中青年和老年代谢健康型肥胖与动脉僵硬度关系的差异  

The difference between younger adults and the elderly regarding the association of metabolically healthy obesity with arterial stiffness

作　　者：王庭俊[1,2,3] 张玲玉 卢丹[1,2] 蔡晓琪 徐国焱[1,2] 谢良地[1,2,3,4,5] WANG Tingjun;ZHANG Lingyu;LU Dan;CAI Xiaoqi;XU Guoyan;XIE Liangdi(Department of General Practice,The First Affiliated Hospital of Fujian Medical University,Fuzhou Fujian 350005,China;The International Medical Services,National Regional Medical Center,Binhai Campus of the First Affiliated Hospital,Fujian Medical University;Fujian Hypertension Research Institute;Department of Geriatrics and Hypertension,The First Affiliated Hospital of Fujian Medical University;Branch of National Clinical Research Center for Aging and Medicine,Fujian Province,Fujian Provincial Clinical Research Center for Geriatric Hypertension Disease,National Clinical Research Center for Aging and Medicine,Huashan Hospital,Fudan University,Fuzhou,P.R.China)

机构地区：[1]福建医科大学附属第一医院全科医学科,福建福州350005 [2]福建医科大学附属第一医院滨海院区国家区域医疗中心国际医疗部 [3]福建省高血压研究所 [4]福建医科大学附属第一医院老年医学及高血压科 [5]国家老年疾病临床医学研究中心福建省分中心、福建省老年高血压疾病临床医学研究中心和国家老年疾病临床医学研究中心(华山)

出　　处：《中华高血压杂志》2023年第7期633-641,共9页Chinese Journal of Hypertension

基　　金：国家自然科学基金(81870316,82170355);福建省自然科学基金(2021J01211);福建医科大学启航基金(2020QH1052)。

摘　　要：目的探讨中青年和老年代谢健康型肥胖(MHO)与动脉僵硬度关系的差异。方法分析2016年2月至2019年12月期间接受颈股动脉脉搏波传导速度(cfPWV)检查者的临床资料,受检者为福建医科大学附属第一医院全科医学科、老年科、干部保健科门诊及住院的体检者和患者,年龄30~95岁。年龄≥65岁定义为老年。cfPWV≥10 m/s定义为动脉僵硬度增高。体重指数≥25 kg/m2定义为肥胖。具有2个及以上美国国家胆固醇教育计划成人组第3次报告(NECP/ATPⅢ)中亚洲人群代谢综合征中的组分(不包括腰围)定义为代谢不健康。根据肥胖和代谢健康状态,将受检者分为代谢健康型非肥胖(MHNO)、MHO、代谢不健康型非肥胖(MUNO)及代谢不健康型肥胖(MUO)。比较四组受检者cfPWV等临床指标的差异,多因素logistic回归分析肥胖和代谢不健康与动脉僵硬度增高的关系。结果3355例受检者纳入分析。在中青年受检者中,MHO的cfPWV[(8.62±1.59)比(8.26±1.47)m/s,t=11.125,P=0.001]和动脉僵硬度增高的检出率[18.12%(95%CI 16.54%~19.76%)比8.14%(95%CI 8.03%~9.26%),χ^(2)=20.046,P<0.001]较MHNO高;在老年受检者中,cfPWV和动脉僵硬度增高检出率在MHNO和MHO之间的差异无统计学意义(P>0.05)。不论中青年还是老年,代谢不健康均与动脉僵硬度增高独立相关[中青年:OR=1.856(95%CI 1.413~2.440),P<0.001;老年:OR=1.519(95%CI 1.088~2.122),P=0.014];只有在中青年代谢健康受检者中,肥胖才是动脉僵硬度增高的独立相关因素[OR=1.887(95%CI 1.189~2.993),P=0.007],并且只有在中青年中,MHO与动脉僵硬度增高独立相关[OR=2.249(95%CI 1.481~3.414),P<0.001]。结论中青年和老年MHO与动脉僵硬度的相关性存在差异。中青年MHO与动脉僵硬度增高相关;在老年人中,这种相关性不明显。Objective To investigate the difference between younger adults and the elderly regarding the association of metabolically healthy obesity(MHO)with arterial stiffness.MethodsData were collected and analyzed from the health check-ups,outpatients and inpatients aged 30-95 years who carried out the measurement of carotid-femoral pulse wave velocity(cfPWV)and admitted to the Department of General Practice,Geriatrics and Cadre Ward of the First Affliated Hospital of Fujian Medical University from February 2016 to December 2019.The elderly was defined as the chronological age of 65 or older.Elevated arterial stiffness was defined as cfPWV≥10 m/s.The Obesity was defined as body mass index≥25 kg/m.Metabolic unhealth was defined as having two and more components(excluding waist circumference)of metabolic syndrome based on the diagnostic criteria of the National Cholesterol Education Program Adult Treatment Panel II(NECP-ATPII).According to obesity and the status of metabolic health,the subjects were divided into metabolically healthy non-obesity(MHNO),MHO,metabolically unhealthy non-obesity(MUNO)and metabolically unhealthy obesity(MUO).The difference was compared among the four groups,and multivariate logistic regression analysis was used to determine the association of obesity and metabolical unhealth with elevated arterial stiffness.Results A total of 3355 subjects were included in this analysis.In younger adults,the detection rates of cfPWV was higher[(8.62±1.59)us(8.26±1.47)m/s,t=11.125,P=0.001Jand elevated arterial stffness was more frequently observed in MHO than those in MHNO[18.12%(95%CI 16.54%-19.76%)vs 8.14%(95%CI 8.03%-9.26%),×2=20.046,P<0.001].In the elderly,there were no statistically significant differences in the level of cfPWV and detection rate of elevated arterial stiffness between MHNO and MHO(P>0.05).In both younger adults and the elderly,metabolic unhealth was observed to be associated with elevated arterial stiffness Lyounger adults:OR=1.856(95%CI 1.413-2.440),P<0.001;the elderly:1.519(95%CI 1.

关 键 词：代谢健康型肥胖 代谢不健康型肥胖 动脉僵硬度 老年 颈股动脉脉搏波传导速度 

分 类 号：R589.2[医药卫生—内分泌]