中国中老年人胰岛素抵抗代谢评分与心血管代谢性共病发病风险的队列研究  

Association between insulin resistance metabolic score and risk of cardiometabolic multimorbidity in middle-aged and elderly Chinese in a cohort study

作　　者：钱燕萍 楼雪勇[2] 潘轶斌[3] 厉玲玲[1] 郑丹娟[1] 史萌萌 QIAN Yan-ping;LOU Xue-yong;PAN Yi-bin;LI Ling-ling;ZHENG Dan-juan;SHI Meng-meng(Jinhua Diabetes,cardiovascular disease prevention office,Jinhua Central Hospital,Jinhua,Zhejiang 321000,China;不详)

机构地区：[1]金华市中心医院,金华市糖尿病、心血管疾病防治办公室,浙江金华321000 [2]金华市中心医院,内分泌代谢科 [3]金华市中心医院,心血管内科

出　　处：《现代预防医学》2024年第16期2911-2917,共7页Modern Preventive Medicine

摘　　要：目的本研究探索中国中老年人胰岛素抵抗代谢评分(METS-IR)与心血管代谢性共病发病(Cardiometabolic multimorbidity,CMM)风险的关联。方法基于人群的队列研究,本研究使用中国健康与养老纵向研究(CHARLS)的数据,在2011—2018年对中国45岁或以上居民进行了调查。Cox比例风险模型被用于计算METS-IR与新发CMM的关联的风险比(HR)和95%可信区间(CI),并在不同人群中进行分层分析,观察协变量与METS-IR的交互作用,应用限制性立方样条观察在不同体重人群中METS-IR与新发CMM的剂量反应关系。构建受试者工作特征(ROC)曲线,分析METS-IR对CMM发病风险的预测价值。结果本研究共纳入5349名研究对象,CMM发病率为2.08%,在调整所有纳入的协变量后,METS-IR作为连续变量与CMM发病风险呈正相关(HR:1.07,95%CI:1.05~1.09,P<0.001)。作为分类变量,METS-IR最高组与CMM发病风险仍呈正相关(HR:3.47,95%CI:2.06~5.84,P<0.001)。在全参与者(P for overall<0.001)、正常体重(P for overall=0.022)和超重肥胖(P for overall=0.008)人群中METS-IR与CMM发病风险仍存在线性关系。METS-IR对CMM发病风险具有一定的预测能力(AUC:0.651,95%CI:0.598~0.704)。结论METS-IR与中老年人群新发CMM风险增加存在正向关联,在正常体重或超重肥胖人群中都应该持续关注,从而减少CMM的风险。Objective To explore the association between metabolic score of insulin resistance(METS-IR)and the risk of Cardiometabolic multimorbidity(CMM)in middle-aged and elderly Chinese.Methods A population-based cohort study was conducted using data from the China Longitudinal Study of Health and Aging(CHARLS)among Chinese residents aged 45 years or older from 2011 to 2018.Cox proportional hazards regression models were used to calculate Hazard Ratio(HR)and 95%confidence intervals(CI)for the association between METS-IR and new CMM,and stratified analyses were performed in different populations to observe the interaction between covariates and METS-IR.The dose-response relationship between METS-IR and new CMM in different body weight population was observed with restricted cubic spline.Receiver operating characteristic(ROC)curve was constructed to analyze the value of METS-IR in predicting the risk of CMM.Results A total of 5349 subjects were included in this study,and the incidence of CMM was 2.08%.After adjusting for all included covariates,METS-IR as a continuous variable was positively correlated with the risk of CMM(HR:1.07,95%CI:1.05-1.09,P<0.001).As a categorical variable,the highest METS-IR group was still positively associated with the risk of CMM(HR:3.47,95%CI:2.06-5.84,P<0.001).In total participants(P for overall<0.001),normal weight(P for overall=0.022)and overweight and obese(P for overall=0.008)populations still had a linear relationship between MET-IR and CMM risk.METS-IR was predictive of CMM risk(AUC:0.651,95%CI:0.598-0.704).Conclusion The study finds that METS-IR is positively associated with an increased risk of new CMM in middle-aged and older adults and should be of continued concern in both normal weight and overweight obese people to reduce the risk of CMM.

关 键 词：胰岛素抵抗代谢评分 心血管代谢性共病 糖尿病 心血管疾病 脑卒中 

分 类 号：R589[医药卫生—内分泌]