摘要目的 探讨成人体脂分布与胰岛素抵抗、胰岛β细胞功能及代谢紊乱的关系.方法 纳入2012年2-11月在中南大学湘雅二医院的成年体检人群共174例,采集人体学参数,进行口服葡萄糖耐量试验(OGTT)、胰岛素释放试验(IRT)并检测血生化指标,采用双能X线吸收法(DEXA)测量体脂分布.结果 受试者的躯干/全身脂肪比(T/B)、腰/臀部脂肪比(A/G)与血压、血脂、血糖、稳态模型胰岛素抵抗指数(HOMA-IR)、高敏C反应蛋白(hs-CRP)呈正相关.与代谢正常组比较,代谢紊乱组的体质指数(BMI)、腰围、腰臀比、腰围/身高比(WHtR)、T/B、A/G均高(均P＜0.05).多元逐步回归分析显示,lnHOMA-IR的主要影响因素为BMI(β=0.36,P=0.000)和T/B(β=0.19,P =0.033)；稳态模型胰岛β细胞的自然对数(InHOMA-β)的主要影响因素为臀部脂肪含量(β=0.31,P =0.000).Logistic回归分析提示,腰部脂肪含量增加(OR =3.01,95％CI 1.86 ～8.17)和A/G增加(OR=2.71,95％ CI 1.75～6.56)分别是发生高血糖、血脂异常的危险因素.结论 躯干及腰部脂肪含量增加可促进胰岛素抵抗、代谢紊乱.躯干及臀部脂肪含量分别是胰岛素抵抗、胰岛β细胞功能的主要影响因素.腰部脂肪含量是糖脂代谢异常的主要危险因素.

abstractsObjective To explore the relationship between body fat distribution,insulin resistance,islet β cell function and metabolic disorders in adult population.Methods From February to November 2012,a total of 174 subjects aged 20-68 years were recruited.Their anthropometric parameters,blood biochemical indices and the results of oral glucose tolerance test (OGTT) and insulin releasing test (IRT) were collected.Body fat distribution was measured with dual energy X-ray absorptiometry (DEXA).Results The values of trunk/total fat mass (T/B) and android/gynoid fat mass ratio (A/G) were positively correlated with blood pressure,blood lipid,plasma glucose,insulin resistance index (HOMA-IR) and highsensitivity C-reactive protein.Compared with the group of normal metabolism,the group of metabolic disorders had higher T/B and A/G (P ＜ 0.05).After multiple stepwise regression analysis,the main influencing factors of lnHOMA-IR and lnHOMA-β were T/B and G respectively.Logistic regression showed that A (OR =3.01,95％ CI 1.86-8.17) was a risk factor for diabetes and A/G (OR =2.71,95％ CI 1.75-6.56) a risk factor for dyslipidemia.Conclusions Trunk and android fat deposition aggravates insulin resistance,metabolic disorders.And the main influencing factors of insulin resistance and islet β cell function are trunk and gynoid fat respectively.Android fat mass is a major risk factor for glycolipid metabolism.