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荷蘭醫學中心的一項研究發現,在有明顯血管疾病的2410名患者中,內臟脂肪量的增加與C-反應蛋白(CRP)水平的提高密切相關。研究利用超聲波技術評估患者的脂肪厚度,並通過線性回歸分析確認了脂肪與CRP之間的相關性,突顯內臟脂肪對全身炎症反應的重要影響。
Increased visceral adipose tissue mass is associated with increased C-reactive protein in patients with manifest vascular diseases
內臟脂肪組織增加與顯性血管疾病患者的C反應蛋白增加有關
Faber DR, van der Graaf Y, Westerink J, Visseren FL. Increased visceral adipose tissue mass is associated with increased C-reactive protein in patients with manifest vascular diseases. Atherosclerosis. 2010;212(1):274-280. doi:10.1016/j.atherosclerosis.2010.04.029
https://pubmed.ncbi.nlm.nih.gov/20494358/
Abstract
Background
Obesity is related to the development of vascular diseases and metabolic complications. Low grade inflammation is a key feature of central obesity, characterized by elevated plasma levels of C-reactive protein (CRP). We hypothesize that visceral adipose tissue contributes to systemic concentrations of CRP.
Methods
In 2410 patients (1729 men and 681 women) with vascular diseases, subcutaneous and visceral fat masses were analyzed with ultrasonography. Metabolic parameters and CRP were measured in a fasting state. The association between fat measurements and plasma CRP was quantified using linear regression analysis. CRP levels were logarithmically transformed. Adjustments were made for age, smoking, type 2 diabetes mellitus, insulin resistance (HOMA-IR) and medication use.
Results
Visceral fat was categorized into quartiles (Q) ranging from 3.2 to 7.8 cm in Q1 (reference) to 11.0–19.8 cm in Q4 in men and 2.7–6.0 cm in Q1 (reference) to 9.0–17.4 cm in Q4 in women. β-coefficients gradually increased across the quartiles from 0.07 (0.01–0.13) in Q2 to 0.25 (0.19–0.31) in Q4 in men and 0.17 (0.07–0.26) in Q2 to 0.42 (0.32–0.52) in Q4 in women, indicating 0.25 and 0.42 mg/l higher logarithmically transformed (log)CRP levels in Q4 compared to Q1 in respectively men and women. Per standard deviation increase of visceral fat, logCRP levels increased with 0.10 mg/l (0.07–0.12) in men and with 0.11 (0.15–0.19) in women. Likewise, in separate analyses waist circumference and body mass index showed a positive, but weaker association with logCRP levels across quartiles (in men: β 0.21 (0.15–0.27) in Q4 for waist circumference and β 0.23 (0.17–0.30) in Q4 for body mass index; in women: β 0.32 (0.22–0.42) in Q4 for waist circumference and β 0.32 (0.22–0.42) in Q4 for body mass index). In men subcutaneous fat was not associated with logCRP (β-coefficients relative to Q1: −0.01 (−0.07 to −0.05), −0.01 (−0.07 to −0.05) and 0.05 (−0.01 to −0.11) in Q2 to Q4 respectively).
Conclusions
In conclusion, visceral fat thickness is the strongest contributor to the systemic CRP concentrations in patients with vascular diseases.
摘要
背景
肥胖與血管疾病和代謝性併發症的發展相關。低度炎症是中心性肥胖的一個關鍵特徵,其特點是C-反應蛋白(CRP)血漿水平升高。我們假設內臟脂肪組織對CRP的系統濃度有所貢獻。
方法
對2410名(1729名男性和681名女性)患有血管疾病的患者進行了超聲波分析,分析了皮下和內臟脂肪質量。在禁食狀態下測量代謝參數和CRP。使用線性回歸分析量化了脂肪測量值與血漿CRP之間的關聯。CRP水平進行了對數轉換。根據年齡、吸煙、2型糖尿病、胰島素抵抗(HOMA-IR)和藥物使用進行了調整。
結果
內臟脂肪被分為四分位(Q),從男性的Q1(參考)的3.2至7.8厘米到Q4的11.0至19.8厘米,女性的Q1(參考)的2.7至6.0厘米到Q4的9.0至17.4厘米。β-係數在四分位中逐漸增加,從男性的Q2中的0.07(0.01–0.13)到Q4中的0.25(0.19–0.31),女性的Q2中的0.17(0.07–0.26)到Q4中的0.42(0.32–0.52),這表明與男性和女性相比,在Q4中的logCRP水平分別高0.25和0.42 mg/l。每增加一個標準差的內臟脂肪,男性的logCRP水平增加0.10 mg/l(0.07–0.12),女性則增加0.11(0.15–0.19)。同樣,在單獨分析中,腰圍和身體質量指數顯示出與logCRP水平的正相關,但在四分位中較弱(男性:腰圍Q4的β 0.21(0.15–0.27),BMI的β 0.23(0.17–0.30);女性:腰圍Q4的β 0.32(0.22–0.42),BMI的β 0.32(0.22–0.42))。在男性中,皮下脂肪與logCRP無關(相對於Q1的β-係數:Q2至Q4分別為−0.01(−0.07至−0.05)、−0.01(−0.07至−0.05)和0.05(−0.01至−0.11))。
結論
總之,內臟脂肪厚度是對患有血管疾病的患者的系統CRP濃度的最強貢獻者。
介紹
腹部肥胖與血管疾病和代謝性併發症(如血脂異常、高血壓、胰島素抵抗和糖尿病)的發展密切相關。低度炎症,通過血漿中腫瘤壞死因子α(TNF-α)、白介素-6(IL-6)和C-反應蛋白(CRP)水平升高來衡量,是中心性肥胖的特徵之一。脂肪組織產生各種調節炎症的蛋白質,如TNF-α、IL-1β、IL-6、巨噬細胞趨化蛋白-1(MCP-1)和轉化生長因子-β(TGF-β)。免疫細胞(如巨噬細胞和淋巴細胞)可能被局部產生的促炎性細胞因子吸引到脂肪組織中,進一步加重促炎性狀態。肥胖細胞中脂肪酸通量增加和脂肪組織缺氧可能誘導內質網(ER)應激和toll樣受體-4的激活,引發炎症反應。內臟脂肪組織產生的脂肪因子直接釋放到門靜脈系統中,影響肝功能,包括脂質和葡萄糖代謝以及急性期反應物和凝血因子的合成。皮下和內臟脂肪組織的分泌特徵不同,IL-6和PAI-1主要由內臟脂肪組織產生。
考慮到肥胖與炎症之間的密切關係,可以想像炎症是肥胖與代謝和血管併發症之間的重要病理生理聯繫。已經顯示,炎症介質的血漿濃度增加,特別是CRP,與血管疾病風險增加有關。
在患有明顯血管疾病的患者中,已經建議進行額外的CRP測量,以評估復發性血管事件的可能性。以前的橫斷面研究數據支持皮下和內臟脂肪組織與炎症標誌物,特別是CRP之間的關聯。然而,目前尚不清楚在具有臨床表現的動脈疾病患者中是否存在這種關係。本橫斷面研究的目標是調查超聲波測量的腹部內臟和皮下脂肪組織是否與體循環(高靈敏度)CRP濃度相關聯,該濃度在具有明顯動脈疾病的患者中。
研究設計與患者
本研究使用了SMART研究(ARTerial疾病的第二次表現)的患者數據,該研究是在荷蘭烏得勒支大學醫學中心進行的一項持續進行的單一中心前瞻性隊列研究。SMART研究始於1996年9月。納入了年齡在18至80歲之間,因動脈粥樣硬化性血管疾病(冠心病、腦血管疾病、周邊血管疾病或腹主動脈瘤)或
基線特徵
具有明顯血管疾病的研究人群主要由男性組成(72%),總人口的平均年齡為59.7 ± 10.4歲。平均腹內脂肪厚度為9.0 ± 2.6厘米(男性:9.5 ± 2.3厘米,女性:7.6 ± 2.2厘米),平均皮下脂肪厚度為2.3 ± 1.2厘米(男性:2.1 ± 1.2厘米,女性:2.7 ± 1.3厘米),平均腰圍為95 ± 12厘米(男性:98 ± 11厘米,女性:87 ± 13厘米),平均BMI為27.0 ± 3.9 kg/m2(男性:27.2 ± 3.6 kg/m2,女性:27.6 ± 4.7 kg/m2)。
討論
在這項針對具有明顯血管疾病的患者的橫斷面研究中,我們觀察到超聲波測量的腹內脂肪厚度與血漿hsCRP濃度呈正相關(男性:在四分位數3和4;女性:在四分位數2-4,表3a,表3b)。此關聯性在較小程度上也表現為腰圍和BMI。皮下脂肪厚度並未影響男性的CRP濃度。然而,在女性中,皮下脂肪
結論
總之,腹內脂肪和腰圍以及較小程度上的BMI,與具有明顯動脈粥樣硬化疾病的患者的血漿CRP濃度增加相關。男性的皮下脂肪與炎症之間沒有關聯。儘管女性的皮下脂肪與CRP水平之間的關係不如其他肥胖測量對CRP的影響顯著,但皮下脂肪對CRP水平的重要貢獻仍然可以得到證明。
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