健康体检人群中肥胖与部分新型心血管标志物的相关性分析

Associations of obesity with several novel cardiovascular markers in a physical examination population

目的研究一般人群中部分新型心血管标志物与肥胖的相关性。方法检测9 361例健康体检人群高敏肌钙蛋白T(hs-cTnT)、氨基末端脑钠肽原(NT-proBNP)、脉压、脉搏波传导速度(PWV)和中心动脉收缩压(cSBP)水平。采用多种统计方法分析上述指标与体质量指数(BMI)的相关性,以及这些指标在不同BMI/代谢综合征(MetS)组合中的差异。结果肥胖与hs-cTnT、baPWV、脉压和cSBP水平正相关,当研究对象按MetS分类后,这些相关性在非MetS组中仍存在(P<0.05);与体重正常者相比,肥胖者hs-cTnT、baPWV、脉压和cSBP增高的风险分别增加1.87(95%CI为1.48~2.36)、1.27(1.02~1.57)、1.89(1.39~2.57)和2.71(2.11~3.47)倍,并且肥胖者存在1到4个心血管标志物增高的风险分别为1.61(1.26~2.05)、1.75(1.27~2.42、2.45(1.46~4.11)和3.14(2.13~4.62)。然而,在MetS组中肥胖与心血管标志物的相关性不再存在。当分别采用腰臀围比、体脂肪率和内脏脂肪指数代替BMI衡量肥胖时,上述结果未改变。结论在非MetS者中肥胖与部分新型心血管标志物(NTproBNP除外)正相关,但在MetS者中未见这种相关性。此外,肥胖但无MetS者多个心血管标志物同时增高的风险更高。结果提示在一般人群中对肥胖的管理更应该做到一级预防和早期干预,特别是在未出现代谢异常时的肥胖管理可能更有效。

Objective To investigate associations between novel cardiovascular markers and obesity in a general population. Methods A total of 9361 individuals who underwent health examinations were included. High-sensitivity cardiac troponin T （hs-cTnT）,N-terminal pro-B-type natriuretic peptide （NT-proBNP）,brachial-ankle pulse wave velocity （baPWV）,pulse pressure,and central systolic blood pressure （cSBP） were analyzed according to body mass index （BMI）levels and various BMI/metabolic syndrome （MetS）combinations. Results Levels of hs-cTnT,baPWV,pulse pressure,and cSBP increased across BMI levels （P for trend 〈0.001）. Obesity was positively associated with these markers in multivariate models （P〈0.05 for all）. When stratified by MetS,these associations remained significant in the non-MetS group. Compared with normal-weight participants ,obese participants had 1.87 （95% confidence interval：1.48,2.36）,1.27 （1.02,1.57）,1.89 （1.39,2.57）,and 2.71 （2.11,3.47）-fold risks of having elevated hs-cTnT,baPWV,pulse pressure,and cSBP,respectively,and had 1.61 （1.26,2.05）,1.75 （1.27,2.42）,2.45 （1.46,4.11）,and 3.14 （2.13,4.62）-fold risks of having 1,2,3,and 4 elevated cardiovascular markers,respectively. No relationship was observed between obesity and these novel markers in the MetS group after multivariate adjustment. These results were unchanged when using the waist-hip ratio , body fat percentage,and visceral adiposity index to redefine obesity. Conclusion Obesity is positively associated with novel cardiovascular markers （except NT-proBNP） in participants without MetS but not in participants with MetS. Obese participants without MetS exhibited higher odds for presenting a higher number of elevated cardiovascular markers. The findings suggest that obesity management may be more effective if metabolic abnormalities are assessed in the general population.