CAJ | 학술논문

目的：本研究尝试从临床角度探讨四种肥胖表型的临床特点。方法选取48例肥胖患者按临床代谢特点分为正常代谢性肥胖组、低代谢性肥胖组、高代谢性肥胖组和炎症代谢性肥胖组,并选取20名正常体重者为正常对照组,分别采用欧姆龙体脂仪和双能X线吸收法进行体脂基本参数及相关体脂分布的测定,并测定血脂、激素分泌水平及炎症指标,所有患者行口服葡萄糖耐量试验测定各点血糖、胰岛素水平。结果(1)正常代谢性肥胖组虽体脂含量较高,但无明显代谢异常和炎症状态,激素水平正常。(2)低代谢性肥胖组代谢率较低,且激素水平多有降低,内脏脂肪含量较高,分布明显异常,躯干/四肢脂肪含量显著高于正常代谢性肥胖组(1.19±0.25对0.97±0.32,P<0.05),血脂升高,出现糖代谢异常状态,其胰岛素作用指数显著小于正常代谢性肥胖组(0.0066±0.0027对0.0121±0.0095,P<0.05),而葡萄糖浓度曲线下面积显著高于正常代谢性肥胖组[(18.71±8.68对12.70±4.63)mmol/L,P<0.05]。(3)高代谢性肥胖组具有较高的代谢率,其心率显著高于正常代谢性肥胖组[(90.50±8.24对73.20±14.11)次/min, P<0.05],激素水平略有升高,腰围显著大于正常代谢性肥胖组[(111.88±10.54对98.05±15.56)cm,P<0.05]。(4)而炎症代谢性肥胖组表现为高胰岛素血症和黑棘皮病,其胰岛素作用指数显著小于正常代谢性肥胖组(0.0070±0.0033对0.0121±0.0095,P<0.05),躯干脂肪含量以及尿酸水平均显著高于正常代谢性肥胖组[(17236.38±4610.60对15816.10±5453.42)g；(468.28±121.32对376.84±97.14)μmol/L,均P<0.05],但血糖水平相对正常。结论基于代谢的临床肥胖诊断对临床肥胖的病因判断和个体化治疗有一定的指导意义。
목적：본연구상시종림상각도탐토사충비반표형적림상특점。방법선취48례비반환자안림상대사특점분위정상대사성비반조、저대사성비반조、고대사성비반조화염증대사성비반조,병선취20명정상체중자위정상대조조,분별채용구모룡체지의화쌍능X선흡수법진행체지기본삼수급상관체지분포적측정,병측정혈지、격소분비수평급염증지표,소유환자행구복포도당내량시험측정각점혈당、이도소수평。결과(1)정상대사성비반조수체지함량교고,단무명현대사이상화염증상태,격소수평정상。(2)저대사성비반조대사솔교저,차격소수평다유강저,내장지방함량교고,분포명현이상,구간/사지지방함량현저고우정상대사성비반조(1.19±0.25대0.97±0.32,P<0.05),혈지승고,출현당대사이상상태,기이도소작용지수현저소우정상대사성비반조(0.0066±0.0027대0.0121±0.0095,P<0.05),이포도당농도곡선하면적현저고우정상대사성비반조[(18.71±8.68대12.70±4.63)mmol/L,P<0.05]。(3)고대사성비반조구유교고적대사솔,기심솔현저고우정상대사성비반조[(90.50±8.24대73.20±14.11)차/min, P<0.05],격소수평략유승고,요위현저대우정상대사성비반조[(111.88±10.54대98.05±15.56)cm,P<0.05]。(4)이염증대사성비반조표현위고이도소혈증화흑극피병,기이도소작용지수현저소우정상대사성비반조(0.0070±0.0033대0.0121±0.0095,P<0.05),구간지방함량이급뇨산수평균현저고우정상대사성비반조[(17236.38±4610.60대15816.10±5453.42)g；(468.28±121.32대376.84±97.14)μmol/L,균P<0.05],단혈당수평상대정상。결론기우대사적림상비반진단대림상비반적병인판단화개체화치료유일정적지도의의。
Objective This study aimed to explore clinical characteristics of four types of obesity based on metabolic classification. Methods Forty-eight obese patients were divided according to their clinical characteristics into 4 groups including metabolic healthy obesity (MHO), hypometabolic obesity (LMO), hypermetabolic obesity (HMO), and metabolic obesity with inflammation (IMO). 20 normal weight individuals were also recruited as a control group. Body fat, body weight, visceral index, and basal metabolism were measured by Omron body fat meter. Fat content and its distribution were measured by dual energy X-ray absorptiometry. All participating patients underwent various tests for 75 g oral glucose tolerance, blood glucose, insulin, C peptide. Lipid profile, thyroid function and sex hormones levels, and inflammation factors were also measured. Results (1)Patients in MHO group had higher body fat content, but had no metabolic disorder and inflammation. Their hormones levels were normal. (2) Lower metabolic rate and lower hormones levels were found in the patients in LMO group with increasing visceral fat. Trunk/subcutaneous fat mass was significantly higher than that in MHO group(1. 19 ± 0. 25 vs 0. 97 ± 0. 32, P<0. 05). There were abnormal lipid and glucose metabolism in LMO group. The insulin action index was significantly lower than that in MHO group(0. 006 6 ± 0. 002 7 vs 0. 012 1 ± 0. 009 5, P<0. 05). The area under the curve of glucoseconcentrationwassignificantlyhigherinLMOgroupthanthatinMHOgroup[(18.71±8.68vs12.70±4.63) mmol/L, P<0. 05]. (3)Heart rate and blood pressure were higher in HMO group. The heart rate was significantly increased compared with that in MHO group [(90. 50 ± 8. 24 vs 73. 20 ± 14. 11) beat/min, P<0. 05]. The waist circumference was significantly larger than that in MHO group [(111. 88 ± 10. 54 vs 98. 05 ± 15. 56) cm, P<0. 05]. (4) In IMO group, insulin action index was significantly lower than MHO group (0. 007 0 ± 0. 003 3 vs 0.0121±0.0095,P<0.05). ThetrunkfatmassanduricacidlevelsweresignificantlyhigherthanMHOgroup [(17236.38±4610.60vs15816.10±5453.42)gand(468.28±121.32vs376.84±97.14) μmol/L,bothP<0. 05]. Patients in IMO group had acanthosis nigricans, but their glucose level was relatively normal. Conclusion The metabolic-based obese diagnosis is essential for understanding the obesity etiology and providing individualized treatment.