体重指数与慢性阻塞性肺疾病患病风险的相关性  

Association between body mass index and the risk of chronic obstructive pulmonary disease

作　　者：张聪[1] 张涵 马经平[1] 龚建化[1] 李春玉[1] 何丽[1] Zhang Cong;Zhang Han;Ma Jingping;Gong Jianhua;Li Chunyu;He Li(Department of Respiratory and Critical Care Medicine,Jingzhou Hospital Affiliated to Yangtze University,Jingzhou 434000,China)

机构地区：[1]长江大学附属荆州医院呼吸与危重症医学科,荆州434000

出　　处：《中华健康管理学杂志》2024年第6期439-445,共7页Chinese Journal of Health Management

基　　金：湖北省公共卫生青年拔尖人才培育计划[鄂卫通(2021)74号]。

摘　　要：目的探讨体重指数(BMI)与慢性阻塞性肺疾病(简称慢阻肺)患病风险的相关性。方法本研究为单中心、横断面研究联合在线数据孟德尔随机化(MR)分析。首先选取2021年9月至2023年10月荆州地区“幸福呼吸”慢阻肺筛查肺功能数据共16187例,对于缺失问卷信息、质控不合格以及存在单纯限制性或小气道功能障碍的数据剔除,最终获得进行分析的数据有3999例,其中非慢阻肺组2330例,慢阻肺组1669例。以是否患有慢阻肺为因变量,以BMI为自变量,采用平滑曲线图法展示BMI与慢阻肺发生之间的关系,若观察到非线性关系,则采用二段线性回归模型计算阈值效应,并对潜在的混杂因素(年龄、性别、吸烟史、生物燃料接触史、慢阻肺认知)进行调整。其次利用在线全基因组关联研究(GWAS)数据,采用MR分析高BMI与慢阻肺发生之间潜在的因果关系。结果利用荆州地区“幸福呼吸”慢阻肺筛查肺功能数据进行分析发现BMI与慢阻肺患病风险存在非线性关系,当BMI<23.7 kg/m2时,BMI每增加1 kg/m2,慢阻肺患病风险下降18%(OR=0.82,95%CI:0.79~0.85),当BMI>23.7 kg/m2后,BMI的增加与慢阻肺患病风险无显著相关性(OR=1.00,95%CI:0.96~1.05)。利用在线GWAS数据进行MR分析发现高BMI与慢阻肺发生可能不存在潜在因果关联,异质性检验及水平多效应检验均P>0.05。结论BMI与慢阻肺患病风险可能存在非线性关系,当BMI>23.7 kg/m2后,BMI与慢阻肺患病风险可能无相关性。Objective To investigate the association between body mass index(BMI)and the risk of chronic obstructive pulmonary disease(COPD).Methods This study employed a single-center,cross-sectional design combined with online Mendelian randomization(MR)analysis.A total of 16187 pieces of lung function data for COPD screening from the“Happy Breathing”project in the Jingzhou area between September 2021 and October 2023 were initially collected.Cases with missing questionnaire information,failed quality control,or isolated restrictive or small airway dysfunction were excluded,resulting in a final dataset of 3999 cases,comprising 2330 non-COPD and 1669 COPD cases.Binary COPD status was set as the outcome variable,with BMI as the exposure variable.A smooth curve plot was used to depict the relationship between BMI and COPD prevalence;if non-linearity was observed,a two-piece linear regression model was employed to calculate threshold effects,adjusting for potential confounders such as age,sex,smoking history,biomass fuel exposure,and COPD awareness.Subsequently,online genome-wide association study(GWAS)data were utilized for MR analysis to explore any potential causal link between high BMI and COPD development.Results Analysis of the“Happy Breathing”COPD screening data from the Jingzhou area revealed a nonlinear relationship between BMI and COPD risk.For BMI values<23.7 kg/m²,each 1 kg/m²increase in BMI was associated with an 18%decrease in COPD risk(OR=0.82,95%CI:0.79-0.85).However,for BMI>23.7 kg/m²,no significant association was found between increasing BMI and COPD risk(OR=1.00,95%CI:0.96-1.05).MR analysis using online GWAS data suggested no potential causal relationship between high BMI and COPD occurrence,with both heterogeneity and pleiotropy tests yielding P>0.05.Conclusion There may be a nonlinear relationship between BMI and the risk of COPD,with no apparent association between BMI and COPD risk for values above 23.7 kg/m².

关 键 词：肺疾病 慢性阻塞性 体重指数 肥胖 孟德尔随机化 非线性回归 

分 类 号：R563.9[医药卫生—呼吸系统]