代谢健康状态转变及其与BMI的交互作用对心血管疾病发生的影响  

The effect of metabolic health state transitions and its interaction with body mass index(BMI)on occurrence of cardiovascular disease(CVD)

作　　者：迪丽胡玛尔·艾力 罗涛 阿娜尔·高少 巴合古·依明尼亚孜 李媛媛[1] 戴江红[1] Dilihumaer Aili;LUO Tao;Anar Gaoshao;Bahegu Yimingniyazi;LI Yuanyuan;DAI Jianghong(School of Public Health,Xinjiang Medical University,Urumqi 830017,China)

机构地区：[1]新疆医科大学公共卫生学院,乌鲁木齐830017

出　　处：《新疆医科大学学报》2024年第5期633-637,643,共6页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区研究生创新项目(XJ2023G187);国家自然科学基金项目(82360662)。

摘　　要：目的探讨代谢健康状态转变与体质指数(BMI)交互作用及与心血管疾病(CVD)的关联。方法基于“新疆多民族自然人群队列建设及健康随访研究”和田调查现场,进行前瞻性队列研究。经过3年随访,根据代谢状态转变将研究对象分为保持代谢健康(MH)、代谢健康转为代谢不健康(MH-MU)、保持代谢不健康(MU)、代谢不健康转为代谢健康(MU-MH)4组,多因素Logistic回归分析不同组代谢状态对CVD发生的影响。应用限制性立方样条探讨BMI为连续变量与CVD风险的关联,分析代谢状态转变和BMI交互作用与CVD的关联。结果共10232人纳入本研究,平均年龄为(52.43±10.29)岁。在随访3年期间新发心血管疾病349例(3.41%);其中MH、MH-MU、MU和MU-MH 4组心血管疾病发生率分别为2.48%、4.21%、5.13%、3.30%。与MH组相比,MH-MU、MU组心血管疾病发生风险分别为OR=1.42(95%CI:1.05~1.93)和OR=1.41(95%CI:1.03~1.92)。限制性立方样条分析表明,基线BMI与心血管疾病发生为非线性关联(P=0.023)。BMI分组与代谢状态转变存在交互作用(χ2=26.025,P=0.001),其归因于交互效应比例为3%[RERI=0.032(95%CI:0.005~0.06)、AP=0.031(95%CI:0.007~0.05)、S=2.157(95%CI:1.194~3.897)]。结论保持或转变为代谢不健康状态均可增加心血管疾病的风险。保持或转为代谢不健康状态与超重、肥胖交互作用能够增加心血管疾病的风险。Objective To investigate the association between metabolic health state change,body mass index(BMI)and cardiovascular disease(CVD).Methods A prospective cohort study was conducted based on the Hotan survey site of“Xinjiang multi-ethnic natural population cohort construction and health follow-up study”.After 3 years of follow-up,the subjects were divided into 4 groups according to the change of metabolic status:metabolically healthy(MH),metabolically healthy to metabolically unhealthy(MHMU),metabolically unhealthy(MU)and metabolically unhealthy to metabolically healthy(MU-MH),and the effects of metabolic status on the occurrence of CVD were analyzed by multifactorial Logistic regression.Restricted cubic spline was applied to explore the association between BMI as a continuous variable and the risk of CVD,and to analyze the association between metabolic status shift and BMI interaction with CVD.Results A total of 10232 individuals with a mean age of(52.43±10.29)years were included in this study.There were 349(3.41%)new cases of CVD during the 3-year follow-up period;the CVD rates in the MH,MH-MU,MU and MU-MH groups were 2.48%,4.21%,5.13%and 3.30%,respectively.Compared with MH group,the risk of CVD occurrence in MH-MU and MU was OR=1.42(95%CI:1.05~1.93)and OR=1.41(95%CI:1.03~1.92),respectively.Restricted cubic spline analysis showed that baseline BMI was a nonlinear association with CVD incidence(P=0.023).There was an interaction between BMI and metabolic state shifts(χ2=26.025,P=0.001),which was attributable to the proportion of the interaction effect of 3%[RERI=0.032(95%CI:0.005~0.06),AP=0.031(95%CI:0.007~0.05)],and S=2.157(95%CI:1.194~3.897).Conclusion Maintaining or shifting to a metabolically unhealthy state can increase the risk of CVD.The interaction between maintaining or changing to metabolic unhealthy state and overweight and obesity can increase the risk of cardiovascular disease.

关 键 词：代谢状态转变 心血管疾病 BMI 交互作用 

分 类 号：R181.3[医药卫生—流行病学]