上海中年人群不同脂肪分布指标与血脂异常的相关性流行病学研究

摘要/Abstract

摘要：目的：探讨上海市淞南地区人口不同脂肪分布指标与血脂异常风险的相关性。方法：采取整群抽样法选取上海市淞南地区40~60岁的550名社区居民进行调查，发放调查问卷收集受检者的既往病史和生活方式等信息，并对进行身高、体重、腰围、血压等体格检查以及血糖、血脂等生化指标检测，采用计算机断层扫描及FATSCAN软件测量其腹部内脏脂肪及腹部皮下脂肪面积。结果：上海市淞南地区550名社区中年居民血脂异常的患病比例为65.1%。血脂异常者的体质量指数（body mass index, BMI）、腰臀比、腰围、皮下脂肪面积、内脏脂肪面积均显著高于血脂正常者（P<0.05）。多元Logistic回归分析显示，在校正性别、年龄、目前吸烟、目前饮酒、高中以上学历、收缩压、糖化血红蛋白和胰岛素抵抗、使用降糖药物后，腰臀比每增加一个标准差（standard deviation，SD），患高低密度脂蛋白胆固醇（low density lipoprotein cholesterol，LDL-c）血症的风险增加0.87倍;腰围每增加一个SD，患低高密度脂蛋白胆固醇（high density lipoprotein cholesterol，HDL-c）血症的风险增加0.60倍，患血脂异常的风险增加0.45倍。结论：大多数脂肪分布指标（包括BMI、腰臀比、腰围、皮下脂肪面积、内脏脂肪面积）均与血脂异常相关，但相关程度存在差异。腰臀比增加与高LDL-c血症风险间相关性最大，腰围增加与低HDL-c血症以及血脂异常风险间相关性最大。

关键词:脂肪分布指标,血脂异常,风险

Abstract:

Objective:To investigate the correlation between different fat distribution indices and dyslipidemia in community residents of Songnan District in Shanghai.Methods:A survey was conducted among 550 community residents in Songnan District, Shanghai. Questionnaires was used to collect information on health status, medical history, and lifestyle. Subjects received physical examinations for height, body weight, waist circumference, and blood pressure measurement. Venous blood sample was collected after an overnight fast and blood lipids and glucose were tested. CT and FATSCAN software were used to measure abdominal visceral fat area and subcutaneous fat area.Results:The proportion of dyslipidemia among 550 community residents in Songnan District was 65.1%. Measures of fat distribution indices such as body-mass index (BMI), waist-hip ratio, waist circumference, visceral fat area, subcutaneous fat area in individuals with dyslipidemia were significantly higher than individuals with normal blood lipids (P<0.05). Multivariable logistic regression analysis showed that after adjustment for sex, age, current smoking, current drinking, educational attainment, systolic pressure, HbA1c, blood glucose-lowering treatment and insulin resistance, one-SD increase in waist-hip ratio was associa-ted with 87% increase in risks of having high LDL-cholesterol; one-SD increase in waist circumference was associated with 60% increase in risks of having low HDL-cholesterol and 45% increase in risks of having dyslipidemia.Conclusions:Most indicators of fat distribution such as BMI, waist-hip ratio, waist circumference, visceral fat area, and subcutaneous fat area are correlated with dyslipidemia, however, the degree of correlation is different. Waist-hip ratio might be more important in the association with high LDL-cholesterol. Waist circumference might be more important in the association with low HDL-cholesterol and dyslipidemia.

Key words:Fat distribution indices,Dyslipidemia,Risk

中图分类号:

R587.1

王姗姗, 周莹霞, 胡利娟, 牛静雅, 王天歌, 李勉, 赵志云, 徐瑜, 陆洁莉, 徐敏, 毕宇芳, 倪衡如. 上海中年人群不同脂肪分布指标与血脂异常的相关性流行病学研究[J]. 诊断学理论与实践, 2019, 18(2): 177-182.

WANG Shanshan, ZHOU Yingxia, HU Lijuan, NIU Jingya, WANG Tiange, LI Mian, ZHAO Zhiyun, XU Yu, LU Jieli, XU Min, BI Yufang, NI Hengru. The correlation between different fat distribution indices and dyslipidemia in middle-aged population in Shanghai[J]. Journal of Diagnostics Concepts & Practice, 2019, 18(2): 177-182.

图/表3

表1

血脂正常组与血脂异常组的特征比较[例（n）]

组别	血脂正常组	血脂异常组	P值^a)
例数	192(34.9%)	358(65.1%)	/
年龄(岁)	51.6±4.4	52.5±4.1	0.015
男性	87(45.3%)	147(41.1%)	0.287
冠心病家族史	45(23.4%)	63(17.6%)	0.102
高中以上学历	67(34.9%)	121(34.8%)	0.703
目前吸烟	61(31.8%)	98(27.4%)	0.534
目前饮酒	50(26.3%)	85(24.1%)	0.887
收缩压(mmHg)	127.2±17.7	134.6±19.6	<0.001
舒张压(mmHg)	77.2±9.3	80.9±10.0	<0.001
TC (mmol/L)	4.51±0.50	5.50±0.95	<0.001
LDL-c (mmol/L)	2.05±0.45	2.57±0.73	<0.001
HDL-c (mmol/L)	1.40±0.28	1.33±0.31	0.004
TG (mmol/L)	1.09(0.82~1.43)	1.84(1.33~2.79)	<0.001
FPG (mmol/L)	5.0(4.7~5.5)	5.3(4.8~6.0)	0.001
PPG (mmol/L)	7.5(5.7~9.2)	8.2(6.5~11.1)	<0.001
HbA1c (%)	5.9(5.6~6.3)	6.1(5.8~6.6)	<0.001
HOMA-IR	1.3(0.8~2.0)	2.0(1.3~2.9)	<0.001
高血压	97(50.5%)	247(69.0%)	<0.001
糖尿病	29(15.1%)	101(28.2%)	<0.001
使用降糖药物	10(5.2%)	22(6.2%)	0.645
脂肪分布指标
BMI (kg/m²)	24.6±3.3	26.0±3.4	<0.001
腰臀比	0.88±0.06	0.90±0.05	<0.001
腰围(cm)	83.5±9.5	88.1±9.1	<0.001
皮下脂肪面积(cm²)	125.6 (89.6~179.2)	157.3 (114.0~204.3)	<0.001
内脏脂肪面积(cm²)	71.7 (48.9~110.7)	96.5 (69.9~125.2)	<0.001

表1

表2

不同脂肪分布指标与脂代谢指标的相关性（β±SE）

模型	TC (mmol/L)	LDL-c (mmol/L)	HDL-c (mmol/L)	Log [TG(mmol/L)]
模型1
BMI (kg/m²)	0.031±0.011^a)	0.030±0.008^a)	-0.015±0.003^a)	0.017±0.003^a)
腰臀比	2.545±0.771^a)	2.420±0.570^a)	-1.303±0.234^a)	1.517±0.212^a)
腰围 (cm)	0.015±0.004^a)	0.013±0.003^a)	-0.007±0.001^a)	0.008±0.001^a)
Log [皮下脂肪面积(cm²)]	0.475±0.182^a)	0.415±0.135^a)	-0.289±0.055^a)	0.268±0.051^a)
Log (内脏脂肪面积(cm²))	0.510 ± 0.173^a)	0.584±0.128^a)	-0.373±0.052^a)	0.377±0.047^a)
模型2
BMI (kg/m²)	0.012±0.013	0.021±0.009^b)	-0.012±0.004^a)	0.006±0.003
腰臀比	1.507±0.841	1.960±0.623^a)	-1.217±0.259^a)	0.957±0.223^a)
腰围 (cm)	0.009±0.005	0.011±0.004^a)	-0.006±0.002^a)	0.004±0.001^a)
Log [皮下脂肪面积(cm²)]	0.296±0.183	0.313±0.137^b)	-0.248±0.057^a)	0.172±0.049^a)
Log (内脏脂肪面积(cm²))	0.208±0.196	0.472±0.145^a)	-0.374±0.059^a)	0.233±0.052^a)

表2

表3

不同脂肪分布指标每增加一个标准差与不同类型血脂异常风险的相关性[OR（95% CI）]

模型	高TC血症	高LDL-c血症	低HDL-c血症	高TG血症	血脂异常
模型1
BMI (kg/m²)	1.31(1.10~1.57)^a)	1.29(0.96~1.73)	1.38(1.06~1.80)^b)	1.31(1.09~1.58)^a)	1.56(1.28~1.90)^a)
腰臀比	1.35(1.11~1.65)^a)	1.92(1.35~2.73)^a)	1.36(1.00~1.85)^b)	1.69(1.36~2.10)^a)	1.69(1.36~2.08)^a)
腰围 (cm)	1.43(1.19~1.73)^a)	1.51(1.11~2.07)^a)	1.50(1.13~1.98)^a)	1.60(1.30~1.95)^a)	1.83(1.48~2.26)^a)
Log [皮下脂肪面积([cm²)]	1.37(1.09~1.71)^a)	1.22(0.80~1.85)	1.51(1.04~2.19)^b)	1.56(1.21~2.03)^a)	1.62(1.29~2.03)^a)
Log [内脏脂肪面积(cm²)]	1.34(1.11~1.62)^a)	1.75(1.19~2.58)^a)	1.42(1.05~1.90)^b)	1.80(1.43~2.25)^a)	1.74(1.43~2.12)^a)
模型2
BMI (kg/m²)	1.13(0.92~1.39)	1.22(0.86~1.72)	1.49(1.09~2.05)^b)	0.91(0.72~1.14)	1.21(0.97~1.51)
腰臀比	1.23(0.99~1.53)	1.87(1.25~2.79)^a)	1.48(1.05~2.09)^b)	1.28(1.00~1.64)^b)	1.40(1.11~1.76)^a)
腰围 (cm)	1.27(1.02~1.57)^b)	1.51(1.04~2.20)^b)	1.60(1.14~2.24)^a)	1.12(0.88~1.42)	1.45(1.14~1.83)^a)
Log [皮下脂肪面积([cm²)]	1.23(0.98~1.54)	1.13(0.73~1.75)	1.42(0.97~2.10)	1.28(0.98~1.68)	1.39(1.11~1.74)^a)
Log [内脏脂肪面积(cm²)]	1.16(0.93~1.44)	1.71(1.08~2.72)^b)	1.52(1.08~2.15)^b)	1.30(1.00~1.68)^b)	1.41(1.13~1.76)^a)

表3

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