·胰岛素抵抗及其相关疾病·

　　【摘要】 目的 探讨腹部脂肪分布与T2DM患者IR的相关性。 方法 将128例T2DM患者根据BMI分为肥胖(OG)组66例和非肥胖 (NOG) 组62例，采用螺旋CT测量T2DM患者腹部平脐腰4、5椎体平面脂肪组织总面积(TA)和内脏脂肪面积(VA)，计算皮下脂肪面积(SA)。检测各组一般资料及生化指标。 结果 OG组WC[男(73.52±0.88) vs (70.66±0.92)cm;女(83.22±0.96) vs (78.98±0.98)cm]、BMI[男(28.85±3.45) vs (25.11±4.36)kg/m2;女(28.23±3.48) vs (25.05±3.89)kg/m2]、SBP[男(158.23±8.25) vs (112.25±7.25)mmHg;女(154.25±6.32) vs (109.68±8.02)mmHg]、DBP[男(95.36±5.26) vs (80.69±7.25)mmHg;女(92.45±4.36) vs (80.26±6.48)mmHg]、FPG[男(9.85±2.89) vs (7.03±2.88)mmol/L;女(9.75±2.65) vs (7.39±2.98)mmol/L]、FIns[男(11.25±3.45) vs (7.02±2.43)mIU/L;女(11.02±3.58) vs (7.18±2.69)mIU/L]、HbA1c[男(7.36±1.36)% vs (5.21±0.37)%;女(7.68±1.22)% vs (5.32±0.42)%]、TG[男(5.98±1.52) vs (3.02±0.89)mmol/L;女(5.78±1.26) vs (2.98±0.92)mmol/L]、TC[男(8.02±1.28) vs (4.39±0.98)mmol/L;女(7.98±1.13) vs (4.23±0.89)mmol/L]、LDL-C[男(9.12±0.58) vs (4.21±0.86)mmol/L;女(8.96±0.78) vs (4.18±0.92)mmol/L]、SUA[男(83.63±21.64) vs (72.98±12.25)μmol/L;女(83.98±19.78) vs (71.98±11.98)μmol/L]、C-RP[男(5.96±1.25) vs (2.32±0.42)mg/L;女(5.05±1.32) vs (2.52±0.56)mg/L]、HOMA-IR[男(4.25±1.12) vs (2.25±1.12);女(4.36±1.42) vs (2.12±1.02)]、TA[男(50.68±9.12) vs (30.96±3.26)cm2;女(47.23±4.23) vs (26.98±3.02)cm2]、VA[男(19.78±5.42) vs (10.59±4.69)cm2;女(17.02±3.96) vs (8.45±3.78)cm2]、SA[男(30.91±6.02) vs (18.96±5.78)mm2;女(28.25±4.23) vs (17.25±4.62)mm2]和VA/SA[男(0.72±0.22)% vs (0.42±0.18)%;女(0.58±0.17)% vs (0.32±0.12)%]高于NOG组，T2DM病程[男(2.36±0.58) vs (2.62±0.78)年;女(2.38±0.62) vs (2.82±0.82)年]、HDL-C[男(0.98±0.21) vs (2.28±0.78)mmol/L;女(0.96±0.32) vs (2.19±0.82)mmol/L]和HOMA-β[男(28.22±9.34) vs (82.22±31.25);女(28.02±8.02) vs (81.36±28.36)]低于NOG组(P<0.05)。Spearman相关性分析结果显示，HOMA-IR与TG、SUA、TA、VA、SA、VA/TA、SA/TA和VA/SA呈正相关。Logistic回归分析结果显示，TG、SA、TA和VA/TA是T2DM患者HOMA-IR的危险因素。 结论 腹部脂肪分布与T2DM患者IR关系密切。

　　【关键词】 糖尿病，2型;内脏脂肪面积;皮下脂肪面积;胰岛素抵抗

　　The correlation of abdominal adipose tissue distribution and insulin resistance in type 2 diabetes mellitus WANG Dan-tong，PENG Ding-qiong.Department of Endocrinology，The General Hospital of Civil Aviation Administration of China，Beijing 100123，China

　　Corresponding author：PENG Ding-qiong，E-mail：dingpq@yeah.net

　　【Abstract】 Objective To investigate correlation of abdominal adipose tissue distribution and insulin resistance in T2DM. Methods A total of 128 T2DM patients were divided into two groups：obese (OG) group (n=66) and non-obese (NOG) group (n=62). Spiral CT was used for the measurement of adipose tissue of the total area (TA) and visceral fat area (VA) at abdominal umbilical level lumbar vertebrae 4，5 plane in T2DM patients. Subcutaneous fat area (SA) was calculated. General and biochemical characteristics were measured in both groups. Results WC [male(73.52±0.88) vs (70.66±0.92)cm;female(83.22±0.96) vs (78.98±0.98)cm]，BMI [male(28.85±3.45) vs (25.11±4.36)kg/m2;female(28.23±3.48) vs (25.05±3.89)kg/m2]，SBP [male(158.23±8.25) vs (112.25±7.25)mmHg;female(154.25±6.32) vs (109.68±8.02)mmHg]，DBP [male(95.36±5.26) vs (80.69±7.25)mmHg;female(92.45±4.36) vs (80.26±6.48)mmHg]，FPG [male(9.85±2.89) vs (7.03±2.88)mmol/L;female(9.75±2.65) vs (7.39±2.98)mmol/L]，FIns [male(11.25±3.45) vs (7.02±2.43)mIU/L;female(11.02±3.58) vs (7.18±2.69)mIU/L]，HbA1c [male(7.36±1.36)% vs (5.21±0.37)%;female(7.68±1.22)% vs (5.32±0.42)%]，TG [male(5.98±1.52) vs (3.02±0.89)mmol/L;female(5.78±1.26) vs (2.98±0.92)mmol/L]，TC [male(8.02±1.28) vs (4.39±0.98)mmol/L;female(7.98±1.13) vs (4.23±0.89)mmol/L]，LDL-C [male(9.12±0.58) vs (4.21±0.86)mmol/L;female(8.96±0.78) vs (4.18±0.92)mmol/L]，SUA [male(83.63±21.64) vs (72.98±12.25)μmol/L;female(83.98±19.78) vs (71.98±11.98)μmol/L]，C-RP [male(5.96±1.25) vs (2.32±0.42)mg/L;female(5.05±1.32) vs (2.52±0.56)mg/L]，HOMA-IR [male(4.25±1.12) vs (2.25±1.12);female(4.36±1.42) vs (2.12±1.02)]，TA [male(50.68±9.12) vs (30.96±3.26)cm2;female(47.23±4.23) vs (26.98±3.02)cm2]，VA [male(19.78±5.42) vs (10.59±4.69)cm2;female(17.02±3.96) vs (8.45±3.78)cm2]，SA [male(30.91±6.02) vs (18.96±5.78)mm2;female(28.25±4.23) vs (17.25±4.62)mm2]and VA/SA [male(0.72±0.22)% vs (0.42±0.18)%;female(0.58±0.17)% vs (0.32±0.12)%] were significantly higher in OG group than in NOG group. T2DM course [male(2.36±0.58) vs (2.62±0.78)years;female(2.38±0.62) vs (2.82±0.82)years]，HDL-C [male(0.98±0.21) vs (2.28±0.78)mmol/L;female(0.96±0.32) vs (2.19±0.82)mmol/L] and HOMA-β [male(28.22±9.34) vs (82.22±31.25);female(28.02±8.02) vs (81.36±28.36)] were lower in OG group than in NOG group(P<0.05). Spearson correlation analysis showed that HOMA-IR was positively associated with TG，SUA，TA，VA，SA，VA/TA，SA/TA and VA/SA. Logistic multiple regression analysis showed that TG，SA，TA and VA/TA were risk factors for insulin resistance in T2DM patients. Conclusion Abdominal fat distribution is closely related to IR in T2DM patients.

　　【Key words】 Diabetes mellitus，type 2;Visceral fat area (VA);Subcutaneous fat area (SA);Insulin resistance (IR)