定量CT在Ⅱ型糖尿病体脂分布中的应用及与骨密度相关性研究

发布时间：2018-04-18 01:22

本文选题：Ⅱ型糖尿病(T2DM) + 定量CT（QCT）　；参考：《山西医科大学》2013年硕士论文

【摘要】：目的运用定量CT（QCT）测量II型糖尿病（T2DM）患者及正常人腹部脂肪面积，能够了解II型糖尿病患者腹部体脂分布的特征，为II型糖尿病患者早期预防提供间接依据和有益信息。同时进行骨密度的测量，对T2DM患者腹部脂肪分布变化与椎体骨密度变化相关性进行初探。方法收集近一年来在医院内分泌科经临床病史、实验室检查及相关参数确诊的病程早期糖尿病患者67例和无糖尿病健康体检人员及志愿者65例。搜集各组研究对象一般资料（年龄、性别、身高、体重，就诊时血脂、血糖生化指标）。利用螺旋CT对II型糖尿病患者及志愿者进行腹部螺旋扫描，并利用定量CT专用工作软件系统，得到腹部内脏脂肪(visceral adipose，VA)面积、腹部皮下脂肪(abdominal subcutaneous adipose，SA)面积、并计算腹部内脏脂肪与腹部皮下脂肪的比值（内壁脂肪比,VSR），并同时测量腰2-4各椎体中间层面骨密度值。按实验分组进行统计学分析，评估II型糖尿病人体脂分布特点；对II型糖尿病人体脂分布特点与血脂、血糖生化指标进行相关性研究；分析2型糖尿病人腹部脂肪变化与骨密度之间是否具有相关性。结果 1、均衡性检验糖尿病组、与正常对照组组间两两比较平均年龄、性别、身高、体重比例构成匹配，均无显著性差异(p0.05)。 2、使用定量CT技术检测，II型糖尿病患者腹部内脏脂肪面积（VA）、腹部内脏脂肪面积与腹部皮下脂肪面积比值(VSR)，具有明显统计学差异(P＜0.005)。 3、II型糖尿病患者内脏脂肪面积与TC、TG、HDL-C、LDL-C、FBG相关性（r=0.279，r=0.370，r=-0.041，r=0.247，r=0.246）大于腹部皮下脂肪面积（r=0.264，r=0.313，r=-0.027，r=0.140，r=0.161）。 4、当II型糖尿病患者VA、SA明显增加(VA120cm2，SA160cm2）与骨密度变化之间存在正相关性(r=0.413，r=0.469)。结论 1、定量CT测量能够反映早期II型糖尿病患者腹部脂肪分布变化情况，II型糖尿病患者向心性肥胖为特征的腹部脂肪分布以腹部内脏脂肪堆积明显；当内壁脂肪比0.685时，所患糖尿病的机率约95%，，所以当肥胖者以腹部内脏脂肪增多为主时且内壁脂肪比0.685时，可以明确提示实验对象患II型糖尿病的几率大大增加。对于临床有十分重要的意义，为II型糖尿病患者早期预防提供有利依据。 2、定量CT测量II型糖尿病患者内脏脂肪含量与皮下脂肪含量与代谢指标的相关性是不同的。腹部内脏脂肪组织与TC、TG、LDL-C、FBG有明显的正相关性，与HDL-C呈负相关性，表明腹部内脏脂肪组织越多，对代谢的危害也就越明显。腹部皮下脂肪组织与TC、TG、LDL-C、FBG也有着正相关关系，但是相关性弱于腹部内脏脂肪组织。腹内脂肪分布的变化特点，能较好的反应血脂、血糖生化指标的变化。3、T2DM患者病程早期腹部脂肪含量增加明显时伴有骨密度值增高，可为T2DM患者病程发展提供参考价值。
[Abstract]:PurposeIn order to understand the characteristics of abdominal fat distribution in patients with type II diabetes mellitus (T2DM) and normal subjects, the quantitative CT-QCTs can provide indirect basis and useful information for early prevention of type II diabetes mellitus.Bone mineral density (BMD) was measured and the correlation between abdominal fat distribution and vertebral bone mineral density (BMD) in T2DM patients was studied.MethodSixty-seven patients with early diabetes diagnosed by clinical history laboratory examination and related parameters and 65 healthy volunteers without diabetes were collected in the Department of Endocrinology in recent one year.To collect general data (age, sex, height, weight, blood lipid, blood sugar biochemical index).The area of abdominal visceral adiposeal adiposesia (VAA) and abdominal subcutaneous subcutaneous adiposeza were obtained by spiral CT scanning in patients with type II diabetes mellitus and volunteers, and the specific quantitative CT software system was used to determine the area of abdominal visceral adiposesia.The ratio of abdominal visceral fat to abdominal subcutaneous fat was calculated.To evaluate the characteristics of body fat distribution in type II diabetes mellitus patients, and to study the correlation between body fat distribution characteristics and blood lipid and blood glucose biochemical indexes in patients with type II diabetes mellitus.To analyze the correlation between abdominal fat changes and bone mineral density (BMD) in type 2 diabetic patients.Result1. There was no significant difference in average age, sex, height and weight ratio between diabetic group and normal control group (P 0.05).2. The abdominal visceral fat area and the ratio of abdominal visceral fat area to abdominal subcutaneous fat area were measured by quantitative CT in patients with type II diabetes mellitus (P < 0.005).3. The correlation between visceral fat area and TCG-TGG HDL-CnLDL-Cfi-FBG was 0.270 ~ 0.270 ~ 0.241 ~ 0.247 ~ 0.246) > 0.264 ~ 0.264 ~ 0.313r-0.027 ~ (0.140) ~ (0.161) ~ (1) ~ (0.161) ~ 0.161 ~ (1)).4. There was a positive correlation between VASA and bone mineral density in patients with type II diabetes mellitus (P < 0.01).Conclusion1. Quantitative CT measurement can reflect the changes of abdominal fat distribution in patients with early type 2 diabetes mellitus. The abdominal fat distribution characterized by cardiac obesity in patients with type II diabetes is obviously accumulated in abdominal visceral fat, and when the ratio of inner wall fat to fat is 0.685,The incidence of diabetes was about 95%, so it was clear that the risk of type 2 diabetes was significantly increased when the abdominal visceral fat was mainly increased and the ratio of inner wall fat to internal fat was 0.685 in the obese subjects.It is of great significance for clinical practice and provides beneficial basis for early prevention of type 2 diabetes mellitus.2. The correlation between the content of visceral fat and subcutaneous fat and metabolic index was different in patients with type 2 diabetes mellitus by quantitative CT.There was a positive correlation between visceral adipose tissue and HDL-C, but a negative correlation with HDL-C, indicating that the more abdominal visceral adipose tissue, the more harmful to metabolism.There was also a positive correlation between abdominal subcutaneous adipose tissue and TCG-TGG LDL-C- FBG, but the correlation was weaker than that of abdominal visceral adipose tissue.The change of abdominal fat distribution can reflect the blood lipids better. The change of blood glucose biochemical index. The increase of abdominal fat content in the early stage of the disease course is accompanied with the increase of bone mineral density. It can provide reference value for the development of the course of T2DM patients.
【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R816.8

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