内脏脂肪与代谢综合征危险因素的相关性研究

发布时间：2018-06-24 13:50

本文选题：内脏脂肪组织 + 中心型肥胖　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]随着肥胖人群的日益增多,代谢综合征的患病率呈逐年增长趋势。内脏脂肪组织(visceral adipose tissue,VAT)被认为是与代谢综合征发生发展密切相关的重要因素。阻塞性睡眠呼吸暂停低通气综合征(Obstructive sleep apnea-hypopnea syndrome,OSAHS)作为最常见的睡眠呼吸疾病,随着病情的发展可导致高血压、冠心病、脑血管意外、糖脂代谢紊乱,也是代谢综合征的危险因素之一。本研究应用生物电阻抗分析法测量内脏脂肪面积,分析内脏脂肪组织与代谢综合征危险因素之间的关系,旨在更好阐释肥胖与慢性疾病风险的相关性,为肥胖相关的代谢性疾病的治疗策略提供依据。[方法]选取2016年8月至2017年1月期间在昆明医科大学附属延安医院老年病科住院治疗150例符合代谢综合征诊断标准(IDF/AHA/NHLBI)的患者,对所有患者的年龄、性别、体重、身高、体质指数(Body mass index,BMI)进行记录,所有患者均行腹部内脏脂肪组织面积(VAT)检测、简易睡眠呼吸监测记录睡眠呼吸暂停低通气指数(apneahypopneaindex, AHI)及夜间最低血氧饱和度(Sp02)、血压测定,采集患者静脉血标本,检测并记录其空腹血糖(FBG)、总胆固醇(TC)、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、脂蛋白a (Lp(a))、尿酸(UA) 。[结果](1)本研究纳入的150例患者中,年龄波动于22-75岁之间,平均年龄为54.18±11.95岁。其中男性113例,所占比例为75. 33%;女性37例,所占比例为24.67%。(2)按BMI值分为3组,分别为BMI正常组(18. 5≤BMI25)、超重组(25≤BMI28)、肥胖组(BMI≥28),其中正常组44例(29.33%),超重组48例(32%),肥胖组58例(38.67%),三组中VAT超标患者所占比例分别为38.64%、75%、96.55%,随着BMI增加,VAT超标所占比例也逐渐升高。(3)根据AHI值分为4组,分别为非OSAHS组(AHI5)、轻度OSAHS组(5≤AHI15)、中度 OSAHS 组(15≤AHI30)、重度 OSAHS 组(AHI≥30),其中非OSAHS患者12例(8%),轻度OSAHS患者36例(24%),中度OSAHS患者51例(34%),重度OSAHS患者51例(34%),四组中VAT超标患者所占比例分别为25%、36.11%、80.39%、98. 04%,随着OSAHS严重程度的加重,VAT超标所占比例也逐渐增高。(4)根据SpO2值分为4组,分别为血氧饱和度正常组(SpO2≥90%)、轻度低氧血症组(85%≤SpO290%)、中度低氧血症组(80%≤SpO285%)、重度低氧血症组(SpO280%),其中血氧饱和正常组88例(58.67%),轻度低氧血症组50例(33. 33%),中度低氧血症组9例(6%)及重度低氧血症组3例(2%),以上四组中VAT超标患者所占比例分别为56. 82%、94%、100%、100%,随着低氧血症的加重,VAT超标所占比例也逐渐升高;(5)根据VAT值分为2组,分别为VAT超标(VAT≥100cm2)组及VAT正常组(VAT100cm2),其中VAT超标组(109例)及VAT正常组(41例),对两组进行差异性分析,统计学分析结果显示,VAT超标组与VAT正常组在BMI、收缩压、舒张压、AHI、最低SpO2、TC、TG、LDL-C、UA有显著差异(P0.05);(6)将差异有统计学意义的指标与VAT进行相关性分析,结果显示,VAT与BMI、收缩压、舒张压、AHI、TC、LDL-C呈正相关,与最低SpO2呈负相关,均有统计学意义(P0.05) , VAT与TG及UA呈正相关,但无统计学意义(P0.05);(7)以VAT是否超标为因变量,以差异有统计学意义的指标为自变量,进行Logistic回归分析,结果显示BMI、舒张压、AHI是VAT超标的主要危险因素。[结论](1) VAT与BMI有显著相关性,两者均能反映肥胖的程度。其中内脏脂肪更能有效筛查出代谢综合征的高危人群,减少漏诊率。(2) VAT与SBP、DBP、TC、LDL-C呈显著相关性,可能是代谢综合征一个新的高危因素。(3)VAT与AHI、Sp02呈显著相关性,能更好的预测心血管事件的发生风险,可作为评估代谢综合征患者预后不良的指标。
[Abstract]:[Objective] with the increasing number of obese people, the prevalence of metabolic syndrome is increasing year by year. Visceral adipose tissue (VAT) is considered as an important factor which is closely related to the development of metabolic syndrome. Obstructive sleep apnea hypopnea syndrome (Obstructive sleep apnea-hypopnea syndrome, OSA) HS) as the most common sleep respiratory disease, with the development of the disease can lead to hypertension, coronary heart disease, cerebrovascular accident, glucose and lipid metabolism disorder, and also one of the risk factors of metabolic syndrome. This study used bioelectrical impedance analysis to measure the area of visceral fat and analyze the relationship between internal fat tissue and metabolic syndrome. The purpose of this study was to better explain the correlation between obesity and the risk of chronic diseases and to provide a basis for the treatment of obesity related metabolic diseases. [Methods] 150 patients in the Department of Geriatrics, affiliated to the Yanan hospital, affiliated to Kunming Medical University, from August 2016 to January 2017, were selected to meet the metabolic syndrome diagnostic criteria (IDF/AHA/NHLBI). All patients' age, sex, weight, height, body mass index (Body mass index, BMI) were recorded, all patients underwent abdominal visceral adipose tissue area (VAT) detection, simple sleep breathing monitoring recorded the sleep apnea hypopnea index (apneahypopneaindex, AHI) and night minimum oxygen saturation (Sp02), blood pressure measurement, and collection of patients. Blood glucose (FBG), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), lipoprotein a (Lp (a)), uric acid (UA). [results] (1) the age fluctuated between the age of 22-75 years and the average age of 54.18 + 11.95 years. The proportion of 113 men was 75.33%, and the proportion of 37 women was 24.67%. (2), which were divided into 3 groups according to the value of BMI, including the normal group of BMI (18.5 < < BMI25), the super recombination (25 < BMI28), the obese group (BMI > 28), including the normal group 44 cases (29.33%), the super recombination (32%), and the obesity group 58 cases (38.67%). 96.55%, with the increase of BMI, the proportion of VAT exceeded the standard. (3) according to the AHI value, it was divided into 4 groups, namely, non OSAHS group (AHI5), mild OSAHS group (5 < < AHI15), moderate OSAHS group (15 < < AHI30), severe OSAHS group (AHI > 30), 12 cases (8%), 36 patients (24%), moderate patients and severe patients. 51 cases (34%), the proportion of VAT overweight patients in the four groups was 25%, 36.11%, 80.39%, 98.04%. With the severity of OSAHS aggravation, the proportion of VAT exceeded the standard. (4) according to the value of SpO2, it was divided into 4 groups (SpO2 > 90%), mild hypoxemia group (85% < < < <), and moderate hypoxemia group (80% < SpO285%). Severe hypoxemia group (SpO280%), of which 88 cases (58.67%), 50 cases (33.33%) of mild hypoxemia, 9 cases in moderate hypoxemia group (6%) and 3 cases of severe hypoxemia (2%), the proportion of patients with VAT exceeding the standard in the four groups were 56.82%, 94%, 100%, 100%, and the proportion of VAT exceeded the standard of hypoxemia. (5) it was divided into 2 groups according to the VAT value, which were VAT super standard (VAT > 100cm2) group and VAT normal group (VAT100cm2), of which VAT exceeded the standard group (109 cases) and VAT normal group (41 cases), and the two groups were analyzed differently. The statistical analysis showed that VAT super standard group and VAT normal group were BMI, systolic pressure, diastolic pressure, AHI, minimum, minimum The difference (P0.05); (6) the correlation analysis of statistically significant indexes and VAT showed that VAT and BMI, systolic pressure, diastolic pressure, AHI, TC, LDL-C were positively correlated, and were negatively correlated with the lowest SpO2 (P0.05), and VAT was positively correlated with TG and UA, but (7) whether or not to exceed the standard as the dependent variable Logistic regression analysis showed that BMI, diastolic pressure and AHI were the main risk factors for VAT exceeding the standard. [Conclusion] [Conclusion] (1) there is a significant correlation between VAT and BMI, both of which can reflect the degree of obesity. Among them, visceral fat can be more effective in screening high-risk groups of metabolic syndrome and reducing the rate of missed diagnosis ((2)) VAT has a significant correlation with SBP, DBP, TC and LDL-C. It may be a new high risk factor for metabolic syndrome. (3) VAT has a significant correlation with AHI, Sp02, and can better predict the risk of cardiovascular events. It can be used as an indicator to assess the poor prognosis of metabolic syndrome.
【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R589

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