Differences in the pathology of the metabolic syndrome with or without visceral fat accumulation
Differences in the pathology of the metabolic syndrome with or without visceral fat accumulation
复制标题
伴有或不伴有内脏脂肪堆积的代谢综合征的病理学差异
作者：
Y. Mori;K. Hoshino;K. Yokota;Y. Itoh;N. Tajima
为了阐明内脏脂肪积累在代谢综合征中的作用，我们研究了有无内脏脂肪积累的代谢综合征的病理差异。共有472名日本男性糖尿病前期患者（平均年龄47.5±7.2岁），空腹血糖（IFG）水平为110-125 mg/dL，符合参加该研究的条件。研究对象分为以下四组，并进行组间比较：I组无内脏脂肪面积[VFA]≥100 cm2，但存在少于两个其他危险因素（即TG≥150 mg/dL， HDL-C<40 mg/dL， BP≥130/≥85 mmHg或FPG≥110 mg/dL） （n=231）；II组无VFA≥100 cm2，但存在3个或更多其他危险因素（n=57）；III组VFA≥100 cm2，单独FPG≥110 mg/dL (n=27)；IV组VFA≥100 cm2，并伴有2项及以上其他危险因素（n=157）。有或没有VFA≥100 cm2的患者中有三个或更多危险因素的患病率为45.3%（214 / 472例），而VFA≥100 cm2的患者中有两个或更多其他危险因素的患病率为33%（157 / 472例）。ⅱ组VFA值显著高于ⅰ组（p<0.05），ⅳ组VFA值显著高于ⅱ组（p<0.001）。HOMA-R值在I组和II组之间无显著差异，但IV组的HOMA-R值明显高于I组和II组（分别p<0.001和p<0.05）。此外，IV组葡萄糖负荷后2小时胰岛素水平显著高于I组（p<0.001）。虽然II组和IV组之间没有显著差异，但IV组的胰岛素水平趋于较高。脂联素水平显示，从I组到II组和III组，VFA水平逐渐下降。与I组相比，III组和IV组的脂联素水平显著低于I组（p<0.05, p<0.001）；IV组脂联素水平显著低于II组（p<0.05）。以VFA、TG、HDL-C和BP为解释变量进行logistic回归分析，VFA≥100 cm2的患者出现高HOMA-R值的相对风险为2.65 (p<0.001)；TG≥150 mg/dL、HDL<40 mg/dL者1.64 (p<0.05)；血压≥130/≥85 mmHg者为1.79 （p<0.01）。这些研究结果表明，胰岛素抵抗的程度和动脉硬化的风险取决于伴随危险因素聚集的代谢综合征是否以内脏脂肪积累为潜在病理，强烈提示内脏脂肪积累在代谢综合征中起着至关重要的作用。
To elucidate the role of visceral fat accumulation in the metabolic syndrome, differences in the pathology of the metabolic syndrome with or without visceral fat accumulation were investigated. A total of 472 prediabetic Japanese men (mean age, 47.5±7.2 yr) with impaired fasting glycemia (IFG) levels of 110–125 mg/dL were eligible for participation in the study. The study subjects were divided into the following four groups, and intergroup comparisons were made: group I without visceral fat area [VFA]≥100 cm2 but presenting with fewer than two other risk factors (i.e., TG≥150 mg/dL, HDL-C<40 mg/dL, BP≥130/≥85 mmHg, or FPG≥110 mg/dL) (n=231); group II without VFA of ≥100 cm2 but presenting with three or more other risk factors (n=57); group III with VFA of ≥100 cm2 accompanied by FPG≥110 mg/dL alone (n=27); and group IV with VFA≥100 cm2 and two or more other risk factors (n=157). The prevalence of patients who had three or more risk factors with or without VFA≥100 cm2 was 45.3% (214 out of 472 patients), while that of those with VFA≥100 cm2 who had two or more other risk factors was 33% (157 out of 472 patients). Group II had significantly higher VFA values than group I (p<0.05), and group IV had significantly higher VFA values than group II (p<0.001). While no significant differences in HOMA-R values were seen between groups I and II, these values were significantly higher in group IV compared to groups I and II (p<0.001 and p<0.05, respectively). Furthermore, group IV showed significantly higher 2-h insulin levels after glucose loading compared to group I (p<0.001). While no significant differences were seen between groups II and IV, insulin levels tended to be higher in group IV. Adiponectin levels showed an incremental fall in VFA from group I through groups II and III to group IV. Groups III and IV showed significantly lower adiponectin levels compared to group I (p<0.05, p<0.001, respectively); and group IV showed significantly lower adiponectin levels than group II (p<0.05). A logistic regression analysis using VFA, TG and HDL-C, and BP as explanatory variables showed that the relative risk for high HOMA-R values were 2.65 (p<0.001) for patients with VFA ≥100 cm2; 1.64 (p<0.05) for those with TG≥150 mg/dL and HDL<40 mg/dL; and 1.79 (p<0.01) for those with BP≥130/≥85 mmHg. These findings demonstrate that the degree of insulin resistance and the risk of arteriosclerosis vary depending on whether or not the metabolic syndrome accompanied by a clustering of risk factors has visceral fat accumulation as an underlying pathology, strongly suggesting a crucial role for visceral fat accumulation in the metabolic syndrome.
影响因子：
7.7
作者：
Carr, DB;Utzschneider, KM;Kahn, SE
通讯作者：
Kahn, SE