心脏代谢指数对体重正常人群代谢异常表型的预测价值分析
Predictive value of cardiometabolic index for metabolic phenotype in normal weight population
背景 心脏代谢指数(cardiometabolic index, CMI)是一种衡量血脂简易指标，与糖尿病、脑卒中的密切相关。体重正常代谢异常(metabolically obese normal weight, MONW)表型个体糖尿病、心脑血管疾病发病和死亡风险更高，正确识别MONW表型个体对代谢相关疾病的预防和控制至关重要。但CMI对 MONW表型预测价值如何，相关研究较少。 目的 探讨CMI与MONW表型的关系，并评估CMI对MONW表型的预测价值。 方法 研究人群来自2017-2018年南京市成人慢性病危险因素监测数据中年龄≥18岁且BMI在18.5-24kg/m2间的30 408名成人(男性占43.45%)。采用稳健Poisson回归模型分析不同性别人群CMI与MONW表型关系。采用受试者工作特征曲线(receiver operating characteristic，ROC)分性别、年龄评估CMI对MONW表型的预测作用。 结果 MONW表型的粗患病率为22.09%(男性：23.34%，女性：21.13%)。多因素调整后，不同性别中MONW表型与CMI水平均呈正向剂量反应关系 (P趋势?0.001)，与低CMI水平组相比，高CMI水平组与MONW表型关联强度的PR值在总人群、男性和女性中分别为5.09（95%CI:4.68~5.53）、3.76 (95%CI:3.28~4.10)和6.94 (95%CI:6.17~7.80)。ROC曲线显示，男性和女性人群中CMI预测MONW表型的AUC值分别为0.767 (95%CI:0.757~0.778)和0.809 (95%CI:0.801~0.818)，均优于WHtR、TG/HDL-C、WC和BMI(P?0.001)。此外，CMI 的预测效能在18-34岁人群中最高，男性和女性的AUC值分别为0.835 (95%CI:0.818~0.852)和0.832 (95%CI:0.817~0.847)。 结论 CMI与MONW表型的患病风险呈正相关, 且CMI具有较强的预测效能，可作为识别体重正常人群中MONW表型的有效工具，尤其适用于年轻人群。
Background Cardiometabolic index (CMI) is a simple index to measure blood lipid, which is closely related to diabetes and stroke. Metabolically obese normal weight (MONW) individuals have higher risk of diabetes and cardiovascular and cerebrovascular diseases. Correctly identifying individuals with MONW phenotype is essential for the prevention and control of metabolism-related diseases. However, there are few studies on the predictive value of CMI for MONW phenotype. Objective To investigate the association between Cardiometabolic index (CMI) and metabolically obese normal weight phenotype (MONW), and to evaluate the predictive value of CMI for MONW phenotype. Methods The study population was 30,408 normal-weight subjects (male 43.45%) aged 18 years from chronic disease and risk factors surveillance in Nanjing city from 2017 to 2018. Robust Poisson regression model was used to analyze the relationship between CMI and MONW phenotype in different genders. The receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic accuracy of CMI, and stratified analysis was performed according to sex and age. Results The crude prevalence of MONW phenotype was 22.09% (male: 23.34%, female: 21.13%). After multivariate adjustment, MONW phenotype showed a positive dose-response relationship with CMI level in all genders (P for trend <0.001). Compared with the lowest quartile, the PR of the associations between the highest quartile of CMI and MONW phenotype were 5.09 (95%CI: 4.68-5.53), 3.76 (95%CI: 3.28-4.10) and 6.94 (95%CI: 6.17-7.80) in the total subjects, males and females, respectively. In the ROC analysis, CMI showed superiority in identifying MONW individuals compare to WHtR, TG/HDL-C, WC and BMI, with an AUC of 0.767 (95%CI: 0.757~0.778) for men and 0.809 (95%CI: 0.801~0.818)for women. In addition, CMI showed the highest diagnostic accuracy in people aged 18-34, with AUC values of 0.835 (95%CI: 0.818~0.852) and 0.832 (95%CI: 0.817~0.847) for males and females, respectively. Conclusion CMI was positively and independently associated with the risk of the MONW phenotype, which has strong predictive power and can be used as an effective tool to identify MONW phenotype in the general population, especially in young people.
陈一佳, 戚圣香, 杜金玲, 王琛琛, 周海茸, 叶青, 秦真真, 苏健, 洪忻
10.12114/j.issn.1007-9572.2022.0755
内科学预防医学基础医学
心脏代谢指数体重正常代谢异常受试者工作特征曲线预测价值
陈一佳, 戚圣香, 杜金玲, 王琛琛, 周海茸, 叶青, 秦真真, 苏健, 洪忻.心脏代谢指数对体重正常人群代谢异常表型的预测价值分析[EB/OL].(2022-10-28)[2025-08-24].https://chinaxiv.org/abs/202211.00030.点此复制
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