由于肥胖症及其相关疾病在全球日益流行的趋势，使肥胖及其相关疾病的发病机制和防治措施的研究成为21世纪医学面临的重要任务。本课题通过对肥胖人群、高脂膳食诱导肥胖大鼠的调查和实验研究，探讨了肥胖发生的危险因素，以及肥胖和胰岛素抵抗与
肿瘤坏死因子的关系。
方法：以BMI≥25为肥胖标准，选择了肥胖与正常对照共322人，其中男性117人，女性205人，进行问卷调查和体格及血清学检查。以高脂膳食饲养Wistar大鼠，复制肥胖模型，以脂体比作为分组标准，检测血清学指标和组织中肿瘤坏死因子α的蛋白水平。人群和
动物实验均以胰岛素敏感指数判断机体胰岛素抵抗状态。
结果：肥胖症发生的危险因素为肥胖家族史和高脂膳食，分性别分析的结果表明，肥胖家族史是肥胖发生的共同危险因素，男性的精神紧张和高脂膳食是肥胖发生的危险因素，而吸烟是一种保护因素。对女性来说，体力活动是肥胖发生的保护因素。肥胖人群特别是腹型肥胖的人群，血压、血脂和血糖的水平和异常结果检出率均明显高于正常人群。肥胖个体的胰岛素敏感指数明显低于对照组。血清肿瘤坏死因子α只在腹型肥胖的男性中升高，在女性中没有显著差别，与胰岛素敏感指数无相关关系。动物实验结果表明，肥胖组大鼠脂肪组织肿瘤坏死因子α水平明显高于基础组，在骨骼肌、肝脏、血清中两组无显著差别。
结论：肥胖、特别是腹型肥胖与高血压、高血脂、胰岛素抵抗、糖尿病密切相关，应采取健康的生活方式，
预防和控制肥胖。而且预防肥胖不仅要控制体重，更要注意在正常体重情况下发生的腹部脂肪堆积。TNFα在肥胖相关IR的发生中有重要作用。循环系统中的TNFα没有参与机体胰岛素抵抗的形成，TNFα并非通过内分泌途径而起作用。TNFα在肥胖机体介导IR是具有组织异质性的。脂肪组织是通过自分泌的作用途径导致IR，TNFα在肌肉和肝脏中更倾向于通过激素和游离脂肪酸等其他因子的间接或协同作用而导致组织的IR。
The Epidemic Study on Obesity, Tumor Necrosis Factor Alpha and
Their Relationships with Insulin Resistance
Objective: because of the prevalence trend of obesity all over the world, the study on obesity and
its relevant diseases has become the main task of medicine in 21st century. This study aims to explore
the risk factors of obesity and the relationships between obesity, TNFα and IR.
Method: According to the criteria of obesity (BMI≥25), 322 (male 117, female 205) persons
worked in service field were interviewed with questionnaire, and body, blood samples were measured.
We get Wistar fat rats by feeding them with high fat food, and ratio of fat to body weight is the criteria
to divide groups. TNFα protein level of serum, muscle, liver and fat tissues were measures. IR of
animal and human was assessed by IAI.
Results: Family history of obesity and high fat food are the main risk factors. Through gender
analysis, Family history of obesity is the common risk factor. High fat food and mental stress are risk
factors of obesity onset for men, but smoking is a protective factor. Physical exercise is a protective
factor for women. The average level and abnormal rate of blood pressure, blood lipid, and blood
glucose in overweight and centrie obesity groups are remarkable higher than those in normal groups.
IAI in overweight and centric obesity groups are remarkable lower than those in normal groups. TNF
α in fat tissue of fat rats group significantly higher than that in normal group, and TNFα in serum,
muscle, liver are not obviously different between the two groups.
Conclusions: Obesity, especially centric obesity has a close correlation with hypertension, lipid
disorder, IR and diabetes mellitus. People should take a healthy life style to prevent and control
obesity especially centric obesity. TNFα has an important role during the IR of obesity. Circlating
TNFα is not involved in the IR. TNFα results in IR of various tissues by different styles. TNFα
induces IR in fat tissues by auto-secretion. And TNFα results in IR in muscle and liver tissues
preferring to indirectly or cooperatively role with other factors, such as hormone, FFA.
Key words: Obesity Centric Obesity Risk Factor Insulin Resistance (IR)
Tumor Necrosis Factor Alpha (TNFα)
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