| 摘要: | 研究目的–1、探討腹部內臟脂肪與皮下脂肪與糖尿病和代謝症候群發生的關係2、建立篩檢空腹血糖正常但葡萄糖耐性測試超過200 mg/dl的策略 材料與方法–以2006年起在台大雲林分院建立的糖尿病研究世代2000名個案為對象，進行每兩年定期追蹤。納入本世代的條件是過去不曾被診斷出糖尿病的30歲以上的成人為對象，進行腹部電腦斷層掃描、葡萄糖耐性測試(OGTT)與各種基本身體測計和生化檢測。 結果-總共追蹤350人。糖尿病達顯著正相關的因子有年齡、體重、腰圍、腰臀比、糖尿病家族史、高血壓、HbA1c、GPT、胰島素阻抗等，負相關的因子主要是高密度膽固醇。電腦斷層掃描腹部的脂肪量，發現腹部內臟脂肪與腹部皮下脂肪都與糖尿病有正相關。與高血壓達顯著相關的因子有體重、GPT、胰島素阻抗、三酸甘油脂與腹部內臟脂肪量。本世代第二次成功世代的樣本數共1413人，總共診斷出142(10.1%)人罹患糖尿病，其中高達83 (58.5%)人沒有經過OGTT無法診斷出來。以第一次追蹤時所建立的單獨空腹血糖偏高的篩檢方法評估，發現其敏感度都高過6成，精確度都高達9成以上。 結論-一、糖尿病與高血壓都跟腹部內臟脂肪高度相關。二、以空腹血糖作為診斷糖尿病標準會流失一大半的病患，應該要在抽血檢查後篩檢出高危險族群進行OGTT，我們建議的四個策略都是不錯的選擇。
OBJECTIVE –The purposes of this cohort study are as followed： 1、 To study the relationship between the abdominal visceral & subcutaneous fat, diabetes, and metabolic syndrome 2、 To develop strategies to screen diabetic subjects with isolated postload hyperglycemia RESEARCH DESIGN AND METHODS –From 2006, about 2000 individuals aged≧30years, who had received health examinations at the National Taiwan University Hospital Yun-Lin branch during the previous year and had fasting plasma glucose levels <126 mg/dL, were invited to participate in the Study. And then, they had an oral glucose tolerance test (OGTT) and physical examination. We follow up the cohort every two-years. In this study, we conducted blood examination for estimation of biochemical, metabolic and anthropometric characteristics, which are including weight, height, waist circumference, hip circumference, OGTT, HbA1c, triglyceride, high and low density cholesterol, blood pressure, insulin resistance, high sensitivity c-reactive protein, GPT, GPT, GGT. Computed tomography was used to measure the abdomen visceral fat and subcutaneous fat. Results—We recruited 350 samples in the project. Compared with subjects without diabetes, diabetes and pre-DM were older, had a higher mean BMI, hypertension, waist circumference, hip circumference, waist-to- hip ratio and had lower high density cholesterol. The risk factors of subjects with hypertension are similar to diabetes. Computed tomography was used to measure the abdomen visceral fat and subcutaneous fat. We found abdomen visceral fat associated with diabetes and hypertension. There were 1413 subjects for assess the subjects with isolated postload hyperglycemia (IPH). The missing rate of new diagnose DM was 58.5% if fasting glucose test was used only. There were four strategies for screening IPH. The sensitivity and specificity were above 60% and 90%. Conclusions- 1. Diabetes and hypertension were associated with found abdomen visceral fat. 2. If we use fasting glucose test for diagnose diabetes, we will miss many subjects with IPH. So we suggest some strategies for screening high risk population who need OGTT. |
