肥胖与慢性炎症、胰岛素抵抗的相关性

Relation of Obesity and Chronic Inflammation, Insulin Resistance

摘要: 目的：肥胖是一种代谢性疾病，同时也是一种慢性炎症状态。肥胖，能引起胰岛素抵抗，进而成为2型糖尿病、心血管疾病和脂质代谢紊乱的高危因素。随着对炎症因子(白介素、C反应蛋白、肿瘤坏死因子等)的认识增加，肥胖作为慢性炎症性疾病的观点已得到共识。肥胖的一些并发症，如胰岛素抵抗，也被认为与慢性炎症有关。本研究旨在通过对肥胖人群的减重干预后，观察其人体测量指标、炎性指标及胰岛素抵抗相关指标的变化，并探索其相关性，从而为临床肥胖患者的诊疗提供参考依据及新思路。方法：本研究在2018年3月~2019年3月对南京医科大学第一附属医院营养科门诊就诊的超重/肥胖患者进行了一项前后对照的临床观察性研究，对48例10~29岁患者根据我国超重/肥胖的诊断标准(超重：体质指数BMI：24~27.9 kg/m²，肥胖BMI ≥ 28 kg/m²)筛选出目标人群，予以为期2个月的饮食干预及抗阻力运动指导，观察干预前后人体测量指标，如体重、脂肪量、骨骼肌量、腰围及臀围等、以及炎症指标(白介素-6IL-6，C反应蛋白CRP)、胰岛素抵抗相关指标(胰岛素抵抗指数HOMA-IR、定量胰岛素敏感性检测指数QUICKI)的变化。结果：本研究筛选48例门诊患者中，皆符合超重/肥胖的诊断标准，并愿配合进行肥胖相关指标的检查，并符合其诊断。其中男：女 = 25:23，平均年龄17.58 ± 4.82岁，最终完成研究的共30人，(因故中途脱组/退出18人)，配合完成本研究检测项目的共10人。干预56 ± 7天后，人体测量指标：干预对象前后体重平均值为：108.96 ± 24.30 kg vs 98.74 ± 21.77 kg；炎症指标：干预前后白介素-6平均值为：59.70 ± 114.53 pg/ml vs 8.00 ± 8.22 pg/ml；干预前后C反应蛋白平均值为：6.07 ± 7.89 mg/L vs 4.84 ± 4.83 mg/L；干预前后胰岛素抵抗指数HOMA-IR平均值为：35.35 ± 11.18 vs 26.78 ± 8.47；定量胰岛素敏感性检测指数QUICKI平均值为：3.12 ± 0.23 mg/L vs 2.84 ± 0.35，P = 0.048 (<0.05)；相关性分析：体重与炎症指标白介素-6的存在相关，P值 = 0.019 (<0.05)；体重、腰围、BMI与胰岛素抵抗指数HOMA-IR存在相关，P < 0.05；体重、腰围与定量胰岛素敏感性检测指数QUICKI存在相关，P值 < 0.05。结论：肥胖患者通过营养干预及运动指导后，人体测量指标、炎症指标及胰岛素抵抗相关指标均有一定的变化；体重的变化与慢性炎症反应及胰岛素抵抗均具有一定的相关性，因此进一步探索炎症介质、胰岛素抵抗与肥胖发生发展中的影响及作用机制，对早期干预及治疗超重及肥胖人群有一定的启发指导意义。

Abstract: Objective: Obesity is not only a metabolic disease, but also a chronic inflammatory state. Obesity can cause insulin resistance, and become a high risk factor for type 2 diabetes, cardiovascular disease and lipid metabolism disorders. With the increasing understanding of inflammatory fac-tors (Lnterleukin, C-reactive protein, Tumor necrosis factor, etc.), obesity has been recognized as a chronic inflammatory disease. Some complications of obesity, such as insulin resistance, are also thought to be associated with chronic inflammation. The purpose of this study is to observe the changes of anthropometric, inflammatory and indicators related insulin resistance in obesity after weight reduction intervention, and explore the correlation and provide reference and new method for clinical diagnosis and treatment of obesity. Methods: In this study, a clinical observation study was conducted on the overweight/obesity patients in the department of Nutrition Department of The First Affiliated Hospital of Nanjing Medical University from March 2018 to March 2019. According to the diagnostic criteria of overweight/obesity in China (Overweight: BMI: 24 - 27.9 kg/m², Obesity: BMI: >28 kg/m²), 48 patients (age: 10 - 29) were selected for diet intervention and resistance exercise in two months to observe the changes of anthropometric indexes (body weight, fat content, skeletal muscle mass, waist circumference and hip circumference), inflammation index (Interleukin-6, C-reactive protein), and insulin resistance related index (HOMA-IR, QUICKI). Results: In this study, 48 patients all met the diagnostic criteria of overweight/obesity. They cooperated with the examination and meet the diagnostic criteria. Among them, male:female is 25:23, with an average age of 17.58 ± 4.82. A total of 30 people completed the study (18 people dropped out of the group for some reasons), and 10 people cooperated with the completion of the test project. After intervention for 56 ± 7 days, anthropometric indicators: the average body weight before and after intervention was 108.96 ± 24.30 kg vs 98.74 ± 21.77 kg; inflammatory indicators: the average value of IL-6 before and after intervention was 59.70 ± 114.53 pg/ml vs 8.00 ± 8.22 pg/ml; the average value of CRP before and after intervention was 6.07 ± 7.89 mg/L vs 4.84 ± 4.83 mg/L; the average value of HOMA-IR before and after intervention was 35.35 ± 11.18 vs 26.78 ± 8.47; the mean value of QUICKI was 3.12 ± 0.23 mg/L vs 2.84 ± 0.35, P = 0.048 (<0.05); correlation analysis: there was a correlation between body weight and inflammation index IL-6, P = 0.019 (<0.05); body weight, waist circumference, BMI and insulin resistance index HOMA-IR were correlated, P < 0.05; body weight and waist circumference were correlated with insulin sensitivity index QUICKI, P < 0.05. Conclusion: After nutritional intervention and exercise guidance, the body measurement index, inflammation index and insulin resistance related index of obesity patients have certain changes; the change of body weight has certain correlation with chronic inflammation and insulin resistance. Therefore, further exploring the influence and mechanism of inflammatory mediators, insulin resistance in the development of obesity will provide inspiration and guidance for early intervention and treatment of overweight and obesity.