lipid accumulation product as an effective index for accessing insulin resistance in patients with adult growth hormone deficiency

作　　者：刘婵[1] 夏佳佳[1] 李林蔓[1] 刘秀容[1] 郑晓雅[1] 任伟[1] 

机构地区：[1]重庆医科大学附属第一医院内分泌科,重庆400016

出　　处：《重庆医科大学学报》2015年第7期975-980,共6页Journal of Chongqing Medical University

基　　金：国家临床重点专科建设项目资助(编号:NA2011);重庆市卫生局医学科学技术研究项目(编号:2010-2-109)

摘　　要：目的:探讨成人生长激素缺乏症(adult growth hormone deficiency,AGHD)患者脂质蓄积指数(lipid accumulation product,LAP)水平与人体测量学参数、糖脂代谢、胰岛素抵抗(insulin resistance,IR)之间的关系。方法:收集42例AGHD患者及42例健康人群,测量2组人群人体测量学参数及糖脂生化指标,计算体质指数(body mass index,BMI)、腰臀比(waist-hip ratio,WHR)、LAP、稳态模型评价胰岛素抵抗指数(homeostasis model assessment of insulin resistance,HOMA-IR)。结果:AGHD组人群LAP高于对照组人群,而且与对照组比较腰围(waist circumference,WC)、WHR、空腹胰岛素(fasting insulin,FINS)、HOMA-IR、甘油三酯(triglyceride,TG)升高,高密度脂蛋白(high density lipoprotein-cholesterol,HDL-C)降低(P<0.05)。根据AGHD人群LAP水平四分位数分组进行比较,体质量、BMI、WC、WHR、收缩压(systemic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、FINS、HOMA-IR、TG随LAP增高而递增(P<0.05)。Pearson相关性分析显示,LAP与年龄、BMI、WC、臀围(hip circumference,HC)、WHR、SBP、DBP、FINS、HOMA-IR、TG、低密度脂蛋白胆固醇(low density lipoprotein-cholesterol,LDL-C)呈正相关(P<0.05);HOMA-IR与BMI、WC、TG呈正相关(P<0.05)。IR人群LAP明显增高,ROC曲线下面积分析,LAP曲线下面积最大,LAP的最佳界限值为31.32,有较高的灵敏度与特异度。进一步进行多元线性回归分析发现LAP与BMI、SBP、HOMA-IR独立相关(β=0.414,0.249,0.329,均P<0.05)。结论:AGHD患者LAP高于健康人群,与IR及血脂相关指标显著相关。与其他体脂指标相比,有较好的IR评价价值。Objective ：To investigate the correlation of lipid accumulation product（LAP） with anthropometrics,glucolipid metabolic markers and insulin resistance（IR） in patients with adult growth hormone deficiency（AGHD）. Methods：Totally 42 patients with AGHD and 42 control subjects matched with the age and gender were enrolled. The general anthropometries and blood biochemical indexes were measured. Body mass index（BMI）,waist-hip ratio（WHR）,LAP and HOMA-IR were calculated. Results：Compared with those in control group,the waist circumference（WC）,WHR,fasting insulin（FINS）,homeostasis model assessment of insulin resistance（HOMA-IR）,triglyceride（TG） and LAP were increased in AGHD group,while high density lipoprotein-cholesterol（HDL-C） level was lower in AGHD group（P0.05）. Weight,BMI,WC,WHR,SBP,DBP,FINS,HOMA-IR and TG increased as LAP increased（P0.05）. Pearson analysis revealed that LAP was positively related with age,BMI,WC,HC,WHR,systemic blood pressure（SBP）,diastolic blood pressure（DBP）,FINS,HOMA-IR,TG and low density lipoprotein cholesterol（LDL-C）（P0.05）. After age was adjusted,the positive correlations were still existed（except DBP）. In addition,HOMA-IR was positively correlated with BMI,WC and TG（P0.05）. LAP was higher in AGHD patients with IR. ROC analysis showed that LAP was a significant discriminator for IR in AGHD patients,and the optimal cutoff point of LAP to predict IR was 31.32（90.9% sensitivity,61.30% specificity）. Further more,multivariable linear regression models revealed that BMI,SBP,HOMA-IR were independently related with the LAP（β=0.414,0.249,0.329,resp,P0.05）. Conclusion：The LAP is significantly higher in AGHD patients than control subjects. LAP is associated with IR and had a strong and reliable diagnostic accuracy for IR in AGHD patients.

关 键 词：生长激素缺乏症 脂质蓄积指数 胰岛素抵抗 

分 类 号：R584.2[医药卫生—内分泌]