超重和肥胖与动脉僵硬度的相关性研究

Association between overweight, obesity and arterial stiffness in community residents

目的 分析超重和肥胖与动脉僵硬度的关系。方法选取2007至2009年江苏省社区自然人群4585名为研究对象进行回顾性研究。以体质指数（BMI）评价超重和肥胖，肱踝脉搏波传导速度（baPWV）评价动脉僵硬度。将BMI分别作为连续变量（以1kg／m2递增）和等级变量（体重正常、体重过轻、超重和肥胖）进行logistic多因素逐步回归分析，评价高动脉僵硬度风险和人群归因危险度百分比，并通过受试者工作（ROC）曲线分析BMI对高动脉僵硬度的预测价值。结果（1）控制年龄后，男性和女性的BMI与baPWV均呈正相关（r值分别为0．213和0．186，P均〈0．01）。超重、肥胖人群baPWV和高动脉僵硬度发生率均高于正常组（P均〈0．01）。（2）logistic回归模型校正年龄、性别、高血压因素后，连续变量BMI致高动脉僵硬度的OR值为1．146（95％CI：1．117—1．175，P〈0．01）；当BMI为等级变量时，体重过轻OR值为0．369（95％CI：0．141—0．962，P〈0．05），超重和肥胖OR值分别为1．576（95％凹：1．333—1．863，P〈0．01）和2．087（95％CI：1．615—2．698，P〈0．01）。超重和肥胖者高动脉僵硬度的人群归因危险度百分比分别为19．1％和11．6％。（3）BMI评估高动脉僵硬度的ROC曲线下面积为0．661（95％CI：0．645—0．678，P〈0．01），BMI预测高动脉僵硬度的最佳分割值为24．25kg／m2。结论超重和肥胖人群的动脉僵硬度高于体重正常人群。超重和肥胖是独立于年龄、性别、高血压之外的高动脉僵硬度危险因素。

Objective To evaluate the relationship between overweight,obesity and arterial stiffness in community residents. Methods A total of 4585 community-dwelling adults in Jiangsu province, China were surveyed with the method of stratified and cluster sampling from 2007 to 2009. Overweight and obesity were defined by body mass index （BMI） and arterial stiffness was assessed by brachial-ankle pulse wave velocity （baPWV）. Statistical analysis of arteriosclerosis included multivariate logistic regression testing among which BMI was viewed as continuous variable （1 kg/m2 increasing to BMI）and categorical variables （underweight, normal, overweight and obesity ） respectively. Odds ratio, population attributable risk percent and the optimal cut-off points for BMI to evaluate arteriosclerosis were analyzed using receiver operator characteristic （ROC） curve. Results （ 1 ）After age control, BMI of male or female were positively correlated with baPWV （r =0.213,P 〈0.01; r =0.186, P 〈0.01）. baPWV and prevalence of arteriosclerosis were significantly higher in obese residents compared with normal body weight group （ all P 〈 0. 01 ）. （2）As a continuous variable, the odds ratio value of BMI on predicting arteriosclerosis was 1. 146 （95%CI： 1. 117 - 1. 175, P 〈 0.01 ） after adjusting of age, gender and hypertension. As categorical variables, the odds ratio value of BMI was 0. 369 （95% CI：0. 141 - 0. 962, P 〈 0.05） for underweight group, 1. 576 （ 95% CI： 1. 333 - 1. 863 ） for overweight group and 2. 087 （ 95% CI： 1. 615 - 2. 698 ） for obesity group （all P 〈 0. 01 ）. （3） The population attributable arteriosclerosis risk was 19. 1% and 11.6% in overweight and obesity groups, respectively. The area under the ROC curve was 0. 661 （95% CI： 0. 645 - 0. 678, P 〈 0. 01 ） and the optimal cut-off point for BMI to evaluate arteriosclerosis was 24. 25 kg/m2. Conclusions Overweight and obese residents faced higher risk for arteriosclerosis than normal population. Overweight and obesity are independent risk factors for arteriosclerosis after adjusting for age, gender and hypertension.