论文标题:男性2型糖尿病患者简易体脂参数与精确体脂的关系及体脂分布与代谢紊乱的相关性研究
Correlation between Anthropometric Parameters and Abdominal Fat Area Assessed by a Computed Tomography Method, and Relationship of the Fat Distribution with Metabolic Disorders in Chinese Type 2 Diabetic Male Patients
论文作者
论文导师 冉兴无,论文学位 硕士,论文专业 内科学
论文单位 四川大学,点击次数 91,论文页数 68页File Size3398K
2006-10-01论文网 http://www.lw23.com/lunwen_192291402/
Type 2 diabetes mellitus;; Visceral adipose area ;;Abdominal subcutaneous adipose area ;;Metabolic risk factors;; The total body fat mass ;;Total abdominal fat area;; Multiple stepwise regression;; Receiver operating characteristic (ROC) curves
[目的]研究男性2型糖尿病患者简易体脂参数与腹壁皮下(SA)及腹腔内脂肪含量(VA)的关系，并用简易体脂参数来建立预测SA及VA的方程；评价体重指数(BMI)、腰围(WC)、腰臀比(WnR)估测男性2型糖尿病患者腹内型肥胖的最佳临界点、敏感度及特异度；探讨男性2型糖尿病患者体脂分布与代谢紊乱的关系。 [对象和方法]横断面研究。①对91例男性2型糖尿病患者，测量体重(W)、身高(H)，并计算BMI，总体脂以BMI表示；体脂分布采用计算机断层扫描在患者腰椎4-5间隙水平进行SA及VA的测量，并计算VA与SA的比值(VSR)以及腹部总脂量(TAF=VA+SA)，同时测量收缩压(SBP)、舒张压(DBP)，空腹甘油三酯(TG)、胆固醇(TC)、高密度脂蛋白胆固醇(HDL-c)、载脂蛋白A1(apoA1)、载脂蛋白B100(apoB100)、空腹血糖(FPG)、糖化血红蛋白A_(1c)(HbA_(1c))、至腹胰岛素(Fins)、空腹及餐后2小时游离脂肪酸(FFA0h，FFA2h)、血尿酸(UA)水平；②随机抽取80％的病例(77例)通过多元逐步回归分析，分别以SA及VA为因变量，W、BMI、WC以及WHR为自变量，建立回归方程，用剩余的20％受试者(14例)对回归方程进行回代验证；③以受试者工作特性(ROC)曲线评价简易体脂参数对男性2型糖尿病患者腹内型肥胖(VFO)的诊断价值；④采用Pearson相关分析和偏相关分析，分析BMI、VA、SA、TAF、VSR与糖尿病患者代谢危险因素的关系；采用多元逐步回归分析方法，进一步分析BMI、VA、SA、TAF、VSR与糖尿瘸患者代谢危险因素的关系。 [结果]①在男性2型糖尿病患者，其体脂分布与年龄无相关关系，无论BMI的高低，其VSR均明显高于欧美肥胖人群和我国肥胖人群；BMI、WC、WHR与VA呈正相关关系，尤以BMI、WC的相关性为好；经CT诊断，超重/肥胖者89．80％、正常体重者47．62％呈VFO(VA≥100cm~2)；②预测SA的回归方程中包含了BMI，预测VA的回归方程中包含了WC和BMI；在回代验证中，SA的预测值与实际测量值之间的平均差异为+4．34％，VA的预测值与实际测量值之间的平均差异为+2．06％，预测值与实际测量值之间的吻合程度较好；③简易体脂参数估测男性2型糖尿病患者腹内脂肪积聚的最佳切割点为BMI：25kg/m~2，WC：90 cm，WHR：0．93；当BMI≥28 kg/m~2，100％的患者为VFO，当WC≥95 cm时，91．90％的患者为VFO；④VFO组的HbA_(1c)、TG、FFA0h水平高于皮下型肥胖(SFO)组，Fins、FPG水平低于SFO组，差异有显著性(P＜0．05)：偏相关分析，在校正年龄、糖尿病病程和BMI后，VA、SA和TAF均与FFA0h呈正相关，VSR与HbAlc呈正相关；⑤多元逐步回归分析显示，BMI为影响DBP、UA、Fins的独立危险因素，是影响SBP、TG、HDL-c的重要因素；TAF是影响FFA2h的独立危险因素；VA为影响FFA0h的独立危险因素；SA是影响FPG的独立危险因素；VSR是影响HbA_(1c)的独立危险因素。 [结论]①与中国肥胖人群一样，男性2型糖尿病患者的体脂分布仍以中心性肥胖为主，尤以VA增加为特点：②男性2型糖尿病患者的SA及VA可以通过简易体脂参数来预测；③BMI、WC及WHR都可估测男性2型糖尿病患者VFO，但以BMI的准确率为高；④BMI、TAF和YA对2型糖尿病患者代谢紊乱的发生起了非常重要的作用。
[Objective] To investigate the relationship of simple anthropometric parameters with abdominal subcutaneous adipose area (SA) and visceral adipose area (VA) in Chinese type 2 diabetic male patients, and to generate equations predicting SA and VA by simple anthropometric parameters; To evaluate the best cut-off point, sensitivity and specificity of simple anthropometric parameters [body index (BMI), waist circumference (WC) and Waist-to-hip ratio (WHR)] in predicting of abdominal visceral obesity in Chinese type 2 diabetic male patients; To investigate the characteristics of body fat distribution and relationship of it with the clinical metabolic parameters in Chinese type 2 diabetic male patients. [Materials and Methods] Observational, cross sectional study.①The total body fat mass was measured using BMI, VA and SA were determined using a computed tomography (CT) scans made at the level of L4/L5 in 91 Chinese type 2 diabetic male patients, VSR is the ratio of the VA to SA and the total abdominal fat area (TAF) was calculated by SFA plus VFA. Blood pressure (BP), fasting serum lipids such as triglycerides (TG), total cholesterol (TC), high density lipoprotein (HDL-c), apolipoprotein A1 (apoA1), apolipoprotein B100 (apoB100), fast plasma glucose (FPG), hemoglobin A_(1c) (HbA_(1c)), fast serum insulin (Fins), fast plasma free fatty acid (FFA0h), postprandial 2 hour plasma free fatty acid (FFA2h) and serum uric acid (UA) were also determined.②Multiple stepwise regression analysis was used to generate equations for predicting SA and VA from simple anthropometric parameters of 77 subjects (80%) randomly selected from the overall sample. These equations were then cross-validated in the remaining 14 subjects (20%). Receiver operating characteristic (ROC) curves was used as index for analysis.④The relationship between the metabolic risk factors and BMI, VA, SA, TAF and VSR in Chinese type 2 diabetic male patients was made by Pearson correlation analyses, partial correlation analyses and Stepwise multiple regression analysis. [Results]①Age had no relation with the body fat distribution; The VSR was significantly higher in Chinese type 2 diabetic male patients than in obese Chinese and in obese European and Americans; VA was significantly positively correlated with simple anthropometric parameters (BMI, WC and WHR, r=0.682, 0.676, 0.410, respectively; p=0.000 ), in which BMI and WC were the better than WHR; 89.80% of over-weight/obesity and 47.62% of normal weight patients were abdominal visceral fat obesity (VFO) (VA≥100 cm~2) by CT diagnosis.②The best regression equations were developed for predicting SA and VA, and the explanatory variables included BMI and WC. The equation for predicting SA included only BMI; the equation for predicting VA included WC and BMI. In the cross-validation study, the differences between predicted and observed values of VA and SA were+2.06% and +4.34%, respectively. The goodness of fit between predicted and observed values is good.③The best cut-off points of these anthropometric parameters in assessing VFO were as follow: BMI: 25 kg/m~2, WC: 90 cm, WHR: 0.93. Among them WC showed most sensitive and specific. 100% and 91.90% of type 2 diabetic male patients appeared VFO in patients with BMI≥28 kg/m~2 or WC≥95cm.④HbA_(1c), TG and FFA0h were higher in patients with VFO than in those with subcutaneous fat obesity (SFO), Fins and FPG were lower in patients with VFO than in those with SFO, P＜0.05. Pearson correlation analyses showed that age and diabetes duration were all positively correlated with SBP, HDL-c, and negatively correlated with TG; BMI was positively correlated with SBP, DBP, Fins, FFA0h, TG and UA, and inversely correlated with HDL-c. TAF, SA and VA were all negatively correlated with FPG and HDL-c, and positively correlated with Fins, FFA0h and TG; TAF and VA were also positively correlated with UA, FFA2h, SBP, DBP; SA was negatively correlated with HbA_(1c), VSR was positively correlated with HbA_(1c). Adjusting for age and diabetes duration, partial correlation analyses showed that BMI was still positively correlated with SBP, DBP, Fins, UA, FFA0h and TG, and negatively correlated with HDL-c and FPG; TAF, SA and VA were negatively correlated with FPG and HDL-c, and positively correlated with Fins, FFA0h, FFA2h and TG; Adjusting for age, diabetes duration and BMI, partial correlation analyses showed that TAF, SA and VA were all only positively correlated with FFA0h, VSR was solely positively correlated with HbA_(1c), but other relationships did not persisted.⑤Stepwise multiple regression analysis showed that BMI was an independent predictor for DBP, UA and Fins (adjusting R~2=0.091, 0.117, 0.203,p=0.004, 0.001, 0.000, respectively), and was an important predictor for SBP, TG and HDL-c (adjusting R~2=0.222, 0.236, 0.166, p=0.000, 0.002, 0.022, respectively, p=0.000); TAF was an independent predictor for FFA2h (adjusting R~2=0.056, p=0.021); VA was an independent variable associated with FFA0h (adjusting R~2=0.215, p=0.000); SA was an independent predictor for FPG (adjusting R~2=0.096, p=0.004); VSR was an independent predictor for HbA_(1c) (adjusting R~2=0.053, p=0.020). [Conclusion]①Similarly with obese Chinese, Our data suggest that in Chinese type 2 diabetic male patients, the body fat distribution was characterized with central obesity.②The absolute amount of human VA and SA in Chinese type 2 diabetic male patients can be predicted from anthropometric measurements.③Simple anthropometric parameters (BMI, WC, WHR) can all predict VFO in Chinese type 2 diabetic male patients, in which BMI was the better than WHR and WC.④The total body fat mass (BMI), TAF and VA play more important role than SA in the metabolic disorders.
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