论文部分内容阅读
目的 探讨 2型糖尿病患者腹部脂肪分布与瘦素和胰岛素抵抗的关系。方法 48例 2型糖尿病患者均进行高胰岛素正血糖钳夹试验 ,根据体重指数 (BMI)和葡萄糖利用率 (GIR)将患者分为非肥胖型胰岛素敏感组 (NIS ,16例 ) ,非肥胖型胰岛素抵抗组 (NIR ,15例 )和肥胖型胰岛素抵抗组 (OIR ,17例 ) ,同时测定血清瘦素 ,胰岛素水平和腹部脂肪面积。结果 两非肥胖组 (NIS和NIR)之间的BMI相似 ,但NIR组的GIR要明显低于NIS组 ,NIR组的内脏脂肪面积比NIS组明显增高 ,NIR组的瘦素水平在皮下脂肪校正之后与NIS组差异无显著性。OIR组的皮下脂肪 ,内脏脂肪和瘦素水平比非肥胖组 (NIS和NIR)明显增高 ,OIR的GIR明显低于NIS和NIR组。多元回归分析显示 ,无论肥胖组还是非肥胖组 ,内脏脂肪是预测胰岛素抵抗的最重要变量 ;皮下脂肪是血清瘦素水平的最重要变量。结论 两种代谢不同的脂肪分布是胰岛素抵抗和瘦素水平的决定因素。
Objective To investigate the relationship between abdominal fat distribution and leptin and insulin resistance in type 2 diabetic patients. Methods 48 patients with type 2 diabetes mellitus were treated with hyperinsulinemic clamp. Patients were divided into non-obese insulin sensitive group (NIS, 16 cases) according to body mass index (BMI) and glucose utilization rate (GIR) Insulin resistance group (NIR, 15 cases) and obese insulin resistance group (OIR, 17 cases). Serum leptin level, insulin level and abdominal fat area were also measured. Results The BMI was similar between the two non-obese groups (NIS and NIR), but the GIR in NIR group was significantly lower than that in NIS group. The visceral fat area in NIR group was significantly higher than that in NIS group. The leptin level in NIR group was significantly lower than that in subcutaneous fat correction No significant difference with NIS group afterwards. The levels of subcutaneous fat, visceral fat and leptin in OIR group were significantly higher than those in non-obese group (NIS and NIR), and the GIR of OIR was significantly lower than that in NIS and NIR groups. Multivariate regression analysis showed that visceral fat was the most important predictor of insulin resistance in both obese and nonobese groups; subcutaneous fat was the most important variable in serum leptin levels. Conclusion The two different metabolic fat distributions are the determinants of insulin resistance and leptin levels.