成人肥胖对外周动脉疾病的影响及发病风险评估研究  

Effect of obesity on peripheral arterial disease and risk assessment in adults

作　　者：陈雪芹 付国涛 李灵兰 辛宝 孙娜 史传道 曲传勇 张荣强 CHEN Xueqin;FU Guotao;LI Linglan;XIN Bao;SUN Na;SHI Chuandao;QU Chuanyong;ZHANG Rongqing;无(School of Public Health,Shaanxi University of Traditional Chinese Medicine,Xianyang Shaanxi 712046;Health Examination Center,The Second Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine,Xianyang Shaanxi 712046;Department of Neurology,People's Hospital of Ningxia Hui Autonomous Region,Yinchuan Ningxia 750021;Department of Disease Control,Chongqing Shizhu Center for Disease Control and Prevention,Shizhu Chongqing 409199,China)

机构地区：[1]陕西中医药大学公共卫生学院 [2]重庆市石柱县疾病预防控制中心疾控科 [3]陕西中医药大学附属二院体检中心 [4]宁夏回族自治区人民医院神经内科

出　　处：《蚌埠医学院学报》2024年第10期1376-1383,共8页Journal of Bengbu Medical College

基　　金：陕西省重点研发计划项目(2020SF-076);富硒产业研究院富硒专项(2020FXZX05-01);陕西中医药大学慢性非传染性疾病病因及机制研究创新团队(132041933);国家自然科学基金项目(82073494)。

摘　　要：目的:通过分析1448名体检者的体检数据,探讨成人肥胖对外周动脉疾病(peripheral arterial disease,PAD)的影响及发病风险预测分析。方法:SPSS 26.0、GraphPad Prism 9.2.1和HIPLOT工具进行统计和绘图。非线性拟合曲线验证肥胖与临床检验指标的关联性,二元和多元logistic回归预测和评估PAD的独立危险因素,列线图和校准曲线评估多元logistic回归预测模型的稳定性和准确性。结果:肥胖与总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、空腹血糖(FPG)、舒张压(SBP)、收缩压(DBP)存在相关性(P<0.05),与踝脉搏波速度(baPWV)及踝肱指数(ABI)存在线性关系。当体质量指数(BMI)=31.1875 kg/m 2(P<0.01)和BMI=36.6875 kg/m 2(P<0.01),baPWV和ABI分别达到最大值。分别控制性别和年龄等变量,超重者出现血管硬化比为1.524(1.177,1.974)、1.532(1.155,2.033);偏瘦者出现血管硬化的优势比为0.233(0.092,0.593)、0.423(0.149,1.197)。进一步调整糖尿病、异常血脂、高血压,结果显示肥胖者的左肢动脉钙化风险先升高后降低。高龄、男性、FPG、血压、TC、脉搏的升高会加重PAD的风险。结论:高血压、糖尿病、高脂血症是PAD的独立危险因素,肥胖是影响PAD的重要危险因素,肥胖女性患PAD的风险小于超重的男性。Objective:To investigate the effect of adult obesity on peripheral arterial disease(PAD)and risk prediction through the physical examination data of 1448 subjects.Methods:SPSS 26.0,GraphPad Prism 9.2.1,and HIPLOT tool were used for statistics and plotting.Nonlinear fitting curves were used to verify the association between obesity and clinical parameters,while binary and multivariate logistic regression were subjected to predict and assess independent risk factors for PAD.Nomograms and calibration curves were applied to assess the stability and accuracy of multivariate logistic regression prediction models.Results:Obesity was significantly correlated with total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),fasting plasma glucose(FPG),diastolic blood pressure(DBP),and systolic blood pressure(SBP)(P<0.05),and performed a linear correlation with brachial-ankle pulse wave velocity(baPWV)and ankle brachial index(ABI).When body mass index(BMI)=31.1875 kg/m 2(P<0.01)and BMI=36.6875 kg/m 2(P<0.01),baPWV and ABI reached a maximum,respectively.Controlling for variables such as gender and age,the odds ratios of vascular sclerosis were 1.524(1.177,1.974)and 1.532(1.155,2.033)in overweight subjects,and 0.233(0.092,0.593)and 0.423(0.149,1.197)in lean subjects,respectively.Further adjustment for diabetes mellitus,dyslipidemia,and hypertension,results showed that the risk of left limb arterial calcification was first increased and then decreased in obese subjects.Advanced age,male,and the elevation of FPG,blood pressure,TC,and pulse could aggravate the risk of PAD.Conclusions:Hypertension,diabetes mellitus and hyperlipidemia are independent risk factors of PAD.Obesity is an important risk factor for affecting PAD,and obese female have a smaller risk of PAD than overweight male.

关 键 词：外周动脉疾病 肥胖 踝脉搏波速度 踝肱指数 

分 类 号：R543.5[医药卫生—心血管疾病]