不同糖耐量人群脂肪組織分布與維生素D及骨代謝指標(biāo)的關(guān)系
發(fā)布時(shí)間：2018-08-06 19:53
【摘要】：[目的]探討不同糖耐量人群中脂肪分布與維生素D(vitaminD)及骨代謝相關(guān)指標(biāo)的關(guān)系。[方法]本研究共收集研究對(duì)象180例,根據(jù)糖耐量狀態(tài)分為三組:糖耐量正常組(NGT組)61例;糖耐量減低組(IGT組)13例;2型糖尿病組(T2DM組)106例。測(cè)定所有研究對(duì)象的一般臨床資料及維生素D中間代謝產(chǎn)物25-羥維生素 D(25-hydroxy vitamin D,25(OH)D)濃度和 1,25-二羥維生素 D3(1,25-dihydroxy vitamin D3,1,25(OH)2D3)濃度、甲狀旁腺素(PTH)、鈣離子濃度等指標(biāo),雙電阻抗法測(cè)定所有研究對(duì)象腹部皮下脂肪組織(subcutaneous adipose tissue,SAT)和內(nèi)臟脂肪組織(visceral adipose tissue,VAT)面積,雙能 X線骨密度儀測(cè)定腰椎骨密度,X線衰減法測(cè)定體脂肪含量并計(jì)算體脂指數(shù)(Fat massindex,FMI),HOMA模型計(jì)算胰島素抵抗指數(shù)(HOMA-IR)、胰島β細(xì)胞功能(HOMA-β),計(jì)算胰島素敏感指數(shù)(ISI),探討不同糖耐量人群中脂肪分布與維生素D及骨代謝相關(guān)指標(biāo)的關(guān)系。[結(jié)果]1、NGT組:①25(OH)D與VAT面積、SAT面積、Weight、BMI、Fat%、FMI、WC、HC、WHR 均無相關(guān)性(P0.05),1,25(OH)2D3 與 VAT 面積、SAT 面積、Weight、BMI、Fat%、FMI 呈顯著負(fù)相關(guān)(P0.05);②將 NGT組按照VAT面積是否大于100cm2分為內(nèi)臟脂肪正常組和內(nèi)臟脂肪超標(biāo)組,按照Fat%是否30%分為 Fat%30%組和 Fat%30%組,按照 BMI 是否24kg/m2分為BMI正常組和BMI超標(biāo)組,1,25(OH)2D3在三種分組下差異均有統(tǒng)計(jì)學(xué)意義(P0.05),1,25(OH)2D3 在 VAT 超標(biāo)組、Fat%30%組,BMI 超標(biāo)組均明顯降低,25(OH)D在三種分組下差異均無統(tǒng)計(jì)學(xué)意義(P0.05);③NGT組1,25(OH)2D3相關(guān)因素多元回歸分析:VAT面積是影響活性維生素D3最主要的因素。2、T2DM 組:①T2DM 組 1,25(OH)2D3 低于 IGT 組;②25(OH)D 與 Weight、VAT面積呈顯著負(fù)相關(guān)(P0.05),1,25(OH)2D3與VAT面積、SAT面積、Weight、BMI、Fat%、FMI、WC、HC、WHR 呈顯著負(fù)相關(guān)(P0.05);③將T2DM 按照VAT面積是否大于100cm2分為內(nèi)臟脂肪正常組和內(nèi)臟脂肪超標(biāo)組,按照Fat%是否30%分為Fat%30%組和Fat%30%組,按照BMI是否24kg/m2分為BMI正常組和BMI超標(biāo)組,1,25(OH)2D3在三種分組下差異均有統(tǒng)計(jì)學(xué)意義(P0.05),1,25(OH)2D3在VAT超標(biāo)組、Fat%30%組,BMI超標(biāo)組均明顯降低,25(OH)D在三種分組下差異均無統(tǒng)計(jì)學(xué)意義(P0.05);④與VAT正常組相比,VAT超標(biāo)組HOMA-IR升高、ISI降低、BMD1、BMD2升高;⑤T2DM組1,25(OH)2D3相關(guān)因素多元回歸分析:VAT面積是影響活性維生素D3最主要的因素。3、NGT組:①VAT面積、SAT面積與BMD2、BMD(L2-L4)呈顯著正相關(guān)(P0.05);②VAT超標(biāo)組與VAT正常組BMD無差異(P0.05)。T2DM組:①SAT面積、VAT面積與BMD無相關(guān)性(P0.05);②VAT超標(biāo)組BMD1、BMD2 高于 VAT 正常組;③25(OH)D 與 Z3、Z4、Z(L1-L4)、Z(L2-L4)呈顯著正相關(guān)(P0.05),1,25(OH)2D3 與 BMD1、BMD2、BMD3、BMD(L2-L4)、T1、T2呈顯著負(fù)相關(guān)(P0.05)。4、NGT組:VAT面積、SAT面積與HOMA-IR呈顯著正相關(guān)(P0.05),與ISI呈顯著負(fù)相關(guān)(P0.05),與HOMA-β無相關(guān)性(P0.05)。T2DM組:VAT面積與HOMA-IR呈顯著正相關(guān)(P0.05),與ISI呈顯著負(fù)相關(guān)(P0.05),SAT面積與HOMA-IR、ISI無相關(guān)性(P0.05),SAT面積、VAT面積與HOMA-β無相關(guān)性(P0.05)。5、NGT組:VAT面積、SAT面積與吸煙、飲酒無相關(guān)性(P0.05);T2DM組:VAT面積與吸煙、飲酒、飲酒指數(shù)呈顯著正相關(guān)(P0.05),SAT面積與吸煙、飲酒無相關(guān)性(P0.05)。[結(jié)論]1、無論在NGT組還是T2DM組,反映脂肪組織含量及分布的指標(biāo)包括BMI、Fat%、VAT、SAT與1,25(OH)2D3均有負(fù)相關(guān),但多元回歸分析顯示VAT是影響1,25(OH)2D3最主要的因素,提示內(nèi)臟脂肪在活性維生素D3的代謝中發(fā)揮了重要作用。2、無論在NGT組還是T2DM組,VAT超標(biāo)者與VAT正常者25(OH)D沒有差異,但存在低1,25(OH)2D3血癥,提示對(duì)于內(nèi)臟型肥胖者應(yīng)更加注重1,25(OH)2D3 的測(cè)量。3、在T2DM組,VAT雖然與1,25(OH)2D3降低有關(guān),但VAT超標(biāo)者存在更高的BMD,提示內(nèi)臟脂肪可能通過其他途徑影響骨密度。4、在T2DM組,VAT與胰島素抵抗正相關(guān),SAT與胰島素抵抗無相關(guān)性,提示在2型糖尿病患者,VAT與胰島素抵抗相關(guān)性更顯著。5、在T2DM組,VAT與吸煙、飲酒正相關(guān),SAT無相關(guān)性,提示吸煙、飲酒可能加重T2DM者內(nèi)臟型肥胖。
[Abstract]:[Objective] to investigate the relationship between fat distribution and vitamin D (vitaminD) and bone metabolism related indexes in people with different glucose tolerance. [Methods] 180 subjects were collected and divided into three groups: 61 cases of normal glucose tolerance group (group NGT), 13 cases of impaired glucose tolerance group (group IGT), and 106 cases of type 2 diabetes group (group T2DM). The general clinical data and the concentration of 25- hydroxyvitamin D (25-hydroxy vitamin D, 25 (OH) D) and the concentration of 1,25- dihydroxyvitamin D3 (1,25-dihydroxy vitamin), parathyroid hormone (1,25-dihydroxy vitamin), calcium ion concentration, and other indexes of the abdominal subcutaneous adipose tissue of all subjects were measured. Bcutaneous adipose tissue, SAT) and visceral adipose tissue (visceral adipose tissue, VAT) area, dual energy X-ray bone densitometer measurement of lumbar bone density, X-ray attenuation method to determine body fat content and calculate body fat index (Fat massindex, FMI), HOMA model of insulin resistance index, islet beta cell function (beta), calculation of insulin Sensitivity index (ISI) was used to investigate the relationship between fat distribution and vitamin D and bone metabolism related indexes in people with different glucose tolerance. [results]1, group NGT: (1) 25 (OH) D and VAT area, SAT area, Weight, BMI, Fat%. NGT group was divided into normal group of visceral fat and visceral fat super standard group according to whether the area of VAT was greater than 100cm2, according to whether Fat% 30% was divided into Fat%30% group and Fat%30% group, according to whether BMI 24kg/m2 was divided into BMI normal group and BMI super standard group, 1,25 (OH) was in the three groups. At%30% group, BMI super standard group decreased significantly, 25 (OH) D in the three groups were not statistically significant differences (P0.05); (3) NGT group 1,25 (OH) 2D3 correlation factor multivariate regression analysis: VAT area is the main factor affecting the active vitamin D3.2. Correlation (P0.05), 1,25 (OH) 2D3 and VAT area, SAT area, Weight, BMI, Fat%, FMI, WC, HC, to be divided into visceral fat normal group and visceral fat super standard group. The differences of 1,25 (OH) 2D3 in the three groups were statistically significant (P0.05). 1,25 (OH) 2D3 in VAT exceeding the standard group, Fat%30% group and BMI exceeding the standard group were obviously decreased, and 25 (OH) D in the three groups had no statistical significance. Multivariate regression analysis: VAT area is the main factor affecting active vitamin D3.3, NGT group: (1) VAT area, SAT area and BMD2, BMD (L2-L4) showed significant positive correlation (P0.05). 25 (OH) D and Z3, Z4, Z (L1-L4), Z (L2-L4) showed significant positive correlation (P0.05), 1,25 (OH) was significant negative correlation. R showed significant positive correlation (P0.05), and there was a significant negative correlation with ISI (P0.05). SAT area and HOMA-IR, ISI had no correlation (P0.05), SAT area, VAT area and HOMA- beta without correlation (P0.05). There was no correlation between smoking and drinking (P0.05). [conclusion]1, both in group NGT and in group T2DM, the indexes of the content and distribution of adipose tissue including BMI, Fat%, VAT, SAT and 1,25 (OH) 2D3 were negatively correlated, but multivariate regression analysis showed that VAT was the most important factor affecting the metabolism of active vitamin. To play a role in.2, both in group NGT and in group T2DM, there is no difference between VAT and VAT normal 25 (OH) D, but there is a low 1,25 (OH) 2D3, suggesting that the visceral obesity should pay more attention to 1,25 (OH) measurement. Other pathways affected bone mineral density.4, in group T2DM, VAT was positively related to insulin resistance, and SAT was not associated with insulin resistance, suggesting that in type 2 diabetic patients, the correlation between VAT and insulin resistance is more significant.5. In the T2DM group, VAT is associated with smoking and alcohol consumption, and SAT has no correlation, suggesting smoking and drinking may aggravate visceral obesity in T2DM.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R589.2
本文編號(hào)：2168817
[Abstract]:[Objective] to investigate the relationship between fat distribution and vitamin D (vitaminD) and bone metabolism related indexes in people with different glucose tolerance. [Methods] 180 subjects were collected and divided into three groups: 61 cases of normal glucose tolerance group (group NGT), 13 cases of impaired glucose tolerance group (group IGT), and 106 cases of type 2 diabetes group (group T2DM). The general clinical data and the concentration of 25- hydroxyvitamin D (25-hydroxy vitamin D, 25 (OH) D) and the concentration of 1,25- dihydroxyvitamin D3 (1,25-dihydroxy vitamin), parathyroid hormone (1,25-dihydroxy vitamin), calcium ion concentration, and other indexes of the abdominal subcutaneous adipose tissue of all subjects were measured. Bcutaneous adipose tissue, SAT) and visceral adipose tissue (visceral adipose tissue, VAT) area, dual energy X-ray bone densitometer measurement of lumbar bone density, X-ray attenuation method to determine body fat content and calculate body fat index (Fat massindex, FMI), HOMA model of insulin resistance index, islet beta cell function (beta), calculation of insulin Sensitivity index (ISI) was used to investigate the relationship between fat distribution and vitamin D and bone metabolism related indexes in people with different glucose tolerance. [results]1, group NGT: (1) 25 (OH) D and VAT area, SAT area, Weight, BMI, Fat%. NGT group was divided into normal group of visceral fat and visceral fat super standard group according to whether the area of VAT was greater than 100cm2, according to whether Fat% 30% was divided into Fat%30% group and Fat%30% group, according to whether BMI 24kg/m2 was divided into BMI normal group and BMI super standard group, 1,25 (OH) was in the three groups. At%30% group, BMI super standard group decreased significantly, 25 (OH) D in the three groups were not statistically significant differences (P0.05); (3) NGT group 1,25 (OH) 2D3 correlation factor multivariate regression analysis: VAT area is the main factor affecting the active vitamin D3.2. Correlation (P0.05), 1,25 (OH) 2D3 and VAT area, SAT area, Weight, BMI, Fat%, FMI, WC, HC, to be divided into visceral fat normal group and visceral fat super standard group. The differences of 1,25 (OH) 2D3 in the three groups were statistically significant (P0.05). 1,25 (OH) 2D3 in VAT exceeding the standard group, Fat%30% group and BMI exceeding the standard group were obviously decreased, and 25 (OH) D in the three groups had no statistical significance. Multivariate regression analysis: VAT area is the main factor affecting active vitamin D3.3, NGT group: (1) VAT area, SAT area and BMD2, BMD (L2-L4) showed significant positive correlation (P0.05). 25 (OH) D and Z3, Z4, Z (L1-L4), Z (L2-L4) showed significant positive correlation (P0.05), 1,25 (OH) was significant negative correlation. R showed significant positive correlation (P0.05), and there was a significant negative correlation with ISI (P0.05). SAT area and HOMA-IR, ISI had no correlation (P0.05), SAT area, VAT area and HOMA- beta without correlation (P0.05). There was no correlation between smoking and drinking (P0.05). [conclusion]1, both in group NGT and in group T2DM, the indexes of the content and distribution of adipose tissue including BMI, Fat%, VAT, SAT and 1,25 (OH) 2D3 were negatively correlated, but multivariate regression analysis showed that VAT was the most important factor affecting the metabolism of active vitamin. To play a role in.2, both in group NGT and in group T2DM, there is no difference between VAT and VAT normal 25 (OH) D, but there is a low 1,25 (OH) 2D3, suggesting that the visceral obesity should pay more attention to 1,25 (OH) measurement. Other pathways affected bone mineral density.4, in group T2DM, VAT was positively related to insulin resistance, and SAT was not associated with insulin resistance, suggesting that in type 2 diabetic patients, the correlation between VAT and insulin resistance is more significant.5. In the T2DM group, VAT is associated with smoking and alcohol consumption, and SAT has no correlation, suggesting smoking and drinking may aggravate visceral obesity in T2DM.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R589.2
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