減重介入與肥胖指標對於心血管疾病危險因子及細胞激素的影響

The effects of weight loss and obesity indices on cardiovascular disease risk factors and cytokines

林韋臣(Wei-Chen Lin)

指導教授 ： 王姿乃

高雄醫學大學/健康科學院/公共衛生學研究所/碩士(2008年)

https://doi.org/10.6832/KMU.2008.00135

摘要

中文摘要
研究背景：
有研究指出不同度量肥胖的指標、如身體質量值數(BMI)、腰圍(Waist)、腰臀比(WHR)及腰身比(WSHT)等與心血管疾病的相關強度不同，此外研究也發現脂肪組織所分泌的細胞激素(即Leptin、IL-6及TNF-α)及其他非由脂肪組織所分泌的細胞激素(即Ghrelin及CRP)，可能是導致肥胖者有較高心血管疾病風險的原因之一，因此我們除了想要探討肥胖者與非肥胖者心血管疾病危險因子及細胞激素間的差異外，也想了解不同肥胖指標與減重介入對於心血管疾病危險因子及細胞激素的影響。
研究設計：
本研究屬於臨床試驗之實驗設計，研究期間自2007年3月起至2008年5月止，受試者為來自高雄某社區與醫院之民眾，其中有35位肥胖者(BMI≧27)及39位與肥胖者配對性別及年齡之非肥胖者(BMI＜25)。研究中所有受試者均測量其身體組成及血清中細胞激素濃度，以比較肥胖者與非肥胖者間的差異。另外肥胖者參與減重介入(非肥胖者無)以探討減重介入對於心血管疾病危險因子及細胞激素的影響。
結果：
本研究發現肥胖者的血壓、血糖、TG、Insulin及HOMA均顯著高於非肥胖者；細胞激素方面發現肥胖者體內Leptin及CRP濃度皆顯著高於非肥胖者，而Ghrelin則顯著低於非肥胖者(見表1-1)。
減重前後發現心血管疾病危險因子(血壓、膽固醇、TG、Insulin及HOMA)及細胞激素(Leptin)均有顯著下降的現象，Ghrelin與IL-6則顯著升高(見表10)。迴歸分析中發現肥胖指標均與HOMA有顯著正相關(見表9)，而在細胞激素方面，發現BMI對於Leptin的解釋力最高(81.3%)；Waist對於TNF-α的解釋力最高(5.4%)；WSHT對於Ghrelin及CRP的解釋力最大(依序為34.5%及5.4%)。另外我們也發現腹部肥胖指標WHR在所探討的五個細胞激素中，其解釋力均為最低。
結論：
本研究發現肥胖者的心血管疾病危險因子及體內細胞激素濃度顯著高於非肥胖者。也發現減重介入對於肥胖指標、心血管疾病危險因子及細胞激素均有顯著改善的現象。在肥胖指標中，我們發現不同肥胖指標對於細胞激素的解釋力均不一。

關鍵字

細胞激素 ； 心血管疾病危險因子 ； 肥胖指標 ； 減重

並列摘要

英文摘要
Background
Some studies had pointed out that different obesity indices ,like BMI , Waist , WHR and WSHT, have different correlation with cardiovascular diseases. Previous studies also discovered that cytokines are secreted by adipose tissue (namely Leptin , IL-6 , TNF-α) and the other cytokines are secreted by non-adipose tissue (namely Ghrelin and CRP) possibly cause to have higher risk of cardiovascular disease among obese subjects . Therefore, we want to discuss the difference of cardiovascular risk factors and cytokines between the obesity and the non-obesity, also understand the effects of different obesity indices and weight loss on cardiovascular risk factors and cytokines.

Study design
Our study is a clinical trial study design , the study period is from March , 2007 to May, 2008. All subjects come from the community or the hospital in Kaohsiung, all of them includes thirty-five obesity (BMI≧27) and thirty-nine non-obeisty (BMI < 25). The controls were matched sex and age(± 5 years) to obese subjects . We measure and compare the differences of physic compositions and cytokines between the obese and the non-obese subjects. Furthermore, the obese subjects attended a weight control course to explore the effects of weight loss on cardiovascular risk factors and cytokines.

Results
We find the blood pressures , blood glucose , TG , Insulin and HOMA in obese group are significant higher than in control group. We also find leptin and CRP concentrations in obese group are higher than in non-obese group but ghrelin concentration of obese subjects is lower than that of non-obese subjects .
After weight loss, we find cardiovascular risk factors (Blood pressure , cholestrerol , TG , Insulin and HOMA) and cytokine (leptin) levels reduce significantly but ghrelin and IL-6 levels increase significantly. All of the four obesity indices have positive correlation with HOMA by running linear regression models. BMI’s coefficient of determination is the highest for Leptin (r2 = 81.3%) and Waist’s coefficient of determination is the highest for TNF-α (r2 =5.4%). WSHT’s coefficient of determination is the highest for Ghrelin and CRP (r2 =34.5% and r2 =5.4% subsequently). Moreover we also find WHR’s coefficient of determination is the lowest in the five cytokines.

Conclusion
In our study, we find cardiovascular risk factors and cytokines in obese group are significant higher than in non-obese group. We also find the effect of weight loss can improve cardiovascular risk factors and levels of cytokines. And we also find different obesity indices have different coefficients of determination for cytokines.

並列關鍵字

Cytokine ； Cardiovascular disease risk factors ； Obesity indices ； Weight loss

參考文獻

參考文獻

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