Identification and importance of brown adipose tissue in adult humans.
Identification and importance of brown adipose tissue in adult humans.
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DOI：
10.1056/nejmoa0810780
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发表时间：
2009-04-09
期刊：
影响因子：
--
通讯作者：
Kahn CR
中科院分区：
文献类型：
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作者：
Cypess AM;Lehman S;Williams G;Tal I;Rodman D;Goldfine AB;Kuo FC;Palmer EL;Tseng YH;Doria A;Kolodny GM;Kahn CR
肥胖是能量摄入和消耗不平衡的结果。在啮齿动物和新生人类中，棕色脂肪组织通过解偶联蛋白1 （uncoupling protein 1, UCP1）表达介导的产热作用帮助调节能量消耗，但棕色脂肪组织被认为在成年人中没有生理相关性。我们分析了3640例连续的18f -氟脱氧葡萄糖（18F-FDG）正电子发射断层扫描和计算机断层扫描（PET-CT），这些扫描在1972年的患者中进行了各种诊断，因为存在大量假定的棕色脂肪组织。这样的仓库被定义为直径大于4mm的组织集合，根据CT具有脂肪组织密度，并且18F-FDG的最大标准化摄取值至少为2.0 g / ml，表明高代谢活性。记录临床指标，并与同期对照进行比较。对手术患者的颈部和锁骨上区活检标本进行UCP1免疫染色。通过PET-CT在从前颈部延伸到胸部的区域发现大量棕色脂肪组织。来自该区域的组织具有ucp1免疫阳性，多室脂肪细胞表明棕色脂肪组织。1013例女性中有76例（7.5%）阳性，959例男性中有30例（3.1%）阳性，对应于男女比例大于2:1 （P<0.001）。女性也有更多的棕色脂肪组织和更高的18F-FDG摄取活性。棕色脂肪组织的检测概率与年龄（P<0.001）、扫描时的室外温度（P= 0.02）、β受体阻滞剂的使用（P<0.001）以及老年患者的体重指数（P= 0.007）呈负相关。成年人中存在功能活跃的棕色脂肪组织的特定区域，女性比男性更常见，并且可以使用18F-FDG PET-CT无创量化。最重要的是，棕色脂肪组织的数量与身体质量指数呈负相关，尤其是在老年人中，这表明棕色脂肪组织在成年人的新陈代谢中具有潜在的作用。
Obesity results from an imbalance between energy intake and expenditure. In rodents and newborn humans, brown adipose tissue helps regulate energy expenditure by thermogenesis mediated by the expression of uncoupling protein 1 (UCP1), but brown adipose tissue has been considered to have no physiologic relevance in adult humans. We analyzed 3640 consecutive 18F-fluorodeoxyglucose (18F-FDG) positron-emission tomographic and computed tomographic (PET–CT) scans performed for various diagnostic reasons in 1972 patients for the presence of substantial depots of putative brown adipose tissue. Such depots were defined as collections of tissue that were more than 4 mm in diameter, had the density of adipose tissue according to CT, and had maximal standardized uptake values of 18F-FDG of at least 2.0 g per milliliter, indicating high metabolic activity. Clinical indexes were recorded and compared with those of date-matched controls. Immunostaining for UCP1 was performed on biopsy specimens from the neck and supraclavicular regions in patients undergoing surgery. Substantial depots of brown adipose tissue were identified by PET–CT in a region extending from the anterior neck to the thorax. Tissue from this region had UCP1-immunopositive, multilocular adipocytes indicating brown adipose tissue. Positive scans were seen in 76 of 1013 women (7.5%) and 30 of 959 men (3.1%), corresponding to a female:male ratio greater than 2:1 (P<0.001). Women also had a greater mass of brown adipose tissue and higher 18F-FDG uptake activity. The probability of the detection of brown adipose tissue was inversely correlated with years of age (P<0.001), outdoor temperature at the time of the scan (P= 0.02), beta-blocker use (P<0.001), and among older patients, body-mass index (P = 0.007). Defined regions of functionally active brown adipose tissue are present in adult humans, are more frequent in women than in men, and may be quantified noninvasively with the use of 18F-FDG PET–CT. Most important, the amount of brown adipose tissue is inversely correlated with body-mass index, especially in older people, suggesting a potential role of brown adipose tissue in adult human metabolism.