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人体脂肪分布与颈动脉粥样硬化的相关性

泰然健康网
2025-08-29 06:06

摘要:

目的

探讨人体脂肪分布与颈动脉粥样硬化的相关性。

方法

以2020年1月—2023年1月于北京协和医院国际医疗部(西单院区)健康管理中心体检的成年健康人群为研究对象。收集其基线资料、实验室指标、Inbody人体成分分析及颈动脉超声检查结果。根据颈动脉超声检查结果将研究对象分为颈动脉粥样硬化组和对照组。比较两组基线资料、实验室指标及人体成分差异，并采用多元Logistic回归分析探究颈动脉粥样硬化与人体成分的相关性。为进一步探究脂肪分布与颈动脉粥样硬化的相关性，根据四分位数(Q1~Q4)将躯干脂肪与四肢脂肪的比值(躯干脂肪/四肢脂肪)、内脏脂肪面积、腰臀比进一步分为Q1组、Q2组、Q3组和Q4组(以Q1组为参照)。绘制森林图分析各亚组发生颈动脉粥样硬化的风险。

结果

本研究共纳入2221名受试者，其中男性1194名(53.76%)，女性1027名(46.24%)，平均年龄(50.28±10.93)岁。颈动脉粥样硬化组1049名，对照组1172名。基线资料分析结果显示，颈动脉粥样硬化组年龄、男性占比高于对照组(P均＜0.001)；颈动脉粥样硬化组体重、体质量指数(body mass index，BMI)、腰臀比、体脂肪量、躯干脂肪、躯干脂肪/四肢脂肪、内脏脂肪面积等指标均显著高于对照组(P均＜0.05)。实验室检查结果显示，颈动脉粥样硬化组血糖、糖化血红蛋白、甘油三酯、尿酸等水平均显著高于对照组(P均＜0.001)。多元Logistic回归分析结果显示，调整年龄、性别、吸烟史和饮酒史后，躯干脂肪/四肢脂肪、腰臀比均与颈动脉粥样硬化发生风险显著相关(P均＜0.05)。与Q1组比较，Q4组动脉粥样硬化风险显著增加(OR=1.81, 95% CI: 1.26~2.61, P＜0.05)；腰臀比、内脏脂肪面积与颈动脉粥样硬化无显著相关性(P＞0.05)。

结论

躯干脂肪/四肢脂肪与颈动脉粥样硬化的发生具有显著相关性。未来应扩大样本量并采用更精确的脂肪分布测量方法以验证本研究结论。

Abstract:

Objective

To explore the correlation between human body fat distribution and carotid athero-sclerosis.

Methods

Adult healthy individuals who underwent physical examinations at the Health Management Center of the International Medical Department(Xidan Campus) of Peking Union Medical College Hospital between January 2020 and January 2023 were selected as study participants. Baseline data, laboratory indicators, Inbody body composition analysis, and carotid ultrasound examination results were collected. Participants were divided into carotid atherosclerosis group and control group based on carotid ultrasound examination results. Baseline data, laboratory indicators, and body composition differences between the two groups were compared, and multivariate Logistic regression analysis was conducted to investigate the correlation between carotid atherosclerosis and body composition. To further explore the correlation between fat distribution and carotid atherosclerosis, the ratio of trunk fat to limb fat(trunk fat/limb fat), visceral fat area, and waist-to-hip ratio were stratified into Q1, Q2, Q3, and Q4 groups(with Q1 group as the reference) based on quartiles(Q1 to Q4), and a forest plot was constructed to analyze the risk of carotid atherosclerosis in each subgroup.

Results

A total of 2221 participants were included in this study, including 1194 males(53.76%) and 1027 females(46.24%), with a mean age of(50.28±10.93) years. There were 1049 cases in the carotid atherosclerosis group and 1172 cases in the control group. Baseline data analysis showed that the carotid atherosclerosis group had a higher age and male proportion compared to the control group(both P < 0.001). The carotid atherosclerosis group also had significantly higher levels of body weight, body mass index(BMI), waist-to-hip ratio, body fat mass, trunk fat, trunk fat/limb fat, and visceral fat area compared to the control group(all P < 0.05). Laboratory test results indicated that the carotid atherosclerosis group had significantly higher levels of blood glucose, glycated hemoglobin, triglycerides, and uric acid compared to the control group(all P < 0.001). Multivariate Logistic regression analysis revealed that after adjusting for age, gender, smoking history, and drinking history, trunk fat, trunk fat/limb fat, and waist-to-hip ratio were significantly associated with the risk of carotid atherosclerosis(both P < 0.05). Compared with the Q1 group, the Q4 group had a significantly increased risk of atherosclerosis(OR=1.81, 95% CI: 1.26-2.61, P < 0.05). However, there were no significant correlations between waist-to-hip ratio, visceral fat area, and carotid atherosclerosis(P > 0.05).

Conclusions

There is a significant correlation between trunk fat/limb fat and the occurrence of carotid atherosclerosis. In the future, the sample size should be expanded, and more precise methods for measuring fat distribution should be adopted to validate the conclusions of this study.

图 1 躯干脂肪/四肢脂肪、内脏脂肪面积及腰臀比与颈动脉粥样硬化关系的森林图

Figure 1. Forest map of the relationships of trunk fat-to-limb fat ratio, visceral fat area, waist-to-hip ratio with carotid atherosclerosis

表 1 颈动脉粥样硬化组与对照组的基线资料比较

Table 1 Comparison of baseline data between carotid atherosclerosis group and control group

指标总体(n=2221) 对照组(n=1172) 颈动脉粥样硬化组(n=1049) P值年龄(x±s，岁) 50.28±10.93 44.99±9.59 56.19±9.16 ＜0.001 身高(x±s，cm) 167.43±8.31 167.42±8.20 167.44±8.43 0.959 体重(x±s，kg) 69.17±13.24 67.87±13.72 70.62±12.52 ＜0.001 BMI(x±s，kg/m2) 24.54±3.52 24.07±3.63 25.07±3.32 ＜0.001 性别[n(%)] ＜0.001 男性 1194(53.76) 556(47.44) 638(60.82) 女性 1027(46.24) 616(52.56) 411(39.18) 高血压病史[n(%)] ＜0.001 有 464(20.89) 138(11.77) 326(31.08) 无 1757(79.11) 1034(88.23) 723(68.92) 糖尿病病史[n(%)] ＜0.001 有 171(7.70) 47(4.01) 124(11.82) 无 2050(92.30) 1125(95.99) 925(88.18) 痛风史[n(%)] 0.370 有 23(1.04) 10(0.85) 13(1.24) 无 2198(98.96) 1162(99.15) 1036(98.76) 吸烟史[n(%)] ＜0.001 有 181(8.15) 51(4.35) 130(12.39) 无 2040(91.85) 1121(95.65) 919(87.61) 饮酒史[n(%)] 0.001 有 122(5.49) 47(4.01) 75(7.15) 无 2099(94.51) 1125(95.99) 974(92.85) 收缩压(x±s，mm Hg) 124.79±17.72 119.66±15.80 130.52±18.01 ＜0.001 舒张压(x±s，mm Hg) 75.83±11.47 74.67±11.49 77.13±11.31 ＜0.001 血糖(x±s，mmol/L) 5.43±1.31 5.20±1.02 5.70±1.54 ＜0.001 糖化血红蛋白(x±s，%) 5.56±0.77 5.39±0.58 5.76±0.90 ＜0.001 TC(x±s，mmol/L) 5.02±0.99 5.00±0.93 5.05±1.05 0.171 TG(x±s，mmol/L) 1.62±1.57 1.54±1.75 1.71±1.33 0.008 HDL-C(x±s，mmol/L) 1.30±0.38 1.34±0.41 1.25±0.32 ＜0.001 LDL-C(x±s，mmol/L) 3.07±0.85 3.05±0.80 3.10±0.90 0.114 UA(x±s，μmol/L) 339.73±89.28 332.76±89.79 347.52±88.10 ＜0.001 HCY(x±s，μmol/L) 10.90±8.01 10.17±5.83 11.61±9.64 0.2941 mm Hg=0.133 kPa; BMI(body mass index)：体质量指数；TC(total cholesterol)：总胆固醇；TG(triglycerides)：甘油三酯；HDL-C(high-density lipoprotein cholesterol)：高密度脂蛋白胆固醇；LDL-C(low-density lipoprotein cholesterol)：低密度脂蛋白胆固醇；UA(uric acid)：尿酸；HCY(homocysteine)：同型半胱氨酸

表 2 颈动脉粥样硬化组与对照组人体成分比较(x±s)

Table 2 Comparison of body composition between the carotid atherosclerosis group and the control group(x±s)

人体成分总体(n=2221) 对照组(n=1172) 颈动脉粥样硬化组(n=1049) P值腰臀比 0.92±0.06 0.91±0.06 0.93±0.06 ＜0.001 去脂体重(kg) 49.07±10.01 48.38±10.23 49.84±9.70 ＜0.001 骨骼肌量(kg) 27.13±6.09 26.74±6.23 27.56±5.91 0.002 SMI(kg/m2) 7.13±1.10 7.09±1.12 7.18±1.07 0.044 体脂肪量(kg) 20.10±6.36 19.49±6.46 20.77±6.18 ＜0.001 体脂率(%) 28.94±6.57 28.59±6.52 29.34±6.60 0.007 躯干脂肪量(kg) 10.41±3.50 10.02±3.55 10.86±3.38 ＜0.001 躯干脂肪率(%) 14.90±3.51 14.58±3.51 15.25±3.48 ＜0.001 四肢脂肪量(kg) 8.51±2.79 8.33±2.82 8.71±2.74 0.001 四肢脂肪率(%) 12.32±3.14 12.29±3.10 12.37±3.18 0.549 躯干脂肪/四肢脂肪 1.22±0.14 1.20±0.14 1.25±0.13 ＜0.001 内脏脂肪面积(cm2) 93.63±34.86 89.53±34.49 98.21±34.72 ＜0.001 基础代谢率(kcal) 1429.93±216.18 1414.99±220.97 1446.63±209.55 ＜0.001SMI(skeletal muscle index)：骨骼肌指数

表 3 颈动脉粥样硬化和人体成分的相关性分析

Table 3 Correlation analysis of carotid atherosclerosis and body composition

人体成分模型1 模型2 OR(95% CI) P值 OR(95% CI) P值体脂肪量 1.033(1.019~1.046) ＜0.001 1.013(0.997~1.030) 0.112 体脂率 1.018(1.005~1.031) 0.007 1.003(0.985~1.021) 0.759 躯干脂肪量 1.072(1.046~1.098) ＜0.001 1.029(0.998~1.060) 0.067 躯干脂肪率 1.056(1.031~1.082) ＜0.001 1.013(0.981~1.046) 0.437 四肢脂肪量 1.051(1.020~1.083) 0.001 1.023(0.984~1.062) 0.250 四肢脂肪率 1.008(0.982~1.035) 0.550 0.993(0.953~1.035) 0.756 躯干脂肪/四肢脂肪 15.626(8.252~29.589) ＜0.001 4.693(1.761~12.506) 0.002 内脏脂肪面积 1.007(1.005~1.010) ＜0.001 1.002(0.999~1.005) 0.198 腰臀比 1.001(1.000~1.001) 0.001 1.001(1.000~1.002) 0.004 SMI 1.081(1.002~1.167) 0.045 1.096(0.994~1.208) 0.066SMI: 同表 2 [1]

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