摘要
目的 分析不同肥胖评价指标对高血压-糖尿病共病(HDC)发病风险的预测价值,为HDC一级预防提供科学依据.方法 以"新疆多民族自然人群队列建设及健康随访研究"2018-2022年和田调查现场的居民作为研究对象,采用Cox比例风险回归模型分析一般肥胖指标:体质指数(BMI),中心性肥胖指标:腰围(WC)、腰高比(WHTR)、锥削指数(CI),综合肥胖指标:体重调整腰围指数(WWI)、身体形态指数(ABSI)与HDC发病风险的关系,并用受试者工作特征(ROC)曲线分析不同肥胖指标对HDC发病风险的预测效果.结果 基线共纳入研究对象12 679人,累计随访57 629.4人年,新发HDC共661例,发病密度为11.47/千人年.调整相关混杂因素后,Cox比例风险回归模型结果显示HDC的发病风险随着肥胖指标的升高而增加(P＜0.01).BMI超重、肥胖组HDC的发病风险分别是BMI正常组的1.63、3.40倍,WC超标组HDC发病风险是WC正常组的2.74倍.WHTR超标组HDC发病风险是 WHTR正常组的2.48倍.根据四分位数的分组情况,WWI、CI、ABSI的Q4组HDC发病风险分别是Q1组的3.02、3.78、1.87倍.ROC曲线分析结果显示,AUC值前3位均为中心性肥胖指标,WC、WHTR、CI预测HDC的AUC分别为 0.685(95％CI:0.676～0.694)、0.673(95％CI:0.664～0.682)、0.666(95％CI:0.657～0.675).中心性肥胖指标的约登指数、特异度高于其他指标,综合肥胖指标的灵敏度高于其他肥胖指标.Delong检验结果显示,WC、WHTR预测HDC发病风险的AUC值高于BMI、ABSI(P＜0.003),BMI 与 CI、WWI、ABSI,WC 与 WHTR、CI、WWI,WHTR 与 CI,CI 与 WWI 的 AUC 值无明显差异.结论 BMI、WC、WHTR、WWI、CI、ABSI均与HDC发病风险增加相关,中心性肥胖指标能更好预测HDC发病风险.
Abstract
Objective To analyze the predictive value of different obesity indicators for the risk of hyperten-sion and diabetes comorbidity(HDC),and to provide scientific basis for the primary prevention of HDC.Methods The residents of 2018-2022 Hotan survey site of"Xinjiang multi-ethnic natural population co-hort construction and health follow-up study"were used as study subjects,and Cox proportional risk re-gression model was used to analyze the general obesity indicators:body mass index(BMI),central obesity indicators:waist circumference(WC),waist-to-height ratio(WHTR),conicity Index(CI),comprehen-sive obesity indicators:weight-adjusted waist circumference index(WWI),body shape index(ABSI),and the risk of HDC,and analyzed the predictive effect of different obesity indicators on the incidence of HDC by using subject work characteristics(ROC)curves.Results A total of 12 679 study subjects were en-rolled at baseline,with a cumulative follow-up of 57 629.4 person-years,and a total of 661 new cases of HDC were reported,with an incidence density of 11.47 per 1 000 person-years.After adjusting for rele-vant confounders,the results of the Cox proportional analysis regression model showed that the risk of HDC was increased with the elevation of obesity indicators(P＜0.01).The risk of HDC incidence in the overweight and obese subgroups of BMI was 1.63 and 3.40 times higher than that of normal group of BMI,respectively,and the risk of HDC incidence in the group of WC overweight was 2.74 times higher than that of group of WC normal.The risk of HDC in patients with elevated WHTR was 2.48 times higher than that in patients with normal WHTR.The risk of HDC incidence in the quartile groups of WWI,CI and ABSI quartile grouping Q4 group had 3.02,3.78 and 1.87 times higher risk of HDC incidence than the Q1 group,respectively.The results of the ROC curve analysis showed that the top 3 AUC values were all central obesity indicators.The AUC of WC,WHTR and CI for predicting HDC were 0.685(95％CI:0.676～0.694),0.673(95％CI:0.664～0.682)and 0.666(95％CI:0.657～0.675),respectively.The Youden index and specificity of central obesity index were higher than those of other obesity indexes,and the sensitivity of the new comprehensive obesity index was higher than that of other obesity indexes.De-long test results showed that the AUC values of WC and WHTR predicting the risk of HDC were higher than BMI,ABSI(P＜0.003).There were no significant differences in AUC values between BMI and CI,WWI,ABSI,WC and WHTR,CI,WWI,WHTR and CI,CI and WWI.Conclusion BMI,WC,WHTR,WWI,CI and ABSI were associated with increased risk of HDC,central obesity indicators can better predict the risk of HDC.
基金项目
国家自然科学基金项目(82360662)
国家自然科学基金项目(82160640)
科技创新团队"天山创新团队"项目(2022TSYCTD0013)
NETL
NSTL
万方数据