中心性肥胖人群胰岛素抵抗和颈动脉内膜中层厚度的相关性研究

Relationship between insulin resistance and carotid intima-media thickness in central obesity patients

关键词:  中心性肥胖  颈动脉内膜中层厚度  胰岛素抵抗

Key words:  nondiabetic central obesity  insulin resistance  carotid intima-media thickness

摘要:

目的　探讨中心性肥胖人群颈动脉内膜中层厚度与胰岛素抵抗的相关关系。方法　采用REACTION研究中在大连地区参加调查的10207人，选取其中5029例非糖尿病的中心性肥胖人群作为本研究的研究对象。所有受试者均测量身高、体重、腰围、臀围、收缩压、舒张压，同时测定空腹血糖（FPG）、75 g OGTTh血糖（2hPG）、空腹胰岛素（FINS）、糖化血红蛋白（HbA1c）、血尿酸（UA）、甘油三酯（TG）、总胆固醇（TC）、低密度脂蛋白（LDL-C）及高密度脂蛋白（HDL-C）、颈动脉内膜中层厚度（CIMT)，计算腰臀比、BMI及稳态模型胰岛素抵抗评估指数（HOMA-IR）。根据HOMA-IR值将研究人群分为胰岛素抵抗组（HOMA-IR≥73）3247例和非胰岛素抵抗组（HOMA-IR＜73）1782例。比较上述各指标在两组间的差异，研究HOMA-IR与颈动脉内膜中层厚度的相关关系。结果　（1）胰岛素抵抗和非胰岛素抵抗两组间年龄、CIMT、收缩压、FPG、2hPG、HbA1c、UA、LDL-C、HDL-C、BMI等指标差异存在显著性意义(P<0.05）;（2）偏相关分析显示，在控制年龄、HDL-C、LDL-C、TC、TG、UA及血压等因素的影响后，HOMA-IR仍与CIMT呈正相关(r=0.033，P=0.007）；Logistic回归分析显示，年龄、HOMA-IR、腰围、LDL-C是CIMT的独立危险因素(P<0.05）。HDL-C是 CIMT的保护因素(P<0.05）。结论　胰岛素抵抗是非糖尿病的中心性肥胖人群颈动脉内膜增厚的独立危险因素。

Abstract:

Objective To analyze the relationship between insulin resistance and carotid intima-media thickness (CIMT) in central obesity patients.Methods We recruited029 nondiabetic central obesity from the population of the0207 data of REACTION research in Dalian.All participants were tested for their anthropometric indices (height，weight，waist circumference，hip circumference，systolic/diastolic pressure) and biochemical indices (fasting plasma glucose （FPG） h postprandial blood glucose （2hPG），fasting insulin （FINS），glycosylated hemoglobin （HbA1c），uric acid （UA），triglycerides （TG），total cholesterol （TC），low density lipoprotein （LDL-C），high-density lipoprotein （HDL-C） and carotid intima-media thickness （CIMT）).Furthermore，BMI，waist-to-hip ratio as well as the HOMA-IR were calculated.Participants were then stratified into two groups according to their HOMA-IR：insulin-resistant group（HOMA IR≥73,n=3247）and non insulin-resistance group（HOMA IR<73,n=1782）.We compared the differences with indices between the two groups and analyzed relationship between HOMA-IR and CIMT. Results (1) There was statistically significant difference (P<0.05) in all indices between two groups stratified by HOMA-IR.(2) The partial correlation analysis showed that HOMA IR(r=0.033，P=0.007）was positively correlated with CIMT when excluding the influence of age，blood pressure，UA，LDL-C and HDL-C.Logistic regression analysis showed that age，HOMA IR，waist circumference and LDL-C were independent risk factors of CIMT(P<0.05）. HDL-C was the protection factor of CIMT(P<0.05）.Conclusion Insulin resistance is the independent risk factor of carotid intima-media thickening in nondiabetic central obesity.