基于肥胖与肌量划分的人体成分类型与动脉硬化的关系研究

The correlation of body composition types based on obesity and muscle mass and atherosclerosis

目的:评价脂肪及肌量指标对于动脉硬化风险的预测及诊断效力。方法:收集2018年11月—2019年11月同时完成动脉弹性检测及人体成分分析的住院患者共1150例的临床资料。使用心-踝血管指数(CAVI)评价动脉弹性,并根据CAVI将患者分为动脉硬化组与非动脉硬化组。使用生物电阻抗(BIA)人体成分测量仪分析人体成分。根据人群年龄四分位数将患者归类为青年、中年、老年前期和老年;根据体脂率分类:肥胖与非肥胖;根据四肢骨骼肌指数(ASMI)分类:肌量减少与非肌量减少;根据肥胖联合肌量分类:非肥胖且非肌量减少、单纯肥胖、单纯肌量减少及肥胖合并肌量减少。比较各类型的人体成分指标及CAVI差异。使用Logistic回归评价各人体成分类型形成动脉硬化的风险。使用ROC曲线评价各人体成分指标或类型对动脉硬化的诊断效力。结果:单纯肥胖、单纯肌量减少和肥胖合并肌量减少对动脉硬化的OR分别为1.74(95%CI:1.31~2.33)、2.21(95%CI:1.34~3.58)和29.30(95%CI:5.15~550.23)。调整年龄后,仅肥胖合并肌量减少表现出对动脉硬化显著的高风险,OR为11.87(95%CI:1.80~235.22)。在人体成分指标中,体重和BMI在动脉硬化组显著低于非动脉硬化组,呈现"肥胖悖论"。内脏脂肪/脂肪具有诊断动脉硬化的良好效力,其ROC曲线下面积(AUC)为0.65(95%CI:0.61~0.69),显著高于BMI(AUC=0.59)、ASMI(AUC=0.59)和内脏脂肪(AUC=0.54)。联合年龄、ASMI和内脏脂肪/脂肪诊断动脉硬化的AUC为0.84(95%CI:0.82~0.87)。结论:肥胖并肌量减少是独立于年龄的动脉硬化高危风险类型,结合年龄、ASMI和内脏脂肪/脂肪是预测动脉硬化的优选方案。

Objective:To evaluate indicators including fat and muscle mass for predicting and diagnosing the risk of arteriosclerosis.Method:Data for a total of 1150 inpatients who completed both the arterial elasticity test and body composition analysis from November 2018 to November 2019 were collected.All patients were evaluated for the degree of arteriosclerosis using the cardio-ankle vascular index(CAVI),and all patients were divided into arteriosclerosis and non-arteriosclerosis group based on CAVI.The body compositions were analyzed using the bioelectrical impedance(BIA)body composition measuring instrument.Then several types of patients were formed in parallel according to various criteria:the youth,the middle-aged,the persenile,and the elderly based on quartiles of population age;the obesity and non-obesity based on body fat percentage;the reduced and non-reduced muscle mass based on appendicular skeletal mass index(ASMI);and the non-obesity with non-muscle mass reduction,simple obesity,simple muscle mass reduction,and obesity with muscle mass reduction based on the combination of obesity and muscle mass reduction.The body composition indicators and CAVI among each type of groups were compared.Logistic regression analysis was used to evaluate the risk of atherosclerosis for each body composition type.The ROC curve was used to evaluate the diagnostic efficacy of body composition indicators and body composition types on atherosclerosis.Result:The OR of the type of simple obesity,simple muscle mass reduction,and obesity with muscle mass reduction to arteriosclerosis were 1.74(95%CI:1.31-2.33),2.21(95%CI:1.34-3.58),and 29.30(95%CI:5.15-550.23),respectively.After adjustment for the age,only the type of obesity with muscle mass reduction remained a significant risk for arteriosclerosis,with OR of 11.87(95%CI:1.80-235.22).Among the body composition indicators,weight and BMI were significantly lower in the arteriosclerosis group than those in the non-arteriosclerosis group,and the difference of weight and BMI between the groups showed the"obesity paradox".Visceral fat/fat demonstrated high capability of diagnosing arteriosclerosis with AUC was 0.65(95%CI:0.61-0.69),which was higher than BMI(AUC=0.59),ASMI(AUC=0.59)and visceral fat(AUC=0.54).The AUC for the diagnosis of arteriosclerosis utilizing age group,ASMI and visceral fat/fat together was 0.84(95%CI:0.82-0.87).Conclusion:The body composition type of obesity with muscle mass reduction is an age-independent high-risk type of arteriosclerosis.The combination of age,ASMI,and visceral fat/fat is a better option for predicting arteriosclerosis.