2型糖尿病病人的内脏脂肪性肥胖和胰岛素抵抗  

Visceral obesity and insulin resistance in type 2 diabetes

作　　者：任颖[1] 刘伟[1] 陆广华[1] 范吴强[1] 厉锦华[2,3] 黄定九[2] 厉锦华 

机构地区：[1]上海第二医科大学附属仁济医院内分泌科,200001 [2]上海第二医科大学附属仁济医院心内科,200001 [3]中美儿童医学中心放射科

出　　处：《中国糖尿病杂志》2003年第2期84-87,共4页Chinese Journal of Diabetes

基　　金：上海科学技术发展基金(99427)

摘　　要：目的 探讨2型糖尿病病人内脏型肥胖和胰岛素抵抗的关系。方法 对50例2型糖尿病病人进行内脏脂肪测定,采用CT影像学检查方法;胰岛素抵抗采用高胰岛素—正血糖钳夹试验,得出葡萄糖利用率。根据有无内脏型肥胖将病人分为内脏肥胖组和非内脏肥胖组。结果 (1)内脏肥胖组的内脏脂肪平均值为127.28cm^2,非内脏肥胖组为70.41cm^2;内脏肥胖组比非肥胖型组有更高的甘油三酯水平和收缩压;内脏肥胖组的葡萄糖利用率平均值为3.54mg/(kg·min),非内脏肥胖组的平均值为9.66mg/(kg·min),二组差异有显著意义。(2)内脏脂肪和皮下脂肪与2型糖尿病病人胰岛素介导的葡萄糖利用率显著相关,内脏脂肪是胰岛素抵抗的影响的最强指数,即使与年龄、性别及体重指数校正以后也不影响结果。结论 内脏脂肪肥胖和心血管危险因子密切相关,是2型糖尿病胰岛素抵抗的独立影响因子。Objective To identify the relationship between visceral obesity and insulin resistance in subjects with type 2 diabetes. Methods 50 type 2 diabetic subjects from Ren-Ji Hospital were divided into two groups:the visceral obesity and the nonobese viscera. Abdominal fat distribution was evaluated using computer tomography scan at L4-5. Glucose disposal was measured by 2-h euglycemic hyperinsulinemic clamp. Results (1) Visceral fat was significantly increased in visceral obese group compared with nonobese visceral group (127. 28 vs 70. 41 cm2, P<0. 01). Total triglyc-erides level and blood pressure were significantly higher in visceral obese group, but diastolic blood pressure was not statistically changed. Glucose disposal was significantly lower in visceral obesity group that in nonobese visceral group [3. 54 vs 9. 66 mg/(kgmin), P<0. 01]. (2) There was a strong inverse correlation of visceral fat and subcutanuous fat with glucose disposal. Visceral fat was the best variable predicting insulin resistance, even after adjustment of age, sex and BMI. Conclusions Visceral obesity contributes to atherogenic cardiovascular risk factor profiles and is an important and independent predictor for insulin resistance in type 2 diabetes.

关 键 词：2型糖尿病 内脏脂肪性肥胖 胰岛素抵抗 CT 影像学检查 心血管危险因子 

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