中老年非糖尿病人群中预估人体脂肪质量及比例与胰岛素抵抗的关系研究  

Associations of Predicted Body Fat Mass and Fat Percentage with Insulin Resistance among a Middle-aged and Elderly Non-diabetic Population

作　　者：阮海燕 李丽英 郑翼[1] 陈晓平[1] 何森[1] RUAN Haiyan;LI Liying;ZHENG Yi;CHEN Xiaoping;HE Sen(Department of Cardiology,West China Hospital of Sichuan University,Chengdu 610041,China;Department of Cardiology,Shuangliu District Hospital of Chinese Medicine,Chengdu 610200,China)

机构地区：[1]四川大学华西医院心内科,四川省成都市610041 [2]四川省成都市双流区中医医院心内科,610200

出　　处：《中国全科医学》2022年第20期2443-2449,共7页Chinese General Practice

基　　金：四川省科技计划项目(2022YFS0186);国家自然科学基金资助项目(81600299)。

摘　　要：背景胰岛素抵抗(IR)是代谢综合征、2型糖尿病、高血压、动脉粥样硬化等多种疾病的共同病理基础,因此识别IR具有重要的临床价值。既往研究提示人体脂肪的过度增加与IR密切相关。临床实践中,测定人体脂肪的金标准通常采用双能X线吸收测量法,但其经济卫生学成本较高。目的探讨在成都地区中老年非糖尿病自然人群中预估人体脂肪质量(pFM)及预估人体脂肪比例(pFP)与IR的关系。方法于2007年5月,在四川省成都市成华区采用随机整群抽样方法抽取中老年自然人群共711例,排除已诊断为糖尿病者141例,最终纳入570例非糖尿病人群。由经培训的医务人员对抽样的人群进行调查研究,调查内容主要包括标准化的问卷调查、体格检查和实验室检查,并计算稳态模型评估的胰岛素抵抗指数(HOMA-IR)、pFM和pFP。结果570例研究对象中,HOMA-IR 0.01~5.50,中位HOMA-IR 1.05(0.72,1.53);pFM 2.34~41.41 kg,平均pFM(18.59±6.47)kg;pFP 13.95%~48.46%,中位pFP 28.97(23.77,37.39)%;共115例(20.17%)研究对象发生IR。随着pFM、pFM的增加,HOMA-IR和IR患病率均逐渐增加(P<0.001)。多因素Logistic回归分析结果显示,pFM〔OR=3.22,95%CI(2.45,4.33)〕、pFP〔OR=3.51,95%CI(2.61,4.84)〕是非糖尿病人群发生IR的影响因素(P<0.05)。分别绘制pFM及pFP预测非糖尿病人群发生IR的受试者工作特征(ROC)曲线,结果显示,ROC曲线下面积(AUC)分别为0.777〔95%CI(0.733,0.822)〕、0.719〔95%CI(0.668,0.769)〕,截断值分别为38.10 kg、17.74%。其他常用人体测量学指标腰围、体质指数(BMI)、腰高比(WHtR)、身体形态指数(ABSI)预测非糖尿病人群发生IR的ROC曲线,结果显示,AUC分别为0.749〔95%CI(0.700,0.798)〕、0.753〔95%CI(0.706,0.801)〕、0.768〔95%CI(0.722,0.815)〕及0.618〔95%CI(0.561,0.675)〕。pFM、pFP的AUC均大于ABSI(Z=4.452,P<0.001;Z=2.486,P=0.013)。结论在成都地区中老年非糖尿病人群中,pFM及pFP与IR独立相关,并可较Background Identifying insulin resistance(IR)is of important clinical value as it is a pathological basis of multiple diseases,such as metabolic syndrome,type 2 diabetes,hypertension,and atherosclerosis.Numerous previous studies have suggested that excessive gain of fat is closely associated with IR.Dual-energy X-ray absorptiometry is often clinically used as the golden standard for measuring human body fat,but its health economic cost is high.Objective To assess the associations of predicted fat mass(pFM)and predicted fat percent(pFP)with IR in a middle-aged and elderly population without diabetes in Chengdu.Methods In May 2007,a cross-sectional survey was conducted by trained medical workers in Chenghua District,Chengdu,Sichuan.A total of 711 middle-aged and elderly individuals were selected as surveyees by random cluster sampling,and 570 of them were included for analysis after excluding 141 with diabetes.The survey includes filling in a standardized questionnaire,a physical examination,and a laboratory test.The homeostasis model assessment of IR(HOMA-IR),pFM,and pFP were calculated.Results Among the 570 subjects,the range of HOMA-IR was from 0.01 to 5.50,with a median value of 1.05(0.72,1.53);the range of pFM was from 2.34 to 41.41 kg,with a value of mean(SD)of(18.59±6.47)kg;the range of pFP was from 13.95%to 48.46%,with a median value of 28.97(23.77,37.39)%.The prevalence of IR was 20.17%(115/570).The results suggested the HOMA-IR value and IR prevalence increased with the increase of pFM and pFP(P<0.001).Multivariate Logistic regression analysis indicated that both pFM〔OR=3.22,95%CI(2.45,4.33)〕and pFP〔OR=3.51,95%CI(2.61,4.84)〕were associated with IR(P<0.05).For predicting IR,the area under the receiver operating characteristic curve(AUC)was 0.777〔95%CI(0.733,0.822)〕with 38.10 kg as the optimal cut-off value for pFM,and 0.719〔95%CI(0.668,0.769)〕with 17.74%as the optimal cut-off value for pFP,respectively.And the AUC for four common traditional anthropometric indicators,namely waist circumfer

关 键 词：胰岛素抵抗 人体脂肪质量 人体脂肪质量比例 中老年人 

分 类 号：R458.5[医药卫生—治疗学]