50岁以上2型糖尿病患者肥胖指标与高尿酸血症和高血压的相关性研究:基于一项前瞻性研究基线数据的再分析

Correlation between obesity indices and hyperuricemia and hypertension in type 2 diabetes mellitus patients over 50 years old:a reanalysis based on baseline data of a prospective study

目的探讨50岁以上2型糖尿病(T2DM)患者不同肥胖指标与高尿酸血症(HUA)和高血压发病的相关性。方法为横断面研究,研究对象选取自2016年6月至2017年1月进行的一项有关中国T2DM患者下肢动脉疾病流行病学的前瞻性研究。收集研究对象身高、体重、腰围(WC)(传统肥胖指标)、臀围、甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C),并计算其另3个传统肥胖指标[体重指数(BMI)、腰臀比(WHR)、腰高比(WHtR)],及5个新型肥胖指标[内脏脂肪指数(VAI)、身体圆度指数(BRI)、身体形态指数(ABSI)、脂质蓄积指数(LAP)、相对脂肪质量(RFM)]。采用logistic回归分析法分析不同肥胖指标与HUA和高血压发生的相关性,采用受试者工作特征曲线下面积(AUC)比较不同肥胖指标预测HUA和高血压的价值。结果最终纳入T2DM患者6646例。其中,HUA组964例,非HUA组5682例;高血压组4388例,非高血压组2258例。多因素logistic回归结果显示,在校正混杂因素后,除新型肥胖指标ABSI外,其余肥胖指标[4个传统肥胖指标(WC、BMI、WHR、WHtR)及4个新型肥胖指标(VAI、BRI、LAP、RFM)]均与HUA发生呈正相关(P<0.05)。男性VAI、LAP预测HUA的AUC分别为0.654、0.651,女性VAI、LAP预测HUA的AUC均为0.671,均高于传统指标。在男性中,9个肥胖指标均与高血压发生呈正相关(P<0.05),ABSI的AUC(0.643)最高;在女性中,除VAI、ABSI外的7种肥胖指标均与高血压发生呈正相关(P<0.05),BMI的AUC(0.620)最高。结论在50岁以上T2DM患者中,BMI、WC、WHR、WHtR、VAI、BRI、LAP、RFM均与HUA发生呈正相关,新肥胖指标VAI和LAP对HUA风险筛查和人群健康干预方面与传统指标相比具有一定优势。在男性中,9种肥胖指标均与高血压发生呈正相关,与传统指标相比,ABSI对该人群高血压的监测和干预具有一定优势;在女性中,除VAI、ABSI外的7种肥胖指标均与高血压发生呈正相关。

Objective To investigate the correlation between different obesity indices and the incidence of hyperuricemia(HUA)and hypertension in patients with type 2 diabetes mellitus(T2DM)older than 50 years old.Methods As a cross-sectional study,the subjects were chosen from a prospective study on the epidemiology of lower extremity arterial disease in Chinese patients with T2DM from June 2016 to January 2017.The height,weight,waist circumference(WC)(traditional obesity index),hip circumference,triglycerides(TG),and high-density lipoprotein cholesterol(HDL-C)of the subjects were collected.Three traditional obesity indices[body mass index(BMI),waist hip ratio(WHR),and waist height ratio(WHtR)],as well as five new obesity indices[visceral fat index(VAI),body roundness index(BRI),a body shape index(ABSI),lipid accumulation index(LAP),and relative fat mass(RFM)],were calculated.Logistic regression analysis was used to analyze the correlation between different obesity indices and the occurrence of HUA and hypertension.The area under the receiver operating characteristic curve(AUC)was used to compare the value of different obesity indices in predicting HUA and hypertension.Results A total of 6646 patients with T2DM were finally included in the study.There were 964 cases in HUA group and 5682 cases in non-HUA group.There were 4388 cases in the hypertension group and 2258 cases in the non-hypertension group.Multivariate logistic regression results showed that after adjusting for confounding factors,except for the new obesity index ABSI,other obesity indices[four traditional obesity indices(WC,BMI,WHR,WHtR)and four new obesity indices(VAI,BRI,LAP,RFM)]were positively correlated with the occurrence of HUA(P<0.05).The AUC of male VAI and LAP for predicting HUA were 0.654 and 0.651,respectively,while the AUC of female VAI and LAP for predicting HUA were both 0.671,which were higher than the traditional indices.In men,the nine obesity indices were all positively associated with the occurrence of hypertension(P<0.05),and the AUC(0.643)of ABSI was the highest.In women,except for VAI and ABSI,the seven obesity indices were positively correlated with hypertension(P<0.05),and the AUC(0.620)of BMI was the highest.Conclusions In T2DM patients over the age of 50,BMI,WC,WHR,WHtR,VAI,BRI,LAP,RFM were all positively correlated with the occurrence of HUA.The new obesity indices VAI and LAP had certain advantages over traditional indices in HUA risk screening and population health intervention.In men,nine obesity indices were positively correlated with the occurrence of hypertension.Compared with traditional indices,ABSI had certain advantages in the monitoring and intervention of hypertension in this population.In women,except VAI and ABSI,7 obesity indices were positively correlated with hypertension.