摘要目的探讨不同脂肪分布在2型糖尿病患者运动中心肌缺血预测中的作用。方法选取2013年7月至2014年11月就诊的140例无临床大血管病变的2型糖尿病患者，男性83例，女性57例，测定身体成分及临床生化指标，通过运动负荷试验结果分为阳性组27例，阴性组113例，采用SPSS19.0软件进行统计分析。结果（1）阳性组与阴性组比较，年龄、性别、糖尿病病程、高血压及血脂异常病史、体质指数（BMI）、腰围及腰臀比差异无统计学意义（P>0.05）；（2）阳性组低密度脂蛋白胆固醇（LDL-C）[（2.48±0.75）mmol/L]较阴性组[（2.81±0.77）mmol/L]低（t=2.009，P<0.05），空腹血糖（FBS）、糖化血红蛋白（HbA1c）、三酰甘油（TC）、总胆固醇（TG）、高密度脂蛋白胆固醇（HDL-C）差异无统计学意义（P>0.05）。（3）阳性组与阴性组比较，总体体脂百分比、骨骼肌重量差异无统计学意义；阳性组腰臀脂肪比率[（0.93±0.06）vs.（0.88±0.08），t=-2.790，P<0.01]及内脏脂肪区域[（99.47±32.84）cm2 vs.（81.10±25.47）cm2，t=-2.822，P<0.01]较阴性组高。男性患者表现在内脏脂肪区域[（100.99±39.33）cm2 vs.（79.91±27.09）cm2，t=-2.231，P<0.05]，女性表现在腰臀脂肪比率[（0.91±0.06）vs.（0.85±0.09），t=-2.043， P<0.05]。结论同样BMI和腰臀比的2型糖尿病患者中，腹型肥胖，尤其是内脏脂肪堆积与运动中心肌缺血密切相关，腰臀脂肪比率与内脏脂肪区域较BMI及腰臀比更能预测无临床大血管病变的2型糖尿病患者运动中心肌缺血的风险。

abstractsObjective To explore the utility of different body composition for the prediction of myocardial ischemia in exercise in type 2 diabetes mellitus (T2DM) patients. Methods T2DM outpatients were selected from Jul. 2013 to Nov. 2014 (male 83, female 57) to measure body composition and clinical biochemical parameters, and divided them into two groups according to treadmill exercise testing results. Group A cases were positive (27 patients) and Group B cases were negative (113 patients). SPSS19.0 was used to make statistical analysis. Results (1) The age, gender, diabetes mellitus (DM) duration, medical history of hypertension and dyslipidemia, body mass index (BMI), waist circumference, the waist-hip fat ratio of the two groups had no significant difference (P>0.05). (2) The fasting blood glucose (FBG), glycosylated hemoglobin (HbA1c), total cholesterol (TC), triglycerides (TG), high density lipoprotein cholesterol (HDL-C) between the two groups had no significant difference. Compared with group B, the low density lipoprotein cholesterol (LDL-C) of group A [(2.48 ± 0.75) mmol/L vs. (2.81 ± 0.77) mmol/L, t=2.009, P<0.05] decreased significantly. (3) Overall body fat percentage, skeletal muscle weight of the two groups had no significant difference. Compared with group B, the waist-hip fat ratio (0.93±0.06 vs. 0.88±0.08, t=-2.790, P<0.01) andvisceral fat area [(99.47 ± 32.84) cm2 vs. (81.10 ± 25.47) cm2, t=-2.822, P<0.01] of group A increased significantly, while this difference mainly existed in male patients visceral fat area [(100.99±39.33) cm2 vs. (79.91 ± 27.09) cm2, t=-2.231, P<0.05], and waist-hip fat ratio was different in female patients of the two groups (0.91±0.06 vs. 0.85±0.09, t=-2.043, P<0.05) . Conclusion Abdominal obesity, especially visceral fat accumulation had close correlation with myocardial ischemia in exercise in T2DM patients. Waist-hip fat ratio and visceral fat area may be more effective indicators of myocardial ischemia in exercise in T 2DM patients than BMI.