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目的探讨血清脂联素浓度与体脂分布及组织胰岛素敏感性的关系。方法对44例上海地区正常糖耐量中国人,其中正常体重组(体重指数<25kg/m2)12例、超重组(25kg/m2≤体重指数<30kg/m2)19例及肥胖组(体重指数≥30kg/m2)13例进行扩展高胰岛素正葡萄糖钳夹试验,以钳夹稳态期的胰岛素介导的葡萄糖利用率(Rd)来判定周围组织的胰岛素敏感性。同时测定总体脂[体重指数、体脂百分比(FAT%)、身体脂肪块重量(FM)]、局部体脂[腰围、臀围、腰臀比、腹部皮下脂肪面积(SA)、腹腔内脂肪面积(VA)和股部皮下脂肪面积(FA)],并应用放射免疫法测定空腹血清脂联素浓度。结果(1)在校正年龄、性别后,超重组及肥胖组的血清脂联素浓度(8.7mg/L±4.8mg/L及6.7mg/L±0.8mg/L)均低于正常体重组(15.7mg/L±1.8mg/L,均P<0.01);(2)血清脂联素浓度与体重指数、腰围、腰臀比、FAT%、FM、VA均呈负相关,但与腰围、VA的相关性最强(r值分别为-0.46和-0.53,均P<0.01);(3)血清脂联素浓度与Rd(r=0.52,P<0.01)及糖原合成率(r=0.36,P<0.05)呈正相关,而与游离脂肪酸浓度呈负相关(r=-0.41,P<0.05);(4)多元逐步回归分析表明,血清脂联素浓度是除性别、体重指数、腰臀比或VA、SA以外,对Rd的独立影响因素,其贡献值分别为3.52%和4.84%(均P<0.05)。结论(1)血清脂联素浓度降低与总体脂增加,尤其是腹腔内体脂增加关系最为密切;(2)血清脂联素浓度是独立于体脂因素之外的影响胰岛素敏感性的因素之一。
Objective To investigate the relationship between serum adiponectin concentration and body fat distribution and tissue insulin sensitivity. Methods Totally 44 Chinese patients with normal glucose tolerance in Shanghai were enrolled. Among them, 12 were normal weight group (body mass index <25kg / m2), 19 were overweight group (25kg / m2 ≤ body mass index <30kg / m2) 30 kg / m2), 13 patients underwent extended hyperinsulinemic positive glucose clamp test to determine the insulin sensitivity of the surrounding tissues with steady-state insulin-mediated glucose utilization (Rd). Body fat [waist circumference, hip circumference, waist-hip ratio, abdominal subcutaneous fat area (SA), intra-abdominal fat area (VA) and subcutaneous fat area (FA)], and the fasting serum adiponectin concentration was determined by radioimmunoassay. Results (1) Serum adiponectin concentrations (8.7 mg / L ± 4.8 mg / L and 6.7 mg / L ± 0.8 mg / L) in both overweight and obesity groups were lower than those of normal body weight group 15.7mg / L ± 1.8mg / L, all P <0.01); (2) Serum adiponectin concentration was negatively correlated with body mass index, waist circumference, waist-hip ratio, (R = 0.52, P <0.01), and glycogen synthesis rate (r = 0.36, r = 0.36, r = , P <0.05), but negatively correlated with free fatty acid concentration (r = -0.41, P <0.05). (4) Multiple stepwise regression analysis showed that serum adiponectin concentrations were significantly higher The independent contribution to Rd other than VA or SA was 3.52% and 4.84%, respectively (all P <0.05). Conclusions (1) The decrease of serum adiponectin concentration is closely related to the increase of total fat, especially the increase of intra-abdominal body fat. (2) The concentration of serum adiponectin is independent of body fat factors that affect insulin sensitivity one.