過重者代謝症候群與胰島素阻抗之相關性探討

The Association between Metabolic Syndrome and Insulin Resistance in Overweight Cases

本研究收集331位體重過重（身體質量指數≧24 kg/m2）者參與研究，每位受檢者經協助以自填方式完成問卷，問卷內容包括基本資料、生活習慣，過去病史與心血管疾病家族史，並測量身高、體重、腰臀圍與血壓；血液檢查包含空腹血糖、胰島素、總膽固醇、高密度脂蛋白膽固醇、三酸甘油酯等；採用HOMA-IR公式來計算分析代謝症候群及其組成因子與胰島素阻抗的相關性。本研究結果顯示在傳統心血管危險因子的比較上，按照American Heart Association/National Heart, Lung, and Blood Institute（AHA/NHLBI）代謝症候群的定義及修正版的相關亞太標準，男性有較高的血壓、總膽固醇、空腹血清胰島素、三酸甘油酯及較低的高密度脂蛋白膽固醇。男性依照HOMA-IR 公式所計算之胰島素阻抗平均值，明顯高於女性（p<0.05）；另外針對胰島素阻抗值進行單變項分析則發現女性胰島素阻抗與代謝症候群五個組成因子都呈現顯著的相關，而男性僅在三酸甘油酯及空腹血糖呈現明顯相關性，同時不論男女性別，在胰島素阻抗與代謝症候群均呈現顯著的關聯。進一步多變項迴歸分析顯示，女性的胰島素阻抗與代謝症候群中血壓偏高以外的組成因子呈正相關。而男性的胰島素阻抗現象，則僅使高空腹血糖值的機會增加。本研究結果顯示過重或肥胖族群其代謝症候群盛行率明顯較國內外一般成人族群高，且胰島素阻抗與代謝症候群呈現正相關，但是代謝症候群各個組成因子與胰島素阻抗的相關性則呈現男女有別的現象。

Three hundred and thirty-one volunteers, who were overweight and had high body mass index (BMI≧24 kg/m2), participated in this study. They were required to fill up their medical history, life style, and family history. Their body weight, height, waist, hip circumference, and blood pressure (BP) were then measured. The blood was sampled to determine the fasting plasma glucose (FPG), insulin level, total cholesterol, triglyceride (TG), and high-density lipoprotein cholesterol (HDL-C). Quantification of insulin resistance (IR) was evaluated by the formula of Homeostatic Model Assessment Index-Insulin Resistance (HOMA-IR). The metabolic syndrome (MS) was defined by the American Heart Association/National Heart, Lung, and Blood Institute (AHA/NHLBI) and was modified by Asian-Pacific standard. The obtained results showed that the MS presented by the level of BP, total cholesterol, plasma insulin, TG, and HDL-C was higher in men than women. Average IR and log IR levels were significantly higher in men than women (p<0.05). IR values obtained from both men and women were all correlated with the MS. However, this correlation displayed gender difference that all of these five items of the MS for women were correlated with the IR and only two items (TG and FPG) of the MS for men were associated with the IR. Data from regression analyses showed that women had four of these five MS items excluding high BP while men had only one item (high FPG) to be positively related to the IR. Based on these results observed, we conclude that there is a positive correlation and gender difference between the IR and MS.