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目的探讨超重肥胖患者常见心血管相关危险因子与体成分构成的关系。方法入选体质量指数(BMI)≥25或23~25kg/m2但腰围增加[≥90(男)、≥80cm(女)]的体检人员1341名作为超重肥胖组(男性664名,女性677名)。非肥胖组为BMI<25kg/m2且当BMI为23~25kg/m2时腰围无增加[<90(男)、<80cm(女)],共1679名作为参照。检测研究对象身高、体质量、血脂、血糖、血压。采用双能X线骨密度仪(DEXA)检测身体各部位脂肪、瘦组织质量。结果躯干脂肪/下肢脂肪质量(TF/LF)与超重肥胖组心血管相关危险因子发生的相关性(r=0.291,P<0.01)高于全身脂肪/体质量(BF/M,r=-0.078)和躯干脂肪/体质量(TF/M,r=0.047)。BMI和TF/LF预测超重肥胖组常见心血管相关危险因子发生对应的临界值分别为26.03kg/m2和2.09,TF/LF的预测价值高于BMI[曲线下面积(AUC)0.684±0.016比0.628±0.017,P<0.01];BMI(OR=1.250,95%CI 1.120~1.395),TF/LF(OR=4.498,95%CI2.818~7.181)与超重肥胖患者心血管相关危险因子的发生呈正相关,TF/LF对超重肥胖组心血管相关危险因子的发生重要性最大(b′=0.418);与BMI<26.03kg/m2且TF/LF<2.09组比较,BMI≥26.03kg/m2且TF/LF<2.09组心血管相关危险因子发生的风险是其2.473倍(95%CI 1.516~4.032),BMI<26.03kg/m2且TF/LF≥2.09组是其2.915倍(95%CI 1.823~4.661),BMI≥26.03kg/m2且TF/LF≥2.09组是其3.894倍(95%CI 2.250~6.737);风险呈增加趋势(χ2trend=108.3,P<0.01)。结论 TF/LF是超重肥胖患者发生常见心血管相关危险因子的一个更有力的独立关联因素。在对超重肥胖心血管相关危险因子管理上,亦应注重体成分与其关系,而体脂的分布重要性远大于BMI,超重肥胖患者TF/LF宜保持于<2.09。
Objective To explore the relationship between common cardiovascular risk factors and body composition in overweight and obesity patients. Methods A total of 1341 physical examiners (664 males and 677 females) were enrolled in the study. Their body mass index (BMI) ≥25 or 23 ~ 25kg / m2 but with increased waist circumference [≥90 (male) . The non-obese group had a BMI of <25 kg / m2 and no increase in waist circumference when the BMI ranged from 23 to 25 kg / m2 [<90 (male), <80 cm (female)] with a total of 1679 as a reference. Test subjects height, body mass, blood lipids, blood glucose, blood pressure. Dual-energy X-ray absorptiometry (DEXA) was used to detect the body fat and the weight of lean tissue. Results The correlation between body fat / body fat mass (TF / LF) and risk factors of cardiovascular related risk factors (r = 0.291, P <0.01) in overweight and obesity group was higher than that of body fat / ) And trunk fat / body mass (TF / M, r = 0.047). The predictive value of TF / LF for BMI and TF / LF in predicting overweight / obesity patients was 26.03kg / m2 and 2.09, respectively. The predicted value of TF / LF was higher than BMI [area under the curve (AUC) 0.684 ± 0.016 vs 0.628 ± 0.017, P <0.01]. The incidence of cardiovascular risk factors in patients with overweight and obesity was significantly higher with BMI (OR = 1.250,95% CI 1.120-1.395) and TF / LF (OR = 4.498,95% CI2.818-7.181) (B ’= 0.418). Compared with BMI <26.03kg / m2 and TF / LF <2.09, BMI≥26.03kg / m2 and TF / LF was the most important in the overweight and obesity group /LF<2.09 group was 2.473 times (95% CI 1.516-4.0232), 2.915 times (95% CI 1.823-4.661) for the BMI <26.03 kg / m2 and for the TF / LF≥2.09 group ), BMI≥26.03kg / m2 and TF / LF≥2.09 was 3.894 times (95% CI 2.250 ~ 6.737). The risk was increased (χ2trend = 108.3, P <0.01). Conclusions TF / LF is a more powerful independent association of common cardiovascular risk factors in overweight and obese patients. In the management of overweight and obesity-related cardiovascular risk factors, body composition should also be emphasized, while the importance of body fat distribution is much greater than that of BMI. TF / LF in overweight and obese patients should be maintained at <2.09.