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肥胖及相关代谢指标与膝骨关节炎的关联: 基于中国中老年人群的横断面研究

Association Between Obesity-Related Metabolic Indices and Knee Osteoarthritis: A Cross-Sectional Study in Middle-Aged and Older Chinese Adults

    摘要
  • 摘要:
    目的 基于中国健康与养老追踪调查(China Health and Retirement Longitudinal Study, CHARLS)数据, 分析肥胖及相关代谢指标与中老年人群(≥45岁)膝骨关节炎(knee osteoarthritis, KOA)发病风险的关系。
    方法 提取CHARLS数据库中2011—2012年和2015—2016年2个调查周期的数据, 收集肥胖指标体质量指数(body mass index, BMI)、腰围(waist circumference, WC)、腰高比(waist-to-height ratio, WHtR)、内脏脂肪指数(visceral adiposity index, VAI)、体型指数(a body shape index, ABSI)、体圆指数(body roundness index, BRI)、脂质积累指数(lipid accumulation product, LAP)、圆锥指数(conicity index, CI)、中国内脏脂肪指数(Chinese visceral adiposity index, CVAI)和代谢指标甘油三酯-葡萄糖指数(triglyceride glucose index, TyG)、TyG-BMI、TyG-WC、TyG-WHtR以及协变量(包括一般人口学特征、生活方式、健康状况)资料, 采用多因素Logistic回归分析构建3种模型, 根据性别亚组分析关联异质性, 构建受试者工作特征(receiver operating characteristic, ROC)曲线并计算曲线下面积(area under the curve, AUC), 评估各项指标对KOA的诊断效能。
    结果 共纳入受试者9527名, KOA患病率为9.59%(914/9527)。线性回归校正混杂因素后发现, BMI(OR=1.02, 95% CI: 1.00~1.04, P=0.048)、BRI(OR=1.06, 95% CI: 1.01~1.13, P=0.030)、LAP(OR=1.03, 95% CI: 1.00~1.05, P=0.020)、TyG-BMI(OR=1.02, 95% CI: 1.00~1.05, P=0.020)和TyG-WHtR(OR=1.13, 95% CI: 1.02~1.25, P=0.020) 与KOA存在显著正相关。亚组分析显示, 在女性受试者中, BMI(OR=1.03, 95% CI: 1.01~1.06, P=0.020)、WHtR(OR=1.18, 95% CI: 1.02~1.36, P=0.020)、BRI(OR=1.08, 95% CI: 1.01~1.16, P=0.020)、LAP(OR=1.03, 95% CI: 1.01~1.06, P=0.020)、CVAI(OR=1.04, 95% CI: 1.01~1.07, P=0.009)、TyG-BMI(OR=1.03, 95% CI: 1.01~1.06, P=0.006)、TyG-WC(OR=1.10, 95% CI: 1.01~1.19, P=0.020)、TyG-WHtR(OR=1.18, 95% CI: 1.04~1.34, P=0.010)与KOA的发生均呈显著正相关; 而在男性受试者中, 所有指标与KOA均不存在显著关联(P均＞0.05)。检验性别与肥胖及代谢指标的交互作用发现, WC(P=0.010)、CVAI(P=0.002)和TyG-WC(P=0.020)与KOA之间的关联在男女之间存在显著差异。ROC诊断效能评估显示, 各项指标的诊断效能均有限BRI(AUC=0.547, 95% CI: 0.526~0.567)、TyG-WHtR(AUC=0.544, 95% CI: 0.524~0.564)、其余AUC值均≤0.530。
    结论 BMI、BRI、LAP、TyG-BMI、TyG-WHtR可作为中老年女性人群KOA风险评估的辅助指标, 但其独立筛查价值有限, 需结合临床评估和其他风险因素综合判断。

     

    Abstract:
    Objective To investigate the association between obesity-related metabolic indices and the risk of knee osteoarthritis(KOA) in middle-aged and older Chinese adults(≥45 years) using data from the China Health and Retirement Longitudinal Study(CHARLS).
    Methods Data from two CHARLS survey waves(2011—2012 and 2015—2016) were analyzed. Obesity indices—including body mass index(BMI), waist circumference(WC), waist-to-height ratio(WHtR), visceral adiposity index(VAI), a body shape index(ABSI), body roundness index(BRI), lipid accumulation product(LAP), conicity index(CI), and Chinese visceral adiposity index(CVAI)-and metabolic indices-triglyceride glucose index(TyG), TyG-BMI, TyG-WC, and TyG-WHtR-were collected. Covariates comprised demographic characteristics, lifestyle factors, and health status. Three multivariate logistic regression models were constructed. Sex-subgroup analyses assessed heterogeneity, and receiver operating characteristic(ROC) curves with area under the curve(AUC) were used to evaluate diagnostic performance.
    Results Among 9527 participants, the prevalence of KOA was 9.59%(914/9527). After adjusting for confounders, linear regression revealed significant positive associations between KOA and BMI(OR=1.02, 95% CI: 1.00-1.04, P=0.048), BRI(OR=1.06, 95% CI: 1.01-1.13, P=0.030), LAP(OR=1.03, 95% CI: 1.00-1.05, P=0.020), TyG-BMI(OR=1.02, 95% CI: 1.00-1.05, P=0.020), and TyG-WHtR(OR=1.13, 95% CI: 1.02-1.25, P=0.020). Sex-stratified analyses showed that in women, BMI(OR=1.03, 95% CI: 1.01-1.06, P=0.020), WHtR(OR=1.18, 95% CI: 1.02-1.36, P=0.020), BRI(OR=1.08, 95% CI: 1.01-1.16, P=0.020), LAP(OR=1.03, 95% CI: 1.01-1.06, P=0.020), CVAI(OR=1.04, 95% CI: 1.01-1.07, P=0.009), TyG-BMI(OR=1.03, 95% CI: 1.01-1.06, P=0.006), TyG-WC(OR=1.10, 95% CI: 1.01-1.19, P=0.02), and TyG-WHtR(OR=1.18, 95% CI: 1.04-1.34, P=0.010) were positively associated with KOA, whereas no significant associations were observed in men(P > 0.05 for all indices). Significant sex interactions were found for WC(P=0.010), CVAI(P=0.002), and TyG-WC(P=0.020). ROC analysis indicated limited diagnostic utility for all indicesBRI(AUC=0.547, 95% CI: 0.526-0.567), TyG-WHtR(AUC=0.544, 95% CI: 0.524-0.564), others ≤0.530.
    Conclusions BMI, BRI, LAP, TyG-BMI, and TyG-WHtR may serve as auxiliary indicators for KOA risk assessment in middle-aged and older women, but their standalone screening value remains modest. Clinical evaluation and integration with other risk factors are recommended for comprehensive risk stratification.

     

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