大腿骨骼肌肌内脂肪组织的含量对肥胖症男性患者糖代谢的影响

doi:10.3969/j.issn.1674-8115.2023.09.011

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (9): 1169-1174.doi: 10.3969/j.issn.1674-8115.2023.09.011

• 论著 · 临床研究 • 上一篇

大腿骨骼肌肌内脂肪组织的含量对肥胖症男性患者糖代谢的影响

卢晓冰¹(), 岳江¹(), 何晟赟², 董莹¹, 路青², 麻静¹()

^1.上海交通大学医学院附属仁济医院内分泌科，上海 200127
^2.上海交通大学医学院附属仁济医院放射科，上海 200127

收稿日期:2023-04-06 接受日期:2023-08-25 出版日期:2023-09-28 发布日期:2023-09-28
通讯作者: 麻静 E-mail:luxiaobingszu@126.com;rjnfm3083@163.com;majing@renji.com
作者简介:卢晓冰（1997—），女，硕士生；电子信箱：luxiaobingszu@126.com
岳　江（1983—），男，博士，主治医师；电子信箱：rjnfm3083@163.com。
基金资助:
上海交通大学医学院“双百人”项目(20181807)

Effect of intramuscular adipose tissue in the skeletal muscle of thigh on glucose metabolism in male patients with obesity

LU Xiaobing¹(), YUE Jiang¹(), HE Shengyun², DONG Ying¹, LU Qing², MA Jing¹()

^1.Department of Endocrinology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
^2.Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China

Received:2023-04-06 Accepted:2023-08-25 Online:2023-09-28 Published:2023-09-28
Contact: MA Jing E-mail:luxiaobingszu@126.com;rjnfm3083@163.com;majing@renji.com
Supported by:
"Two-hundred Talents" Program of Shanghai Jiao Tong University School of Medicine(20181807)

摘要/Abstract

摘要：

目的·探讨单纯性肥胖症男性患者中大腿骨骼肌肌内脂肪组织（intramuscular adipose tissue，IMAT）含量与糖代谢的相关性。方法·选取2019年12月—2020年12月于上海交通大学医学院附属仁济医院内分泌科肥胖专病门诊就诊的80例单纯性肥胖症男性患者，根据口服葡萄糖耐量试验（oral glucose tolerance test，OGTT）结果将其分为糖耐量正常（normal glucose tolerance，NGT）组与糖调节受损（impaired glucose regulation，IGR）组。收集并比较2组患者的一般资料及实验室检测指标。采用mDixon-Quant技术测量2组患者的大腿各骨骼肌IMAT含量，并对其骨骼肌质子密度脂肪分数（proton density fat fraction，PDFF）进行比较。通过多因素Logistic回归模型分析IGR发生的独立影响因素。结果·与NGT组相比，IGR组患者的腰围较大（P=0.017），谷丙转氨酶、谷草转氨酶、γ-谷氨酰转移酶（γ-glutamyl transferase，GGT）、三酰甘油（triacylglycerol，TAG）、血清游离脂肪酸（nonestesterified fatty acid，NEFA）水平以及缝匠肌PDFF均较高（均P<0.05）。经对年龄、体质量指数、GGT、TAG、NEFA等混杂因素进行校正后，多因素Logistic回归分析的结果显示股外侧肌PDFF、半腱肌PDFF与缝匠肌PDFF是IGR发生的危险因素（均P<0.05）。结论·单纯性肥胖症男性患者中大腿股外侧肌IMAT、半腱肌IMAT、缝匠肌IMAT的含量升高将增加IGR的发生风险。

关键词: 肥胖症, 肌内脂肪, 糖代谢, 骨骼肌, 磁共振成像

Abstract:

Objective ·To investigate the correlation between intramuscular adipose tissue (IMAT) content and glucose metabolism in male patients with obesity. Methods ·Eighty male patients with obesity were recruited from the Endocrinology Department of Renji Hospital, Shanghai Jiao Tong University School of Medicine from December 2019 to December 2020. According to the results of oral glucose tolerance test (OGTT), they were divided into normal glucose tolerance (NGT) group and impaired glucose regulation (IGR) group. General data and laboratory test indicators of the two groups were collected and compared. mDixon-Quant technique was used to measure the IMAT content in each skeletal muscle of the thigh in the two groups, and the proton density fat fractions (PDFF) of skeletal muscle in the two groups were compared. The multivariate Logistic regression model was used to analyze the independent influencing factors of IGR occurrence. Results ·Compared with the NGT group, patients in the IGR group had a larger waist circumference (P=0.017), higher glutamic-pyruvic transaminase level, glutamic-oxaloacetic transaminase level, γ-glutamyl transferase (GGT) level, triacylglycerol (TAG) level, nonestesterified fatty acid (NEFA) level and sartorius PDFF (all P<0.05). After adjusting for confounding factors such as age, body mass index, GGT, TAG and NEFA, the results of multivariate Logistic regression analysis showed that PDFF of vastus lateralis, semitendinosus and sartorius were the risk factors for IGR (all P<0.05). Conclusion ·Higher levels of IMAT content in vastus lateralis, semitendinosus and sartorius will increase the risk of IGR in male patients with obesity.

Key words: obesity, intramuscular adipose, glucose metabolism, skeletal muscle, magnetic resonance imaging (MRI)

中图分类号:

R589.1

卢晓冰, 岳江, 何晟赟, 董莹, 路青, 麻静. 大腿骨骼肌肌内脂肪组织的含量对肥胖症男性患者糖代谢的影响[J]. 上海交通大学学报（医学版）, 2023, 43(9): 1169-1174.

LU Xiaobing, YUE Jiang, HE Shengyun, DONG Ying, LU Qing, MA Jing. Effect of intramuscular adipose tissue in the skeletal muscle of thigh on glucose metabolism in male patients with obesity[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2023, 43(9): 1169-1174.

图/表 3

参考文献 24

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Item	NGT group (n=41)	IGR group (n=39)	P value
General data
Age/year	32.00 (28.50, 42.00)	35.00 (31.00, 41.00)	0.338
BMI/(kg·m^-2)	34.34 (30.80, 38.55)	34.56 (31.95, 37.65)	0.605
WC/cm	114.31±11.55	124.25±18.26	0.017
HC/cm	115.00 (107.00, 122.00)	117.50 (110.25, 126.25)	0.101
WHR	0.99±0.06	1.01±0.06	0.095
Laboratory test indicators
FBG/(mmol·L^-1)	5.10 (4.63, 5.43)	5.99 (5.33, 7.54)	0.000
PBG-0.5h/(mmol·L^-1)	8.61 (7.56, 9.92)	9.24 (8.32, 11.41)	0.043
PBG-1h/(mmol·L^-1)	9.18 (6.97, 9.97)	12.39 (9.87, 13.99)	0.000
PBG-2h/(mmol·L^-1)	6.41 (5.78, 7.03)	10.35 (8.88, 12.86)	0.000
PBG-3h/(mmol·L^-1)	4.18 (3.78, 4.81)	6.60 (5.71, 8.81)	0.000
FINS/(μIU·mL^-1)	15.12 (10.15, 20.69)	21.20 (12.02, 28.63)	0.064
INS-0.5h/(μIU·mL^-1)	107.18 (80.63, 162.12)	79.47 (25.74, 116.61)	0.025
INS-1h/(μIU·mL^-1)	127.05 (83.54, 171.24)	113.44 (52.24, 175.94)	0.307
INS-2h/(μIU·mL^-1)	70.69 (45.45, 117.95)	98.84 (53.35, 205.92)	0.028
INS-3h/(μIU·mL^-1)	20.75 (11.08, 28.14)	48.82 (33.61, 106.97)	0.000
FCP/(ng·mL^-1)	3.95 (3.33, 4.85)	4.67 (3.80, 5.73)	0.037
CP-0.5h/(ng·mL^-1)	11.83 (8.13, 13.76)	7.96 (6.41, 12.01)	0.015
CP-1h/(ng·mL^-1)	13.22 (10.83, 16.94)	10.77 (8.43, 16.27)	0.115
CP-2h/(ng·mL^-1)	11.43 (9.17, 14.97)	13.68 (10.87, 18.24)	0.051
CP-3h/(ng·mL^-1)	6.01 (4.43, 7.84)	10.29 (8.03, 12.70)	0.000
HbA1c/%	5.50 (5.20, 5.70)	6.45 (5.70, 7.95)	0.000
HOMA-IR	3.31 (2.14, 4.56)	6.24 (3.45, 8.17)	0.002
GPT/(U·L^-1)	40.00 (20.00, 69.00)	67.00 (38.00, 87.00)	0.013
GOT/(U·L^-1)	22.00 (16.00, 35.75)	36.00 (25.00, 54.00)	0.001
GGT/(U·L^-1)	40.50 (26.00, 55.00)	52.00 (41.00, 77.00)	0.002
BUN/(mmol·L^-1)	4.83±1.08	4.60±0.99	0.324
Cre/(μmol·L^-1)	79.97±12.98	74.28±13.37	0.060
UA/(mmol·L^-1)	487.82±122.65	479.23±104.40	0.740
TAG/(mmol·L^-1)	1.63 (1.25, 2.71)	2.36 (1.83, 3.41)	0.010
TC/(mmol·L^-1)	5.01±1.09	5.44±0.99	0.068
HDL-C/(mmol·L^-1)	1.09±0.24	1.06±0.20	0.531
LDL-C/(mmol·L^-1)	3.07±0.84	3.34±0.86	0.164
NEFA/(mmol·L^-1)	0.53 (0.47, 0.64)	0.69 (0.57, 0.78)	0.004

Item	NGT group (n=41)	IGR group (n=39)	P value
General data
Age/year	32.00 (28.50, 42.00)	35.00 (31.00, 41.00)	0.338
BMI/(kg·m^-2)	34.34 (30.80, 38.55)	34.56 (31.95, 37.65)	0.605
WC/cm	114.31±11.55	124.25±18.26	0.017
HC/cm	115.00 (107.00, 122.00)	117.50 (110.25, 126.25)	0.101
WHR	0.99±0.06	1.01±0.06	0.095
Laboratory test indicators
FBG/(mmol·L^-1)	5.10 (4.63, 5.43)	5.99 (5.33, 7.54)	0.000
PBG-0.5h/(mmol·L^-1)	8.61 (7.56, 9.92)	9.24 (8.32, 11.41)	0.043
PBG-1h/(mmol·L^-1)	9.18 (6.97, 9.97)	12.39 (9.87, 13.99)	0.000
PBG-2h/(mmol·L^-1)	6.41 (5.78, 7.03)	10.35 (8.88, 12.86)	0.000
PBG-3h/(mmol·L^-1)	4.18 (3.78, 4.81)	6.60 (5.71, 8.81)	0.000
FINS/(μIU·mL^-1)	15.12 (10.15, 20.69)	21.20 (12.02, 28.63)	0.064
INS-0.5h/(μIU·mL^-1)	107.18 (80.63, 162.12)	79.47 (25.74, 116.61)	0.025
INS-1h/(μIU·mL^-1)	127.05 (83.54, 171.24)	113.44 (52.24, 175.94)	0.307
INS-2h/(μIU·mL^-1)	70.69 (45.45, 117.95)	98.84 (53.35, 205.92)	0.028
INS-3h/(μIU·mL^-1)	20.75 (11.08, 28.14)	48.82 (33.61, 106.97)	0.000
FCP/(ng·mL^-1)	3.95 (3.33, 4.85)	4.67 (3.80, 5.73)	0.037
CP-0.5h/(ng·mL^-1)	11.83 (8.13, 13.76)	7.96 (6.41, 12.01)	0.015
CP-1h/(ng·mL^-1)	13.22 (10.83, 16.94)	10.77 (8.43, 16.27)	0.115
CP-2h/(ng·mL^-1)	11.43 (9.17, 14.97)	13.68 (10.87, 18.24)	0.051
CP-3h/(ng·mL^-1)	6.01 (4.43, 7.84)	10.29 (8.03, 12.70)	0.000
HbA1c/%	5.50 (5.20, 5.70)	6.45 (5.70, 7.95)	0.000
HOMA-IR	3.31 (2.14, 4.56)	6.24 (3.45, 8.17)	0.002
GPT/(U·L^-1)	40.00 (20.00, 69.00)	67.00 (38.00, 87.00)	0.013
GOT/(U·L^-1)	22.00 (16.00, 35.75)	36.00 (25.00, 54.00)	0.001
GGT/(U·L^-1)	40.50 (26.00, 55.00)	52.00 (41.00, 77.00)	0.002
BUN/(mmol·L^-1)	4.83±1.08	4.60±0.99	0.324
Cre/(μmol·L^-1)	79.97±12.98	74.28±13.37	0.060
UA/(mmol·L^-1)	487.82±122.65	479.23±104.40	0.740
TAG/(mmol·L^-1)	1.63 (1.25, 2.71)	2.36 (1.83, 3.41)	0.010
TC/(mmol·L^-1)	5.01±1.09	5.44±0.99	0.068
HDL-C/(mmol·L^-1)	1.09±0.24	1.06±0.20	0.531
LDL-C/(mmol·L^-1)	3.07±0.84	3.34±0.86	0.164
NEFA/(mmol·L^-1)	0.53 (0.47, 0.64)	0.69 (0.57, 0.78)	0.004

Skeletal muscle PDFF	NGT group (n=41)	IGR group (n=39)	P value
Vastus lateralis	6.49±1.87	7.36±2.48	0.080
Rectus femoris	6.08±2.00	6.44±2.02	0.431
Vastus medialis	4.85 (4.07, 5.85)	5.04 (3.97, 6.90)	0.353
Vastus internus	5.41 (4.44, 6.24)	5.30 (4.47, 6.64)	0.878
Biceps femoris	10.22±3.28	11.37±3.53	0.136
Semitendinosus	10.01 (6.98, 11.69)	10.83 (7.87, 14.90)	0.088
Semimembranosus	9.94 (7.56, 14.61)	11.07 (8.99, 12.73)	0.607
Adductor magnus	4.81 (4.18, 5.71)	5.29 (4.46, 6.50)	0.103
Gracilis	10.03 (8.48, 14.57)	12.24 (9.43, 16.20)	0.172
Sartorius	10.92 (8.94, 16.30)	15.09 (11.92, 18.82)	0.006

Skeletal muscle PDFF	NGT group (n=41)	IGR group (n=39)	P value
Vastus lateralis	6.49±1.87	7.36±2.48	0.080
Rectus femoris	6.08±2.00	6.44±2.02	0.431
Vastus medialis	4.85 (4.07, 5.85)	5.04 (3.97, 6.90)	0.353
Vastus internus	5.41 (4.44, 6.24)	5.30 (4.47, 6.64)	0.878
Biceps femoris	10.22±3.28	11.37±3.53	0.136
Semitendinosus	10.01 (6.98, 11.69)	10.83 (7.87, 14.90)	0.088
Semimembranosus	9.94 (7.56, 14.61)	11.07 (8.99, 12.73)	0.607
Adductor magnus	4.81 (4.18, 5.71)	5.29 (4.46, 6.50)	0.103
Gracilis	10.03 (8.48, 14.57)	12.24 (9.43, 16.20)	0.172
Sartorius	10.92 (8.94, 16.30)	15.09 (11.92, 18.82)	0.006

Model	Vastus lateralis		Semitendinosus		Sartorius
Model	OR (95% CI)	P value	OR (95% CI)	P value	OR (95% CI)	P value
Model 1	1.204 (0.975‒1.488)	0.085	1.128 (1.010‒1.260)	0.088	1.125 (1.021‒1.239)	0.006
Model 2	1.199 (0.959‒1.499)	0.112	1.134 (1.008‒1.277)	0.036	1.128 (1.020‒1.248)	0.019
Model 3	1.402 (1.037‒1.895)	0.028	1.253 (1.051‒1.493)	0.012	1.149 (1.016‒1.300)	0.027

大腿骨骼肌肌内脂肪组织的含量对肥胖症男性患者糖代谢的影响

Effect of intramuscular adipose tissue in the skeletal muscle of thigh on glucose metabolism in male patients with obesity

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