不同糖耐量人群脂肪组织分布与维生素D及骨代谢指标的关系
发布时间：2018-08-06 19:53
【摘要】：[目的]探讨不同糖耐量人群中脂肪分布与维生素D(vitaminD)及骨代谢相关指标的关系。[方法]本研究共收集研究对象180例,根据糖耐量状态分为三组:糖耐量正常组(NGT组)61例;糖耐量减低组(IGT组)13例;2型糖尿病组(T2DM组)106例。测定所有研究对象的一般临床资料及维生素D中间代谢产物25-羟维生素 D(25-hydroxy vitamin D,25(OH)D)浓度和 1,25-二羟维生素 D3(1,25-dihydroxy vitamin D3,1,25(OH)2D3)浓度、甲状旁腺素(PTH)、钙离子浓度等指标,双电阻抗法测定所有研究对象腹部皮下脂肪组织(subcutaneous adipose tissue,SAT)和内脏脂肪组织(visceral adipose tissue,VAT)面积,双能 X线骨密度仪测定腰椎骨密度,X线衰减法测定体脂肪含量并计算体脂指数(Fat massindex,FMI),HOMA模型计算胰岛素抵抗指数(HOMA-IR)、胰岛β细胞功能(HOMA-β),计算胰岛素敏感指数(ISI),探讨不同糖耐量人群中脂肪分布与维生素D及骨代谢相关指标的关系。[结果]1、NGT组:①25(OH)D与VAT面积、SAT面积、Weight、BMI、Fat%、FMI、WC、HC、WHR 均无相关性(P0.05),1,25(OH)2D3 与 VAT 面积、SAT 面积、Weight、BMI、Fat%、FMI 呈显著负相关(P0.05);②将 NGT组按照VAT面积是否大于100cm2分为内脏脂肪正常组和内脏脂肪超标组,按照Fat%是否30%分为 Fat%30%组和 Fat%30%组,按照 BMI 是否24kg/m2分为BMI正常组和BMI超标组,1,25(OH)2D3在三种分组下差异均有统计学意义(P0.05),1,25(OH)2D3 在 VAT 超标组、Fat%30%组,BMI 超标组均明显降低,25(OH)D在三种分组下差异均无统计学意义(P0.05);③NGT组1,25(OH)2D3相关因素多元回归分析:VAT面积是影响活性维生素D3最主要的因素。2、T2DM 组:①T2DM 组 1,25(OH)2D3 低于 IGT 组;②25(OH)D 与 Weight、VAT面积呈显著负相关(P0.05),1,25(OH)2D3与VAT面积、SAT面积、Weight、BMI、Fat%、FMI、WC、HC、WHR 呈显著负相关(P0.05);③将T2DM 按照VAT面积是否大于100cm2分为内脏脂肪正常组和内脏脂肪超标组,按照Fat%是否30%分为Fat%30%组和Fat%30%组,按照BMI是否24kg/m2分为BMI正常组和BMI超标组,1,25(OH)2D3在三种分组下差异均有统计学意义(P0.05),1,25(OH)2D3在VAT超标组、Fat%30%组,BMI超标组均明显降低,25(OH)D在三种分组下差异均无统计学意义(P0.05);④与VAT正常组相比,VAT超标组HOMA-IR升高、ISI降低、BMD1、BMD2升高;⑤T2DM组1,25(OH)2D3相关因素多元回归分析:VAT面积是影响活性维生素D3最主要的因素。3、NGT组:①VAT面积、SAT面积与BMD2、BMD(L2-L4)呈显著正相关(P0.05);②VAT超标组与VAT正常组BMD无差异(P0.05)。T2DM组:①SAT面积、VAT面积与BMD无相关性(P0.05);②VAT超标组BMD1、BMD2 高于 VAT 正常组;③25(OH)D 与 Z3、Z4、Z(L1-L4)、Z(L2-L4)呈显著正相关(P0.05),1,25(OH)2D3 与 BMD1、BMD2、BMD3、BMD(L2-L4)、T1、T2呈显著负相关(P0.05)。4、NGT组:VAT面积、SAT面积与HOMA-IR呈显著正相关(P0.05),与ISI呈显著负相关(P0.05),与HOMA-β无相关性(P0.05)。T2DM组:VAT面积与HOMA-IR呈显著正相关(P0.05),与ISI呈显著负相关(P0.05),SAT面积与HOMA-IR、ISI无相关性(P0.05),SAT面积、VAT面积与HOMA-β无相关性(P0.05)。5、NGT组:VAT面积、SAT面积与吸烟、饮酒无相关性(P0.05);T2DM组:VAT面积与吸烟、饮酒、饮酒指数呈显著正相关(P0.05),SAT面积与吸烟、饮酒无相关性(P0.05)。[结论]1、无论在NGT组还是T2DM组,反映脂肪组织含量及分布的指标包括BMI、Fat%、VAT、SAT与1,25(OH)2D3均有负相关,但多元回归分析显示VAT是影响1,25(OH)2D3最主要的因素,提示内脏脂肪在活性维生素D3的代谢中发挥了重要作用。2、无论在NGT组还是T2DM组,VAT超标者与VAT正常者25(OH)D没有差异,但存在低1,25(OH)2D3血症,提示对于内脏型肥胖者应更加注重1,25(OH)2D3 的测量。3、在T2DM组,VAT虽然与1,25(OH)2D3降低有关,但VAT超标者存在更高的BMD,提示内脏脂肪可能通过其他途径影响骨密度。4、在T2DM组,VAT与胰岛素抵抗正相关,SAT与胰岛素抵抗无相关性,提示在2型糖尿病患者,VAT与胰岛素抵抗相关性更显著。5、在T2DM组,VAT与吸烟、饮酒正相关,SAT无相关性,提示吸烟、饮酒可能加重T2DM者内脏型肥胖。
[Abstract]:[Objective] to investigate the relationship between fat distribution and vitamin D (vitaminD) and bone metabolism related indexes in people with different glucose tolerance. [Methods] 180 subjects were collected and divided into three groups: 61 cases of normal glucose tolerance group (group NGT), 13 cases of impaired glucose tolerance group (group IGT), and 106 cases of type 2 diabetes group (group T2DM). The general clinical data and the concentration of 25- hydroxyvitamin D (25-hydroxy vitamin D, 25 (OH) D) and the concentration of 1,25- dihydroxyvitamin D3 (1,25-dihydroxy vitamin), parathyroid hormone (1,25-dihydroxy vitamin), calcium ion concentration, and other indexes of the abdominal subcutaneous adipose tissue of all subjects were measured. Bcutaneous adipose tissue, SAT) and visceral adipose tissue (visceral adipose tissue, VAT) area, dual energy X-ray bone densitometer measurement of lumbar bone density, X-ray attenuation method to determine body fat content and calculate body fat index (Fat massindex, FMI), HOMA model of insulin resistance index, islet beta cell function (beta), calculation of insulin Sensitivity index (ISI) was used to investigate the relationship between fat distribution and vitamin D and bone metabolism related indexes in people with different glucose tolerance. [results]1, group NGT: (1) 25 (OH) D and VAT area, SAT area, Weight, BMI, Fat%. NGT group was divided into normal group of visceral fat and visceral fat super standard group according to whether the area of VAT was greater than 100cm2, according to whether Fat% 30% was divided into Fat%30% group and Fat%30% group, according to whether BMI 24kg/m2 was divided into BMI normal group and BMI super standard group, 1,25 (OH) was in the three groups. At%30% group, BMI super standard group decreased significantly, 25 (OH) D in the three groups were not statistically significant differences (P0.05); (3) NGT group 1,25 (OH) 2D3 correlation factor multivariate regression analysis: VAT area is the main factor affecting the active vitamin D3.2. Correlation (P0.05), 1,25 (OH) 2D3 and VAT area, SAT area, Weight, BMI, Fat%, FMI, WC, HC, to be divided into visceral fat normal group and visceral fat super standard group. The differences of 1,25 (OH) 2D3 in the three groups were statistically significant (P0.05). 1,25 (OH) 2D3 in VAT exceeding the standard group, Fat%30% group and BMI exceeding the standard group were obviously decreased, and 25 (OH) D in the three groups had no statistical significance. Multivariate regression analysis: VAT area is the main factor affecting active vitamin D3.3, NGT group: (1) VAT area, SAT area and BMD2, BMD (L2-L4) showed significant positive correlation (P0.05). 25 (OH) D and Z3, Z4, Z (L1-L4), Z (L2-L4) showed significant positive correlation (P0.05), 1,25 (OH) was significant negative correlation. R showed significant positive correlation (P0.05), and there was a significant negative correlation with ISI (P0.05). SAT area and HOMA-IR, ISI had no correlation (P0.05), SAT area, VAT area and HOMA- beta without correlation (P0.05). There was no correlation between smoking and drinking (P0.05). [conclusion]1, both in group NGT and in group T2DM, the indexes of the content and distribution of adipose tissue including BMI, Fat%, VAT, SAT and 1,25 (OH) 2D3 were negatively correlated, but multivariate regression analysis showed that VAT was the most important factor affecting the metabolism of active vitamin. To play a role in.2, both in group NGT and in group T2DM, there is no difference between VAT and VAT normal 25 (OH) D, but there is a low 1,25 (OH) 2D3, suggesting that the visceral obesity should pay more attention to 1,25 (OH) measurement. Other pathways affected bone mineral density.4, in group T2DM, VAT was positively related to insulin resistance, and SAT was not associated with insulin resistance, suggesting that in type 2 diabetic patients, the correlation between VAT and insulin resistance is more significant.5. In the T2DM group, VAT is associated with smoking and alcohol consumption, and SAT has no correlation, suggesting smoking and drinking may aggravate visceral obesity in T2DM.
【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】：R589.2
本文编号：2168817
[Abstract]:[Objective] to investigate the relationship between fat distribution and vitamin D (vitaminD) and bone metabolism related indexes in people with different glucose tolerance. [Methods] 180 subjects were collected and divided into three groups: 61 cases of normal glucose tolerance group (group NGT), 13 cases of impaired glucose tolerance group (group IGT), and 106 cases of type 2 diabetes group (group T2DM). The general clinical data and the concentration of 25- hydroxyvitamin D (25-hydroxy vitamin D, 25 (OH) D) and the concentration of 1,25- dihydroxyvitamin D3 (1,25-dihydroxy vitamin), parathyroid hormone (1,25-dihydroxy vitamin), calcium ion concentration, and other indexes of the abdominal subcutaneous adipose tissue of all subjects were measured. Bcutaneous adipose tissue, SAT) and visceral adipose tissue (visceral adipose tissue, VAT) area, dual energy X-ray bone densitometer measurement of lumbar bone density, X-ray attenuation method to determine body fat content and calculate body fat index (Fat massindex, FMI), HOMA model of insulin resistance index, islet beta cell function (beta), calculation of insulin Sensitivity index (ISI) was used to investigate the relationship between fat distribution and vitamin D and bone metabolism related indexes in people with different glucose tolerance. [results]1, group NGT: (1) 25 (OH) D and VAT area, SAT area, Weight, BMI, Fat%. NGT group was divided into normal group of visceral fat and visceral fat super standard group according to whether the area of VAT was greater than 100cm2, according to whether Fat% 30% was divided into Fat%30% group and Fat%30% group, according to whether BMI 24kg/m2 was divided into BMI normal group and BMI super standard group, 1,25 (OH) was in the three groups. At%30% group, BMI super standard group decreased significantly, 25 (OH) D in the three groups were not statistically significant differences (P0.05); (3) NGT group 1,25 (OH) 2D3 correlation factor multivariate regression analysis: VAT area is the main factor affecting the active vitamin D3.2. Correlation (P0.05), 1,25 (OH) 2D3 and VAT area, SAT area, Weight, BMI, Fat%, FMI, WC, HC, to be divided into visceral fat normal group and visceral fat super standard group. The differences of 1,25 (OH) 2D3 in the three groups were statistically significant (P0.05). 1,25 (OH) 2D3 in VAT exceeding the standard group, Fat%30% group and BMI exceeding the standard group were obviously decreased, and 25 (OH) D in the three groups had no statistical significance. Multivariate regression analysis: VAT area is the main factor affecting active vitamin D3.3, NGT group: (1) VAT area, SAT area and BMD2, BMD (L2-L4) showed significant positive correlation (P0.05). 25 (OH) D and Z3, Z4, Z (L1-L4), Z (L2-L4) showed significant positive correlation (P0.05), 1,25 (OH) was significant negative correlation. R showed significant positive correlation (P0.05), and there was a significant negative correlation with ISI (P0.05). SAT area and HOMA-IR, ISI had no correlation (P0.05), SAT area, VAT area and HOMA- beta without correlation (P0.05). There was no correlation between smoking and drinking (P0.05). [conclusion]1, both in group NGT and in group T2DM, the indexes of the content and distribution of adipose tissue including BMI, Fat%, VAT, SAT and 1,25 (OH) 2D3 were negatively correlated, but multivariate regression analysis showed that VAT was the most important factor affecting the metabolism of active vitamin. To play a role in.2, both in group NGT and in group T2DM, there is no difference between VAT and VAT normal 25 (OH) D, but there is a low 1,25 (OH) 2D3, suggesting that the visceral obesity should pay more attention to 1,25 (OH) measurement. Other pathways affected bone mineral density.4, in group T2DM, VAT was positively related to insulin resistance, and SAT was not associated with insulin resistance, suggesting that in type 2 diabetic patients, the correlation between VAT and insulin resistance is more significant.5. In the T2DM group, VAT is associated with smoking and alcohol consumption, and SAT has no correlation, suggesting smoking and drinking may aggravate visceral obesity in T2DM.
【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】：R589.2
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