【作者】 付玲涛；

【导师】 任庆云；

【作者基本信息】 河北医科大学 ， 影像医学与核医学， 2009， 硕士

【摘要】 目的:通过测量2型糖尿病内脏型肥胖患者、非内脏型肥胖患者以及非肥胖型患者腹部内脏、皮下脂肪面积及C反应蛋白水平,探讨2型糖尿病患者腹部脂肪分布特征及其与C反应蛋白之间的关系。方法:按照1999年世界卫生组织(WHO)制定的糖尿病诊断标准,选取我院2型糖尿病病人36例,根据腰围(男性≥85cm,女性≥90cm,将病人分为腹型肥胖组26例和非肥胖10例(C)组,再根据CT测量值将腹型肥胖糖尿病病人分为内脏肥胖14例(A)组(内脏脂肪面积≥100cm2)和非内脏肥胖12例(B)组。健康对照(NC)组15例。受试者均测量身高、腰围、体重、臀围,检测空腹血糖(FPG)、血脂(TC、TG、LDL-C及HDL-C)、载脂蛋白(A、B)、血压、空腹胰岛素(FINS)及C反应蛋白(CRP)水平。根据CT扫描,测量腹部皮下脂肪面积(SA)、腹部内脏脂肪面积(VA)。计算体重指数(BMI)、腰臀比(WHR)、胰岛素抵抗指数(HOMA-IR)、内脏/皮下面积比值(VA/SA)。比较四组间空腹血糖、血脂、血压、空腹胰岛素、胰岛素抵抗指数、体重指数、腰臀比、C反应蛋白、皮下脂肪面积、内脏脂肪面积、内脏/皮下面积比值;观察C反应蛋白与腹部脂肪面积分布的相关性。采用SPSS12.0软件进行统计学处理。组间比较采用方差分析或秩检验,采用Pearson和Spearman进行相关分析。结果: 1、C反应蛋白水平在A组和B组均值分别为5.03±1.06mg/L和4.73±1. 12mg/L,C组为4.68±1.13 mg/L,NC组均值为3.85±1.45 mg/L。A组C反应蛋白水平高于NC组,差异有统计学意义(P<0.01);B组和C组C反应蛋白水平高于NC组,差异有统计学意义(P<0.05); A组C反应蛋白水平高于B组和C组,差异有统计学意义(P<0.05);B组CRP水平高于C组,差异无统计学意义(P>0.05)。NC组、C组、B组至A组,C反应蛋白水平依次升高。2、A组内脏脂肪面积(VA)和皮下脂肪面积(SA)分别为129.06±38.55cm2和137.13±35.15cm2;B组内脏脂肪面积和皮下脂肪面积分别为90.52±40.26cm2和123.42±37.14cm2;C组内脏脂肪面积和皮下脂肪面积分别为87.57±38.14cm2和112.36±40.73cm2;NC组内脏脂肪面积和皮下脂肪面积分别为79.23±35.13cm2和110.26±40.73cm2。内脏脂肪面积:A组和B组高于NC组,差异有统计学意义(P<0.01); C组高于NC组,差异有统计学意义(P<0.05); B组高于C组,差异有统计学意义(P<0.05); A组高于B组和C组,差异无统计学意义(P>0.05);皮下脂肪面积:A组和B组高于NC组,差异有统计学意义(P<0.05); B组高于C组,差异有统计学意义(P<0.05); A组高于B组和C组,差异有统计学意义(P<0.05);内脏/皮下脂肪面积比值:A组高于C组和NC组,差异有统计学意义(P<0.01); B组高于C组和NC组,差异有统计学意义(P<0.05); A组高于B组,差异有统计学意义(P<0.05).4、研究结果表明:C反应蛋白与内脏脂肪面积、皮下脂肪面积、内脏面积/皮下面积比、腰围、胰岛素抵抗指数、血糖、体重指数、低密度脂蛋白、腰臀比呈正相关,在控制血糖和胰岛素抵抗指数后,C反应蛋白与内脏脂肪、内脏脂肪/皮下脂肪比、腰围呈正相关(相关系数分别为γ=0.446 p<0.01,γ=0.341 p<0.05,γ=0.374 p<0.05)。结论: 2型糖尿病患者存在C反应蛋白水平升高,提示2型糖尿病患者体内存在一定的炎症反应;合并内脏型肥胖的患者这种异常更加明显,提示C反应蛋白水平的升高和内脏脂肪的增多密切相关。减少内脏脂肪的增加是减少2型糖尿病患者体内炎症重要措施。更多还原

【Abstract】 Objective: By measuring visceral fat area (VA), subcutaneous fat area (SA) and C-reactive protein levels in the normal(NC group), type 2 diabetes patients without obesity(C group) ,type 2 diabetes patients with non-visceral obesity(B group) and type 2 diabetes patients with visceral obesity(A group) to explore relationship between C-reactive protein and abdominal fat distribution in type 2 diabetic patients.Methods: In accordance with the 1999 World Health Organization (WHO) diagnostic criteria for diabetes to develop, select 36 patients with type 2diabetes for this study our hospital. According to waist circumference (man≥85cm, females≥90cm,to navel horizontal), they were divided into two groups: type 2daibetes patients with or without obesity. According to area of visceral fat, type 2 diabetes patients with obesity were divided into two group: type 2daibetes patients with or without visceral obesity. Take 15 people as normal controls. The subjects were measured height, waist circumference, weight, hip circumference, fasting blood glucose testing(FPG), lipid(TC, TG, LDL-C, HDL-C), Apo lipoprotein(A, B), blood pressure, fasting insulin(FINS) and C-reactive protein levels, subcutaneous fat area and visceral fat area. All of body mass index (BMI), waist-hip ratio(WHR), insulin resistance index(HOMS-IR), and visceral/subcutaneous area ratio(VA/SA) were calculated. Comparison among the three groups of fasting blood glucose, blood lipids, blood pressure, fasting insulin, insulin resistance index, waist-hip ratio, C-reactive protein, subcutaneous fat area, visceral fat area, visceral/subcutaneous area ratio; observation of C-reactive protein and abdominal fat the relevance of the distribution area. All data were expressed as mean±SD, or median. Statistical comparisons were done by Pearson and Spearman analysis.Result: 1. C-reactive protein in A group were significantly higher than the normal control (P<0.01); C-reactive protein levels of B group and C group higher than the normal control (P<0.05). C-reactive protein in A group were significantly higher than B group and C group (P<0.05); C-reactive protein in B group were significantly higher than C group(P>0.05); From the normal control, C group, B group to A group, C-reactive protein levels increased in turn.2. Visceral fat area in A group, B group and C group was significantly higher than that of normal control (P<0.01); Visceral fat area in A group was significantly higher than that in B group and C group (P<0.05); visceral fat area in B group higher in C group (P>0.05); subcutaneous fat area of A group, B group, C group was higher than that of normal control (P<0.05); subcutaneous fat area in B group was higher than that in C group (P<0.05); subcutaneous fat area of A group and was higher than that in B group and C group(P<0.05); VA/SA ratio of A group, B group and C group was significantly higher than that of normal control (P<0.01); VA/SA ratio of A group and B group was significantly higher than that of C group (P<0.05); VA/SA ratio of A group was significantly higher than that of B group (P<0.05).3. C-reactive protein levels were positively correlated with waist circumference, visceral fat area, subcutaneous fat area, waist hip ratio, insulin resistance index, low density protein, body mass index, fasting glucose testing. C-reactive protein levels were positively correlated with waist circumference, visceral fat area, subcutaneous fat area, VA/SA after adjusting HOMA-IR, FPG.Conclusion: Compared with normal control group, C-reactive protein levels with type 2 diabetes patients significantly increased, suggesting that there is a certain degree of chronic inflammation process in type 2 diabetes patients. C-reactive protein levels activity increased with visceral fat. Visceral fat reduction is very important solution for type 2 diabetes patients to reduce inflammation in vivo.更多还原