摘要
背景随着中国人口老龄化的加剧及多病共存现象的日益普遍,心血管代谢性共病(CMM)的高风险特征已成为研究的重要领域。中国内脏肥胖指数(CVAI)作为预测心血管疾病的新指标,与CMM的关系目前尚不明确。目的探讨≥60岁人群CVAI与CMM风险之间的关系,并评估CVAI在CMM防治中的潜在作用。方法基于2017—2021年安徽省心血管疾病高危人群早期筛查与综合干预项目的60029例受试者数据,分析其人口学信息、心血管健康状况、体格检查及实验室检查指标,计算CVAI。根据CVAI四分位数将不同性别受试者分为4组(男性:T1~T4组;女性F1~F4组),比较不同性别受试者4组基线特征,并采用多因素Logistic回归分析探讨不同性别人群中CVAI与CMM高危风险的关系。通过限制性立方样条(RCS)曲线评估不同性别间CVAI与CMM的关系,确定OR=1为阈值。结果60029例受试者中男27203例(45.32%)、女32826例(54.68%)。在不同性别CVAI四分位数组中,年龄、吸烟、饮酒、农村、高中学历、BMI、平均动脉压(MAP)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、空腹血糖(FPG)及糖尿病、卒中、高血压、缺血性心脏病比例比较,差异均有统计学意义(P<0.05)。在女性中,CVAI四分位数组高血压用药史比例比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,与T1(F1)组相比,T2~T4(F2~F4)组CMM风险增加(P<0.05)。在完全调整混杂因素后,T4组男性(OR=2.335,95%CI=1.741~3.180,P<0.001)和F4组女性(OR=2.075,95%CI=1.678~2.686,P<0.001)均表现出最高的CMM风险。各组不同性别间CMM风险比较,差异均无统计学意义(P>0.05)。控制不同的混杂因素后,RCS曲线显示,男性CVAI与CMM风险呈非线性关系,且OR=1的阈值为94.75;女性CVAI与CMM风险呈线性关系,且OR=1的阈值为114.87。结论高水平CVAI可能与CMM风险密切相关,且在不同性别中CVAI预测CMM的效能一致。应特别关注CVAI超过94.75的男性和超过114.87的女性以降低CMM风险。
Background With the aging of the population and the increasing prevalence of multimorbidity in China,the high-risk characteristics of cardio-metabolic multimorbidity(CMM)have become an important research field.The exact nature of the relationship between the Chinese visceral adiposity index(CVAI)and CMM remains to be elucidated.Objective This study aims to investigate the relationship between the CVAI and the high risk of CMM,and to evaluate the potential role of CVAI in the prevention and treatment of CMM in the elderly in China.Methods This study was based on the data of 60029 subjects from the Early Screening and Comprehensive Intervention of High-risk Populations of Cardiovascular Disease in Anhui Province from 2017 to 2021.The demographic information,cardiovascular health status,physical examination and biochemical indicators were analyzed,and the CVAI index was calculated.The subjects were grouped according to the quartile of CVAI(male:T1-T4 group,female:F1-F4 group),and the differences in baseline characteristics were compared.Multtivariate Logistic regression analysis was used to explore the relationship between CVAI and the high risk of CMM.The nonlinear relationship between CVAI and CMM between different genders was assessed by restricted cubic spline(RCS)curves,and a threshold of OR=1 was determined.Results There were 60029 subjects,including 27203 males(45.32%)and 32826 females(54.68%).There were statistically significant differences in age,smoking,drinking,rural area,high school education,BMI,mean arterial pressure(MAP),total cholesterol(TC),triglyceride(TG),high density lipoprotein(HDL-C),fasting plasma glucose(FPG),diabetes,stroke,hypertension,and ischemic heart disease in CVAI quartiles between different genders(P<0.05).There was no significant difference in the history of hypertension medication among males.In women,the difference in medication history of hypertension was statistically significant multivariate.Multtivariate Logistic regression analysis showed that compared with T1(F1)group,the risk of CMM was significantly increased in T2 toT4(F2 to F4)group.After fully adjusting for confounding factors,the T4(F4)group showed the highest risk of CMM in both sexes,male(OR=2.335,95%CI=1.741-3.180,P<0.001),and female(OR=2.735,95%CI=1.778-2.686,P<0.001).There was no significant difference in the odds ratio between different genders.There was no significant difference in the risk of CMM between males in T4 group and females in F4 group(P>0.05).After controlling for different confounding factors,RCS curve suggested that there was a nonlinear relationship between CVAI index and CMM risk in men,and the threshold of OR=1 was 94.75.There was a linear relationship between CVAI index and CMM risk in women,and the threshold of OR=1 was 114.87.Conclusion High level of CVAI may be closely related to the risk of CMM,and the predictive power is consistent in different genders.Special attention should be paid to men with CVAI over 94.75 and women with CVAI over 114.87 to reduce the risk of CMM.
作者
韩正
傅方琳
孙梦
潘姚佳
王为强
HAN Zheng;FU Fanglin;SUN Meng;PAN Yaojia;WANG Weiqiang(Department of General Medicine,Suzhou Hospital Affiliated to Anhui Medical University(Suzhou Municipal Hospital of Anhui Province),Suzhou 234000,China;Anhui Medical University,Hefei 230000,China)
出处
《中国全科医学》
北大核心
2026年第6期693-698,709,共7页
Chinese General Practice
基金
安徽省科技创新战略与软科学研究专项计划项目(202106f01050042)。
关键词
心血管代谢性共病
中国内脏肥胖指数
内脏肥胖指标
肥胖症
安徽省
横截面研究
Cardiometabolic multimorbidity
Chinese visceral adiposity index
Visceral obesity indicator
Obesity
Anhui Province
Cross-sectional study
