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胰岛素相关指标在超重肥胖成年人体脂率与血压关联中的中介效应
作者:阳益德 杨宜婷 付连国 王烁 从仁怀 汪晓凌 王政和 马冬梅 马蕊 邹志勇 马军

摘要:

目的  分析超重肥胖成年人体脂率与血压关联中胰岛素相关指标的中介效应。方法  采用志愿者招募的形式,于2014年4—5月,利用方便抽样方法选取在北京市居住1年以上、20~55岁的超重或肥胖者为研究对象,研究对象均在某体检中心经过医生严格的检查。排除标准:心、肺、肝、肾等重要脏器疾病和身体发育异常、残疾、畸形和继发性肥胖等疾病患者,以及正在服用降压药、降脂药、降糖药等药物者。最终共调查1 221名。采用自行设计调查问卷,调查研究对象的出生日期、性别、服用药物情况(降压药、降脂药、降糖药)及既往病史等,及其身高、体重、血压、空腹胰岛素水平、体脂率等,并计算BMI。采用中介效应模型计算体脂率与血压关联中的总效应值(c)、体脂率与胰岛素相关指标的关联(a)以及中介效应值,分析体脂率与血压关联中胰岛素相关指标的中介效应。结果  男性和女性体脂率与SBP均呈正相关(c值分别为0.25±0.05和0.19±0.03,P值均<0.001)。男性的体脂率与空腹胰岛素水平和胰岛素抵抗水平(HOMA-IR)均呈正相关,与胰岛素敏感性(HOMA-%S)呈负相关(a值分别为0.28±0.05、0.24±0.05和-0.29±0.05,P值均<0.001);女性的体脂率与空腹胰岛素水平、HOMA-IR均呈正相关,与HOMA-%S呈负相关(a值分别为0.21±0.04、0.20±0.04和-0.13±0.04,P值均<0.001)。女性体脂率与SBP的关联中,空腹胰岛素水平、HOMA-IR及HOMA-%S中介效应百分比分别为13.78%,18.3%和5.98%;女性体脂率与DBP关联中,空腹胰岛素水平、HOMA-IR中介效应百分比分别为11.98%和14.13%。结论  在女性体脂率与血压关联中胰岛素相关指标具有中介效应。

关键词:胰岛素;脂肪体;血压;肥胖症;中介效应

Abstract:

Objective  To examine the contribution of insulin related indices on the association between body fat and blood pressure among overweight adults.Methods  From April to May 2014, based on convenience sampling, we recruited overweight and obese volunteer participants aged 20-55 years living in Beijing at least 1 year through a strict examination by doctors in a physical examination center. In this study, we excluded the participants who reported suffering from any severe heart, lung, liver or kidney organic diseases, and abnormal development, disabilities, and secondary obesity caused by other disease. Also participants with use of antihypertensive drugs, hypoglycemic drugs and lipid lowering drugs were excluded for this study. A total of 1 221 participants were investigated in this study. With a simple self-designed questionnaire, the birthdates, sex, drug use, and disease history were examined. Participants' blood pressure (BP), percentage of body fat (PBF), glucose and fasting insulin level were measured. Mediation analysis was used to analyze the total effect of PBF on BP (c), the association between PBF and insulin related indices (a), and the mediation effect of serum fasting insulin level/HOMA-IR/HOMA-%S on relation between PBF and systolic/diastolic blood pressure (SBP/DBP).Results  PBF was positively associated with SBP (c=0.25±0.05 and 0.19±0.03 for male and female, respectively, P<0.001). In males, PBF was positively associated with fasting insulin level and HOMA-IR (a=0.28±0.05 and 0.24±0.05, P<0.001), and negatively associated with HOMA-%S (a=-0.29±0.05, P<0.001); in females, PBF was positively associated with fasting insulin level, HOMA-IR (a=0.21±0.04 and 0.20±0.04, P<0.001), and negatively associated with HOMA-%S (a=-0.13±0.04, P<0.001). In further mediation analysis for female participants, fasting insulin level/HOMA-IR/HOMA-%S played mediation roles in the relation between PBF and SBP, with ratio of mediation of 13.78%,18.3%, and 5.98%. Fasting insulin level/HOMA-IR also mediated the relation between PBF and DBP, with mediation ratio of 11.98% and 14.13%.Conclusion  In overweight/obese female participants, insulin related indices mediated the relation between PBF and BP.

Key words: Insulin;Fat body;Blood pressure;Obesity;Mesomeric effect

发表日期:2016/3

引用本文:

图/表:

  • 10.3760/cma.j.issn.0253-9624.2016.03.007.F001:图1 胰岛素相关指标在体脂率与血压关联中中介效应模型图

    10.3760/cma.j.issn.0253-9624.2016.03.007.F001:图1 胰岛素相关指标在体脂率与血压关联中中介效应模型图

  • 10.3760/cma.j.issn.0253-9624.2016.03.007.T001:表1 不同性别调查对象基本情况比较(n=1 221)

    10.3760/cma.j.issn.0253-9624.2016.03.007.T001:表1 不同性别调查对象基本情况比较(n=1 221)

  • 10.3760/cma.j.issn.0253-9624.2016.03.007.T002:表2 胰岛素相关指标在不同性别超重人群体脂率与SBP和DBP关联中的中介效应()

    10.3760/cma.j.issn.0253-9624.2016.03.007.T002:表2 胰岛素相关指标在不同性别超重人群体脂率与SBP和DBP关联中的中介效应()

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