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中国成人BMI和腹型肥胖与急性心肌梗死发病关系的前瞻性研究

张鑫, 王文绢, 张润, 由晓庆, 李剑虹. 中国成人BMI和腹型肥胖与急性心肌梗死发病关系的前瞻性研究[J]. 中华疾病控制杂志, 2022, 26(7): 750-755. doi: 10.16462/j.cnki.zhjbkz.2022.07.002
引用本文: 张鑫, 王文绢, 张润, 由晓庆, 李剑虹. 中国成人BMI和腹型肥胖与急性心肌梗死发病关系的前瞻性研究[J]. 中华疾病控制杂志, 2022, 26(7): 750-755. doi: 10.16462/j.cnki.zhjbkz.2022.07.002
ZHANG Xin, WANG Wen-juan, ZHANG Run, YOU Xiao-qing, LI Jian-hong. Relationship between BMI, abdominal obesity and the incidence of acute myocardial infarction in Chinese adults: a prospective study[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2022, 26(7): 750-755. doi: 10.16462/j.cnki.zhjbkz.2022.07.002
Citation: ZHANG Xin, WANG Wen-juan, ZHANG Run, YOU Xiao-qing, LI Jian-hong. Relationship between BMI, abdominal obesity and the incidence of acute myocardial infarction in Chinese adults: a prospective study[J]. CHINESE JOURNAL OF DISEASE CONTROL & PREVENTION, 2022, 26(7): 750-755. doi: 10.16462/j.cnki.zhjbkz.2022.07.002

中国成人BMI和腹型肥胖与急性心肌梗死发病关系的前瞻性研究

doi: 10.16462/j.cnki.zhjbkz.2022.07.002
基金项目: 

国家重点研发计划 2018YFC1313904

详细信息
    通讯作者:

    李剑虹,E-mail: lijianhong@ncncd.chinacdc.cn

  • 中图分类号: R181.3+8

Relationship between BMI, abdominal obesity and the incidence of acute myocardial infarction in Chinese adults: a prospective study

Funds: 

National Key Research and Development Program of China 2018YFC1313904

More Information
  • 摘要:   目的  了解中国成人BMI和腹型肥胖与急性心肌梗死(acute myocardial infarction, AMI)的发病关系。  方法  从2010年中国慢性病及危险因素监测中抽取11个省(市),再从中选择60个监测点作为随访点,并于2016―2017年进行随访调查,共随访到27 604人,数据清理后共26 794名调查对象纳入分析。采用Cox比例风险回归模型分析BMI和腹型肥胖与AMI发病的关系。  结果  26 794名调查对象,平均随访6.0年,随访期间共观察到256例AMI事件。在调整相关混杂因素后,与腰围(waist circumference, WC)正常、BMI < 24 kg/m2组相比,腹型肥胖、BMI < 24 kg/m2组AMI的发病风险增加85%(HR=1.85, 95% CI: 1.14~3.01),腹型肥胖、BMI≥24 kg/m2组AMI的发病风险增加56%(HR=1.56, 95% CI: 1.11~2.18),而WC正常、BMI≥24 kg/m2组与AMI的发病风险无相关(HR=0.85, 95% CI: 0.49~1.47)。  结论  无论BMI值为多少,腹型肥胖都是AMI发病的重要危险因素。
  • 图  1  不同BMI和腹型肥胖分组与AMI发病关系亚组分析

    注:a以WC正常、BMI < 24 kg/m2者为参照,报告腹型肥胖、BMI < 24 kg/m2者发生AMI风险效应值;模型调整年龄、性别、城乡、高血压、血脂异常、糖尿病、身体活动不足、吸烟、饮酒,不包括分层因素。

    Figure  1.  Subgroup analysis of the relationship between different BMI and abdominal obesity groups and the incidence of AMI

    表  1  2010年中国11省市研究对象基线特征[n(%)]

    Table  1.   Baseline characteristics of subjects in 11 Provinces and Cities of China in 2010 [n(%)]

    变量 WC正常BMI < 24 kg/m2(n=12 350) WC正常BMI≥24 kg/m2(n=3 085) 腹型肥胖BMI < 24 kg/m2(n=1 931) 腹型肥胖BMI≥24 kg/m2(n=9 428) P
    年龄(x±s, 岁) 46.07±14.52 46.62±12.35 51.14±13.69 49.53±12.59 < 0.001
    年龄组(岁) < 0.001
      18~ < 45 5 867 (47.51) 1 408 (45.64) 627 (32.47) 3 336 (35.38)
      45~ < 60 4 097 (33.17) 1 184 (38.38) 783 (40.55) 4 040 (42.85)
      ≥60 2 386 (19.32) 493 (15.98) 521 (26.98) 2 052 (21.76)
    5 919 (47.93) 1 473 (47.75) 700 (36.25) 3 927 (41.66) < 0.001
    文化程度 < 0.001
      小学以下 5 657 (45.81) 1 285 (41.65) 1 001 (51.84) 4 330 (45.93)
      小学 4 118 (33.34) 1 121 (36.34) 583 (30.19) 3 090 (32.77)
      初中 1 679 (13.59) 469 (15.20) 257 (13.31) 1 394 (14.79)
      高中及以上 896 (7.26) 210 (6.81) 90 (4.66) 614 (6.51)
    婚姻状况a < 0.001
      未婚 1 054 (8.55) 143 (4.65) 59 (3.06) 256 (2.72)
      已婚/同居 10 056 (81.61) 2 668 (86.79) 1 640 (85.06) 8 210 (87.28)
      丧偶/离婚/分居 1 213 (9.84) 263 (8.56) 229 (11.88) 941 (10.00)
    家庭年总收入(元) 0.054
       < 10 000 4 135 (33.48) 975 (31.60) 631 (32.68) 2 970 (31.50)
      10 000~ < 20 000 2 784 (22.54) 746 (24.18) 447 (23.15) 2 142 (22.72)
      20 000~ < 30 000 1 926 (15.60) 509 (16.50) 296 (15.32) 1 577 (16.73)
      ≥30 000 3 505 (28.38) 855 (27.72) 557 (28.85) 2 739 (29.05)
    城市 4 446 (36.00) 1 188 (38.51) 738 (38.22) 4 133 (43.84) < 0.001
    吸烟状况 < 0.001
      当前吸烟 3 529 (28.58) 716 (23.21) 407 (21.05) 1 996 (21.17)
      以前吸烟 326 (2.64) 115 (3.73) 39 (2.05) 255 (2.70)
      从不吸烟 8 493 (68.78) 2 254 (73.06) 1 485 (76.90) 7 177 (76.13)
    当前饮酒 4 665 (37.78) 1 147 (37.18) 659 (34.13) 3 279 (34.78) < 0.001
    糖尿病 429 (3.47) 148 (4.80) 145 (7.51) 1 065 (11.30) < 0.001
    血脂异常 4 913 (39.78) 1 695 (54.94) 980 (50.75) 6 284 (66.65) < 0.001
    蔬果摄入不足 6 723 (54.44) 1 631 (52.87) 1 127 (58.36) 5 341 (56.65) < 0.001
    身体活动不足 2 088 (16.91) 558 (18.09) 391 (20.25) 1 806 (19.16) < 0.001
    红肉摄入过多 1 629 (13.19) 404 (13.10) 179 (9.27) 1 163 (12.34) < 0.001
    高血压 3 398 (27.51) 1 288 (41.75) 789 (40.86) 5 321 (56.44) < 0.001
    SBP (x±s, mmHg) 128.39±20.12 135.09±20.88 135.82±21.51 141.31±22.19 0.012
    DBP (x±s, mmHg) 77.86±10.63 82.81±11.18 81.65±10.58 86.34±11.49 < 0.001
    TG (x±s, mmol/L) 1.16±1.03 1.49±1.43 1.46±1.28 1.85±1.63 < 0.001
    TC (x±s, mmol/L) 3.92±1.00 4.12±1.15 4.18±1.05 4.30±1.13 < 0.001
    HDL-C (x±s, mmol/L) 1.19±0.33 1.09±0.29 1.12±0.30 1.04±0.28 < 0.001
    LDL-C (x±s, mmol/L) 2.14±0.72 2.35±0.81 2.36±0.77 2.50±0.79 < 0.001
    FPG (x±s, mmol/L) 5.32±1.16 5.48±1.18 5.68±1.69 5.79±1.56 < 0.001
    OGTT-2h (x±s, mmol/L) 6.01±21.18 6.27±2.51 6.62±2.97 6.89±2.84 0.519
    注:a缺失62例;口服糖耐量试验(oral glucose tolerance test, OGTT)。
    下载: 导出CSV

    表  2  2010年中国11省市随访人群与失访人群特征分析[n(%)]

    Table  2.   Analysis of the characteristics of follow-up population and lost follow-up population in 11 Provinces and Cities of China in 2010 [n(%)]

    变量 随访人群 失访人群 χ2/t P
    人数 27 604 (75.78) 8 822 (24.22)
    年龄(x±s, 岁) 48.22 ±14.15 44.12 ±17.07 22.50 < 0.001
    12 485 (45.23) 4 165 (47.21) 10.59 0.001
    城市 10 772 (39.02) 4 395 (49.82) 320.61 < 0.001
    吸烟 6 894 (24.98) 1 987 (22.53) 24.70 < 0.001
    饮酒 10 018 (36.30) 3 315 (37.58) 4.73 0.030
    超重肥胖 14 796 (53.60) 5 043 (57.16) 34.22 < 0.001
    腹型肥胖 11 677 (42.30) 3 505 (39.73) 18.19 < 0.001
    糖尿病 2 856 (10.35) 943 (10.69) 0.84 0.359
    血脂异常 14 298 (51.80) 4 690 (53.16) 5.00 0.025
    蔬果摄入不足 15 331 (55.54) 5 011 (56.80) 4.32 0.038
    身体活动不足 5 073 (18.38) 1 903 (21.57) 44.03 < 0.001
    红肉摄入过多 3 449 (12.49) 1 133 (12.84) 0.74 0.390
    高血压 11 277 (40.67) 3 104 (35.18) 84.34 < 0.001
    SBP (x±s, mmHg) 134.50 ±21.97 132.00 ±22.10 9.07 < 0.001
    DBP (x±s, mmHg) 81.73 ±11.68 80.47 ±11.76 8.72 < 0.001
    TG (x±s, mmol/L) 1.46 ±1.36 1.41 ±1.40 3.03 0.002
    TC (x±s, mmol/L) 4.10 ±1.08 4.03 ±1.10 4.88 < 0.001
    HDL-C (x±s, mmol/L) 1.12 ±0.31 1.11 ±0.31 3.27 0.001
    LDL-C (x±s, mmol/L) 2.30 ±0.78 2.28 ±0.80 1.84 0.065
    FPG (x±s, mmol/L) 5.54 ±1.39 5.53 ±1.51 0.20 0.843
    OGTT-2h (x±s, mmol/L) 6.40 ±14.48 6.34 ±2.68 0.40 0.692
    下载: 导出CSV

    表  3  不同BMI和腹型肥胖分组与AMI发病的关系

    Table  3.   Relationship between different BMI and abdominal obesity groups and the incidence of acute myocardial infarction

    变量 WC正常BMI < 24 kg/m2(n=12 350) WC正常BMI≥24 kg/m2(n=3 085) 腹型肥胖BMI < 24 kg/m2(n=1 931) 腹型肥胖BMI≥24 kg/m2(n=9 428)
    AMI
      发病人数 75 26 25 130
      随访人年 73 992.35 18 448.90 11 552.43 56 366.27
      发病密度(/10万人年) 101.36 140.93 216.41 230.63
    HR(95% CI)值
      模型1 1.00 0.96(0.56~1.64) 2.04(1.26~3.30) 2.01(1.47~2.74)
      模型2 1.00 0.85(0.50~1.46) 1.82(1.12~2.95) 1.52(1.10~2.12)
      模型3 1.00 0.85(0.49~1.47) 1.85(1.14~3.01) 1.56(1.11~2.18)
    注:模型1:调整年龄、性别;模型2:在模型1基础上调整高血压、血脂异常、糖尿病;模型3:在模型2基础上调整文化程度、收入、婚姻状况、吸烟、饮酒、身体活动不足、蔬果摄入不足、红肉摄入过多。
    下载: 导出CSV
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  • 收稿日期:  2021-12-20
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