本文選題：內(nèi)臟脂肪組織 + 中心型肥胖��； 參考：《昆明醫(yī)科大學》2017年碩士論文

【摘要】：[目的]隨著肥胖人群的日益增多,代謝綜合征的患病率呈逐年增長趨勢。內(nèi)臟脂肪組織(visceral adipose tissue,VAT)被認為是與代謝綜合征發(fā)生發(fā)展密切相關的重要因素。阻塞性睡眠呼吸暫停低通氣綜合征(Obstructive sleep apnea-hypopnea syndrome,OSAHS)作為最常見的睡眠呼吸疾病,隨著病情的發(fā)展可導致高血壓、冠心病、腦血管意外、糖脂代謝紊亂,也是代謝綜合征的危險因素之一。本研究應用生物電阻抗分析法測量內(nèi)臟脂肪面積,分析內(nèi)臟脂肪組織與代謝綜合征危險因素之間的關系,旨在更好闡釋肥胖與慢性疾病風險的相關性,為肥胖相關的代謝性疾病的治療策略提供依據(jù)。[方法]選取2016年8月至2017年1月期間在昆明醫(yī)科大學附屬延安醫(yī)院老年病科住院治療150例符合代謝綜合征診斷標準(IDF/AHA/NHLBI)的患者,對所有患者的年齡、性別、體重、身高、體質(zhì)指數(shù)(Body mass index,BMI)進行記錄,所有患者均行腹部內(nèi)臟脂肪組織面積(VAT)檢測、簡易睡眠呼吸監(jiān)測記錄睡眠呼吸暫停低通氣指數(shù)(apneahypopneaindex, AHI)及夜間最低血氧飽和度(Sp02)、血壓測定,采集患者靜脈血標本,檢測并記錄其空腹血糖(FBG)、總膽固醇(TC)、甘油三酯(TG)、高密度脂蛋白膽固醇(HDL-C)、低密度脂蛋白膽固醇(LDL-C)、脂蛋白a (Lp(a))、尿酸(UA) 。[結(jié)果](1)本研究納入的150例患者中,年齡波動于22-75歲之間,平均年齡為54.18±11.95歲。其中男性113例,所占比例為75. 33%;女性37例,所占比例為24.67%。(2)按BMI值分為3組,分別為BMI正常組(18. 5≤BMI25)、超重組(25≤BMI28)、肥胖組(BMI≥28),其中正常組44例(29.33%),超重組48例(32%),肥胖組58例(38.67%),三組中VAT超標患者所占比例分別為38.64%、75%、96.55%,隨著BMI增加,VAT超標所占比例也逐漸升高。(3)根據(jù)AHI值分為4組,分別為非OSAHS組(AHI5)、輕度OSAHS組(5≤AHI15)、中度 OSAHS 組(15≤AHI30)、重度 OSAHS 組(AHI≥30),其中非OSAHS患者12例(8%),輕度OSAHS患者36例(24%),中度OSAHS患者51例(34%),重度OSAHS患者51例(34%),四組中VAT超標患者所占比例分別為25%、36.11%、80.39%、98. 04%,隨著OSAHS嚴重程度的加重,VAT超標所占比例也逐漸增高。(4)根據(jù)SpO2值分為4組,分別為血氧飽和度正常組(SpO2≥90%)、輕度低氧血癥組(85%≤SpO290%)、中度低氧血癥組(80%≤SpO285%)、重度低氧血癥組(SpO280%),其中血氧飽和正常組88例(58.67%),輕度低氧血癥組50例(33. 33%),中度低氧血癥組9例(6%)及重度低氧血癥組3例(2%),以上四組中VAT超標患者所占比例分別為56. 82%、94%、100%、100%,隨著低氧血癥的加重,VAT超標所占比例也逐漸升高;(5)根據(jù)VAT值分為2組,分別為VAT超標(VAT≥100cm2)組及VAT正常組(VAT100cm2),其中VAT超標組(109例)及VAT正常組(41例),對兩組進行差異性分析,統(tǒng)計學分析結(jié)果顯示,VAT超標組與VAT正常組在BMI、收縮壓、舒張壓、AHI、最低SpO2、TC、TG、LDL-C、UA有顯著差異(P0.05);(6)將差異有統(tǒng)計學意義的指標與VAT進行相關性分析,結(jié)果顯示,VAT與BMI、收縮壓、舒張壓、AHI、TC、LDL-C呈正相關,與最低SpO2呈負相關,均有統(tǒng)計學意義(P0.05) , VAT與TG及UA呈正相關,但無統(tǒng)計學意義(P0.05);(7)以VAT是否超標為因變量,以差異有統(tǒng)計學意義的指標為自變量,進行Logistic回歸分析,結(jié)果顯示BMI、舒張壓、AHI是VAT超標的主要危險因素。[結(jié)論](1) VAT與BMI有顯著相關性,兩者均能反映肥胖的程度。其中內(nèi)臟脂肪更能有效篩查出代謝綜合征的高危人群,減少漏診率。(2) VAT與SBP、DBP、TC、LDL-C呈顯著相關性,可能是代謝綜合征一個新的高危因素。(3)VAT與AHI、Sp02呈顯著相關性,能更好的預測心血管事件的發(fā)生風險,可作為評估代謝綜合征患者預后不良的指標。
[Abstract]:[Objective] with the increasing number of obese people, the prevalence of metabolic syndrome is increasing year by year. Visceral adipose tissue (VAT) is considered as an important factor which is closely related to the development of metabolic syndrome. Obstructive sleep apnea hypopnea syndrome (Obstructive sleep apnea-hypopnea syndrome, OSA) HS) as the most common sleep respiratory disease, with the development of the disease can lead to hypertension, coronary heart disease, cerebrovascular accident, glucose and lipid metabolism disorder, and also one of the risk factors of metabolic syndrome. This study used bioelectrical impedance analysis to measure the area of visceral fat and analyze the relationship between internal fat tissue and metabolic syndrome. The purpose of this study was to better explain the correlation between obesity and the risk of chronic diseases and to provide a basis for the treatment of obesity related metabolic diseases. [Methods] 150 patients in the Department of Geriatrics, affiliated to the Yanan hospital, affiliated to Kunming Medical University, from August 2016 to January 2017, were selected to meet the metabolic syndrome diagnostic criteria (IDF/AHA/NHLBI). All patients' age, sex, weight, height, body mass index (Body mass index, BMI) were recorded, all patients underwent abdominal visceral adipose tissue area (VAT) detection, simple sleep breathing monitoring recorded the sleep apnea hypopnea index (apneahypopneaindex, AHI) and night minimum oxygen saturation (Sp02), blood pressure measurement, and collection of patients. Blood glucose (FBG), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), lipoprotein a (Lp (a)), uric acid (UA). [results] (1) the age fluctuated between the age of 22-75 years and the average age of 54.18 + 11.95 years. The proportion of 113 men was 75.33%, and the proportion of 37 women was 24.67%. (2), which were divided into 3 groups according to the value of BMI, including the normal group of BMI (18.5 < < BMI25), the super recombination (25 < BMI28), the obese group (BMI > 28), including the normal group 44 cases (29.33%), the super recombination (32%), and the obesity group 58 cases (38.67%). 96.55%, with the increase of BMI, the proportion of VAT exceeded the standard. (3) according to the AHI value, it was divided into 4 groups, namely, non OSAHS group (AHI5), mild OSAHS group (5 < < AHI15), moderate OSAHS group (15 < < AHI30), severe OSAHS group (AHI > 30), 12 cases (8%), 36 patients (24%), moderate patients and severe patients. 51 cases (34%), the proportion of VAT overweight patients in the four groups was 25%, 36.11%, 80.39%, 98.04%. With the severity of OSAHS aggravation, the proportion of VAT exceeded the standard. (4) according to the value of SpO2, it was divided into 4 groups (SpO2 > 90%), mild hypoxemia group (85% < < < <), and moderate hypoxemia group (80% < SpO285%). Severe hypoxemia group (SpO280%), of which 88 cases (58.67%), 50 cases (33.33%) of mild hypoxemia, 9 cases in moderate hypoxemia group (6%) and 3 cases of severe hypoxemia (2%), the proportion of patients with VAT exceeding the standard in the four groups were 56.82%, 94%, 100%, 100%, and the proportion of VAT exceeded the standard of hypoxemia. (5) it was divided into 2 groups according to the VAT value, which were VAT super standard (VAT > 100cm2) group and VAT normal group (VAT100cm2), of which VAT exceeded the standard group (109 cases) and VAT normal group (41 cases), and the two groups were analyzed differently. The statistical analysis showed that VAT super standard group and VAT normal group were BMI, systolic pressure, diastolic pressure, AHI, minimum, minimum The difference (P0.05); (6) the correlation analysis of statistically significant indexes and VAT showed that VAT and BMI, systolic pressure, diastolic pressure, AHI, TC, LDL-C were positively correlated, and were negatively correlated with the lowest SpO2 (P0.05), and VAT was positively correlated with TG and UA, but (7) whether or not to exceed the standard as the dependent variable Logistic regression analysis showed that BMI, diastolic pressure and AHI were the main risk factors for VAT exceeding the standard. [Conclusion] [Conclusion] (1) there is a significant correlation between VAT and BMI, both of which can reflect the degree of obesity. Among them, visceral fat can be more effective in screening high-risk groups of metabolic syndrome and reducing the rate of missed diagnosis ((2)) VAT has a significant correlation with SBP, DBP, TC and LDL-C. It may be a new high risk factor for metabolic syndrome. (3) VAT has a significant correlation with AHI, Sp02, and can better predict the risk of cardiovascular events. It can be used as an indicator to assess the poor prognosis of metabolic syndrome.
【學位授予單位】：昆明醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R589

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