正常体重中心性肥胖对新发心血管疾病和全因死亡的影响  

Association Between Normal-weight Central Obesity With New-onset Cardiovascular Disease and All-cause Mortality

作　　者：马占莹 王洁蕊 宋海澄[2] 杨帆[1] 李娇艳 赵明珠 陈立志 李丽娜 杨文芳 陈朔华 吴寿岭[5] 崔刘福[2] MA Zhanying;WANG Jierui;SONG Haicheng;YANG Fan;LI Jiaoyan;ZHAO Mingzhu;CHEN Lizhi;LI Lina;YANG Wenfang;CHEN Shuohua;WU Shouling;CUI Liufu(School of Public Health,North China University of Science and Technology,Tangshan 063210,China;Department of Rheumatology and Immunology,Kailuan General Hospital,Tangshan 063000,China;Hebei North University,Zhangjiakou 075000,China;Kailuan Staff Health Care Center,Kailuan General Hospital,Tangshan 063000,China;Department of Cardiology,Kailuan General Hospital,Tangshan 063000,China)

机构地区：[1]华北理工大学公共卫生学院,唐山063210 [2]开滦总医院风湿免疫科,唐山063000 [3]河北北方学院第一临床医学院,张家口075000 [4]开滦总医院开滦员工健康保障中心,唐山063000 [5]开滦总医院心内科,唐山063000

出　　处：《中国循环杂志》2024年第11期1110-1116,共7页Chinese Circulation Journal

基　　金：唐山市风湿免疫性疾病重点实验室项目(2019TS005)。

摘　　要：目的:探讨正常体重中心性肥胖对新发心血管疾病和全因死亡的影响。方法:采用前瞻性队列研究的方法,选取2006~2007年首次参加开滦集团健康体检的职工中符合入选标准者93885例。根据腰围(中心性肥胖:男性腰围≥90 cm,女性腰围≥85 cm;非中心性肥胖:男性腰围<90 cm,女性腰围<85 cm)和体重指数(BMI,正常体重:18.5 kg/m^(2)≤BMI<24.0 kg/m^(2);超重/肥胖:BMI≥24.0 kg/m^(2))将研究对象分为4组:正常体重无中心性肥胖组(G1组)、正常体重中心性肥胖组(G2组)、超重/肥胖无中心性肥胖组(G3组)和超重/肥胖中心性肥胖组(G4组)。采用Kaplan-Meier法计算不同组的新发心血管事件(包括出血性脑卒中、缺血性脑卒中及心肌梗死)和全因死亡的累积发病率,并采用log-rank检验进行组间比较;采用多因素Cox比例风险回归模型分析不同组别与心脑血管事件和全因死亡的发病风险的关联。结果:经中位14.97(14.55,15.17)年随访,G1组、G2组、G3组、G4组的新发心血管疾病累积发生率分别为7.62%、10.84%、8.67%、12.91%(log-rank P<0.05),全因死亡的累积发生率分别为12.83%、19.72%、10.65%、16.33%(logrank P<0.01)。Cox回归分析结果显示,在校正混杂因素后,与G1组相比,G2组、G3组、G4组的发生心血管事件的HR(95%CI)分别为1.14(1.04~1.25)、1.07(1.01~1.14)、1.27(1.21~1.34),P值均<0.05;全因死亡的HR(95%CI)分别为1.06(1.00~1.14)、0.90(0.85~0.95)、0.97(0.93~1.01),P值分别为0.07、<0.01、0.15。分别排除超重/肥胖、随访过程发生癌症的人群后,进行敏感性分析,结果与以上主要研究结果趋势一致。结论:正常体重中心性肥胖增加新发心血管疾病和全因死亡风险。Objectives:To investigate the association between normal-weight central obesity with new-onset cardiovascular disease and all-cause mortality risk.Methods:A prospective cohort study was conducted,selecting a total of 93885 participants from the Kailuan Study who had their first physical examination in 2006-2007.According to waist circumference(central obesity:male waist circumference≥90 cm,female waist circumference≥85 cm;no central obesity:male waist circumference<90 cm,female waist circumference<85 cm)and body mass index(BMI,normal weight:18.5 kg/m^(2)≤BMI<24.0 kg/m^(2);overweight/obesity:BMI≥24.0 kg/m^(2)),the participants were divided into 4 groups:normal weight no central obesity group(G1 group),normal weight central obesity group(G2 group),overweight/obesity no central obesity group(G3 group)and overweight/central obesity group(G4 group);Using the Kaplan-Meier method,the cumulative incidence of new-onset cardiovascular diseases(including hemorrhagic stroke,ischemic stroke and myocardial infarction)and all-cause mortality in different groups was calculated,and the Log-rank test was used for intergroup comparisons.Furthermore,the associations between the different groups and the risk of new-onset cardiovascular diseases and all-cause mortality were analyzed using the multivariate Cox proportional hazard regression model.Results:After a median follow-up of 14.97(14.55,15.17)years,the cumulative incidence of new-onset cardiovascular diseases in G1 group,G2 group,G3 group and G4 group was 7.62%,10.84%,8.67%,12.91%respectively(log-rank P<0.05)and the cumulative incidence of all-cause mortality was 12.83%,19.72%,10.65%,16.33%respectively(log-rank P<0.01).After adjusting for confounding factors,Cox regression analysis showed that the HR(95%CI)of new-onset cardiovascular diseases in G2 group,G3 group and G4 group were 1.14(1.04-1.25),1.07(1.01-1.14),1.27(1.21-1.34),respectively compared with G1 group(all P<0.05).The HR(95%CI)of all-cause mortality were 1.06(1.00-1.14),0.90(0.85-0.95),0.97(0.93-1.01)compared

关 键 词：正常体重中心性肥胖 心血管疾病 全因死亡 

分 类 号：R54[医药卫生—心血管疾病]