定量CT测量的腹部内脏脂肪与心血管代谢风险的相关性  

Quantitative computed tomography-derived abdominal visceral adipose tissue and cardiometabolic risk in a large-scale population

作　　者：董剩勇[1] 查晓娟 冉利梅 李永丽[4] 陈爽[5] 高剑波[6] 李绍林[7] 陆勇[8] 张玉琴 马骁[10] 李跃华 肖喜刚[12] 龚向阳[13] 杨泽宏[14] 陈伟 杨营营 陈白如 吕英茹[5] 吴艳[6] 吴静 赵凯平[18] 付晓霞 杜霞 付海鸿[21] 程晓光[22] 曾强[1] Dong Shengyong;Zha Xiaojuan;Ran Limei;Li Yongli;Chen Shuang;Gao Jianbo;Li Shaolin;Lu Yong;Zhang Yuqin;Ma Xiao;Li YueHua;Xiao Xigang;Gong Xiangyang;Yang Zehong;Chen Wei;Yang Yingying;Chen Bairu;Lyu Yingru;Wu Yan;Wu Jing;Zhao Kaiping;Fu Xiaoxia;Du Xia;Fu Haihong;Cheng Xiaoguang;Zeng Qiang(Health Management Institute,the Second Medical Center&National Clinical Research Center for Geriatric Diseases,Chinese People's Liberation Army General Hospital,Beijing 100853,China;Department of Health Center,Yijishan hospital of Wannan medical college,Wuhu 241001,China;Department of Health Center,the Affiliated Hospital of Guiyang Medical University,Guiyang 550004,China;Department of Health Management,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,Zhengzhou 450003,China;Department of Radiology,the Affiliated Huashan hospital of Fudan University,Shanghai 200040,China;Department of Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Radiology,the Fifth Affiliated Hospital of Sun Yat-Sen University,Guangzhou 519000,China;Department of Radiology,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Radiology,Ningbo Medical Center Li Huili Hospital,Ningbo 315040,China;China-Japan Friendship Hospital,Beijing 100029,China;Shanghai Jiao Tong University Affiliated Ninth People's Hospital,Shanghai 200011,China;Department of Radiology,the First Affiliated Hospital of Harbin Medical University,Harbin 150001,China;Department of Radiology,the People's Hospital of Zhejiang Province,Hangzhou 310014,China;Sun Yat-sen Memorial Hospital of the Sun Yat-sen University,Guangzhou 510235,China;Department of Radiology,Southwest Hospital,Army Medical University,Chongqing 400038,China;Department of Radiology,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,Zhengzhou 450003,China;National Center for Chronic and Noncommunicable Disease Control and Prevention,Chinese Center for Disease Control and Preventio

机构地区：[1]解放军总医院第二医学中心健康管理研究院,北京100853 [2]皖南医学院弋矶山医院健康管理中心,芜湖241001 [3]贵州医科大学附属医院健康管理中心,贵阳550004 [4]河南省人民医院健康管理中心,郑州450003 [5]复旦大学华山医院放射科,上海200040 [6]郑州大学第一附属医院放射科,郑州450052 [7]中山大学附属第五医院放射科,广州519000 [8]上海交通大学医学院附属瑞金医院放射科,上海200025 [9]宁波医学中心李惠利医院放射科,宁波315040 [10]中日友好医院,北京100029 [11]上海交通大学医学院附属第九人民医院,上海200011 [12]哈尔滨医科大学第一附属医院放射科,哈尔滨150001 [13]浙江省人民医院,杭州310014 [14]中山大学孙逸仙纪念医院,广州510235 [15]陆军军医大学第一附属医院,重庆400038 [16]郑州大学人民医院河南省人民医院放射科,郑州450003 [17]中国疾控中心慢病中心,北京100050 [18]北京积水潭医院病案统计科,北京100035 [19]中华心血管病杂志编辑部,北京100710 [20]贵州医科大学附属医院放射科,贵阳550004 [21]北京协和医院放射科,北京100730 [22]北京积水潭医院放射科,北京100035

出　　处：《中华健康管理学杂志》2021年第5期425-431,共7页Chinese Journal of Health Management

基　　金：国家自然科学基金面上项目(81872920)。

摘　　要：目的探讨定量CT测量的腹内脂肪与心血管代谢风险(cardiometabolic risk,CMR)的相关性。方法本研究选取中国健康定量CT大数据项目中符合入组标准的研究对象76226例。腹内脂肪面积的测量采用Mindways的定量CT(QCT)Pro Model 4系统。本研究收集的心血管代谢指标包括收缩压、舒张压、空腹血糖、总胆固醇、三酰甘油、低密度脂蛋白胆固醇和高密度脂蛋白胆固醇。CMR得分定义为血压、血糖、三酰甘油和高密度脂蛋白胆固醇水平异常得分之和。采用限制性立方样条模型和有序多分类Logistic回归模型分析腹内脂肪面积与心血管代谢风险的相关性。结果研究对象年龄为(50±13)岁,男性占58.8%。男性腹内脂肪面积平均值显著高于女性[(191.7±77.1)cm^(2)比(116.4±56.2)cm^(2),P<0.001]。随着腹内脂肪面积的增加,年龄校正后的心血管代谢指标水平(高密度脂蛋白胆固醇除外)均呈上升趋势。当腹内脂肪面积为300 cm^(2)时,CMR得分≥1的年龄校正后比值比[OR值(95%CI)]男性为14.61(13.31~16.04),女性为5.46(4.06~7.36);CMR得分≥3的年龄校正后可能性男性为31.7%,女性为31.3%。结论基于CT扫描的QCT测量的腹内脂肪面积与心血管代谢风险密切相关。在接受低剂量CT扫描筛查肺癌的健康体检人群中可考虑同时测量腹内脂肪,有助于控制和管理腹型肥胖(特别是内脏脂肪)。Objective To investigate the relationship between abdominal visceral adipose tissue(VAT)and cardiometabolic risk(CMR)through quantitative computed tomography(QCT).Methods The present study included 76226 participants.Abdominal fat areas were measured using the QCT Pro Model 4 system.Cardiometabolic indices were collected,including systolic and diastolic blood pressures,fasting plasma glucose,total cholesterol,triglyceride,and low-density and high-density lipoprotein cholesterols CMR score was the sum of abnormal blood pressure,fasting glucose,triglyceride,and high-density lipoprotein cholesterol.Restricted cubic spline and ordered logistic regression models were applied.Results The mean age was 50±13 years and the percentage of men was 58.8%.The level of VAT area was higher in men than in women(191.7±77.1 cm^(2) vs 116.4±56.2 cm^(2),P<0.0001 for all).After adjustment for age,the cardiometabolic indices except high-density lipoprotein cholesterol increased with increasing VAT area.When VAT area was 300 cm^(2),age-adjusted odds ratios and 95%confidence intervals of a CMR score≥1 were 14.61(13.31,16.04)for men and 5.46(4.06,7.36)for women,and the age-adjusted probability of a CMR score≥3 was 31.7%for men and 31.3%for women.Conclusions QCT-derived VAT is closely related to CMR.The findings suggest that measurement of visceral fat is recommended for the management of abdominal obesity in subjects who agree to undergo lung cancer screening via low-dose CT without additional radiation exposure.

关 键 词：腹部脂肪 内脏脂肪组织 心血管代谢风险 定量CT 

分 类 号：R734.2[医药卫生—肿瘤] R730.44[医药卫生—临床医学] R589.2