诊断学理论与实践

诊断学理论与实践 ›› 2017, Vol. 16 ›› Issue (04): 419-424.doi: 10.16150/j.1671-2870.2017.04.015

• 论著 • 上一篇    下一篇

上海社区人群代谢健康型肥胖、胰岛素抵抗与糖尿病发病风险的相关性研究

倪衡如1, 林琳2, 彭魁2, 郝明丽2, 王天歌2, 高金丽1   

  1. 1.上海市宝山区淞南镇社区卫生服务中心,上海 200441;
    2.上海市内分泌代谢病临床医学中心上海市内分泌代谢病研究所 上海交通大学医学院附属瑞金医院内分泌科,上海 200025
  • 收稿日期:2017-02-09 出版日期:2017-08-25 发布日期:2017-08-25
  • 通讯作者: 高金丽 E-mail: songnansqk@163.com
  • 基金资助:
    上海卫生系统重要疾病联合攻关项目（2013ZYJB1002）; 上海市宝山区科学技术委员会科研项目（13-E-44）

Association of metabolically healthy obesity, insulin resistance with risk of diabetes: a prospective study

NI Hengru1, LIN Lin2, PENG Kui2, HAO Mingli2, WANG Tiange2, GAO Jinli1   

  1. 1. Songnan Community Health Service Center, Baoshan District, Shanghai 200441, China;
    2. Shanghai Clinical Center for Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Department of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2017-02-09 Online:2017-08-25 Published:2017-08-25

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摘要： 目的: 分析上海社区40岁及以上居民的代谢健康型肥胖与随访4年中的糖尿病发病风险间的相关性,并进一步探究胰岛素抵抗在两者关系中的作用。方法: 采用整群抽样的方法,选取上海宝山区淞南社区常住居民中非糖尿病者1 967名,根据体质量指数和代谢水平分为代谢健康型非肥胖（metabolically healthy non-obese,MHNO）组、代谢不健康型非肥胖（metabolically unhealthy non-obese,MUNO）组、代谢健康型肥胖（metabolically healthy obese,MHO）组及代谢不健康型肥胖（metabolically unhealthy obese,MUO）组。对其进行4年随访,针对相关病史进行问卷调查,并完成人体指标测量及相关实验室检查,观察各组间临床指标及随访时糖尿病发生率的差异。结果: 研究人群中,MHNO、MUNO、MHO和MUO组随访4年中的糖尿病发生率分别为3.4%、16.4%、7.7%和17.5%。多元Logistic回归分析显示,在校正年龄、性别、体质量指数、当前吸烟、当前饮酒、积极运动及糖尿病家族史后,与MHNO组相比,MHO组随访4年中的糖尿病发病风险增加了1.25倍（OR=2.25, 95%CI为1.31~3.85）。将4组人群再按胰岛素抵抗情况（胰岛素抵抗指数≥2.5）分组,与MHNO不合并胰岛素抵抗组相比,MHO不合并胰岛素抵抗组随访4年中的糖尿病发生风险没有显著增加,而MHO合并胰岛素抵抗组随访4年中的糖尿病发生风险增加了4.20倍（OR=5.20, 95%CI为2.56~10.56）。结论: MHO组较MHNO组随访4年中的糖尿病发生风险高,且胰岛素抵抗可能在上述相关性中起了一定作用。

关键词: 肥胖, 代谢健康, 糖尿病, 胰岛素抵抗

Abstract: Objective: To investigate the association between metabolically healthy obesity (MHO) and risk of diabetes in population in Shanghai and to assess the role of insulin resistance in their relationship. Methods: A prospective study was performed among 1 967 participants aged 40 years or older in Baoshan community, Shanghai. The participants were categorized into four groups according to obesity and metabolic status: metabolically healthy non-obese (MHNO), metabolically unhealthy non-obese(MUNO), metabolically healthy obese (MHO), and metabolically unhealthy obese (MUO). Questionnaire interview, anthropometric measurements, and biochemical measurements were obtained in the participants. Metabolic profiles and rate of incident diabetes were compared between the groups. Results: After a median follow-up period of 4 years, the rate of incident diabetes in group MHNO, group MUNO, group MHO, and group MUO were 3.4%, 16.4%, 7.7%, and 17.5%, respectively. Multivariate logistic analysis revealed that patients in group MHO had an increased risk of incident diabetes [odds ratio (OR)=2.25, 95% confidence interval (CI) 1.31-3.85] when compared with subjects in MHNO. Compared with patients in group MHNO, patients resistant to insulin [homeostasis model assessment of insulin resistance(HOMA-IR≥2.5)] in group MHO had an increased OR for incident diabetes (OR=5.20, 95% CI 2.56-10.56). Conclusions: The 4-year follow-up revealed that patients of MHO have a high incidence of diabetes in which insulin resistance might play a role.

Key words: Obesity, Metabolic healthy, Diabetes, Insulin resistance

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