| 代谢性肥胖与高血压发病的队列研究 |
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| 引用本文： | 陈嫦萤,杨松,庄乾,孙俊翔,魏鹏飞,赵祥海,陈燕春,沈冲.代谢性肥胖与高血压发病的队列研究[J].中华疾病控制杂志,2023,27(1):17-22. |
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| 作者姓名： | 陈嫦萤 杨松 庄乾 孙俊翔 魏鹏飞 赵祥海 陈燕春 沈冲 |
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| 作者单位： | 1.211166 南京，南京医科大学公共卫生学院流行病学系 |
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| 基金项目： | 国家自然科学基金81872686 |
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| 摘 要： | 目的 探讨代谢性肥胖与高血压发病的关系，为人群高血压防制提供理论依据。 方法 采用前瞻性队列研究设计，于2009年在江苏省宜兴市官林、徐舍2个乡镇采用整群抽样方法纳入4 128名成人进行流行病学基线调查。排除基线2 012名高血压病例，截至2020年7月对2 116名非高血压对象进行高血压发病随访。根据体重和代谢状态将研究对象分为4组:代谢正常体重正常(metabolically healthy and normal weight, MHNW)、代谢正常超重/肥胖(metabolically healthy overweight/obesity, MHO)、代谢异常体重正常(metabolically unhealthy and normal weight, MUNW)、代谢异常超重/肥胖(metabolically unhealthy overweight/obesity, MUO)。采用Cox比例风险回归模型对代谢性肥胖与高血压发病关联进行分析，进一步做分层分析、异质性检验及相加与相乘交互作用分析；排除随访第一年发病的高血压对象、排除偏瘦人群进行敏感性分析。 结果 共随访到新发高血压637例，超重肥胖及代谢异常联合相较于体重正常代谢正常的人群归因危险度(population attributable risk, PAR)及PAR%分别为17.4%、57.93%。Cox回归分析结果显示:与MHNW相比，MHO、MUNW、MUO三组的高血压发病风险增加均有统计学意义，调整后的HR(95% CI)值分别为1.29(1.08~1.56)、1.48(1.09~2.01)、1.70(1.37~2.11)，并呈风险递增的趋势(均有P < 0.001)。分层分析和异质性检验结果显示:女性MUO的高血压发病风险(调整HR:2.14)高于男性MUO(调整HR:1.22)，P异质性检验= 0.017。相乘交互作用分析结果显示:性别与代谢状态之间存在相乘交互作用，调整后的HR(95% CI)值为1.53(1.06~2.22)，P=0.024。排除随访第一年高血压发病的对象或排除偏瘦人群进行敏感性分析，关联强度无明显变化。 结论 代谢性肥胖增加人群高血压发病风险，尤其在女性人群中风险更高。因此，对超重肥胖及代谢异常相关人群进行主动健康干预预防高血压具有十分重要意义。
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| 关 键 词： | 代谢性肥胖 高血压 队列研究 交互作用 |
| 收稿时间： | 2022-03-04 |
A cohort study on the association between metabolically unhealthy obesity and hypertension |
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| Affiliation: | 1.Department of Epidemiology, School of Public Health, Nanjing Medical University, Nanjing 211166, China2.Department of Cardiology, Affiliated Yixing People's Hospital of Jiangsu University, Wuxi 214200, China |
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| Abstract: | Objective To explore the association between metabolically unhealthy obesity and hypertension, so as to provide theoretical basis for prevention and control of hypertension. Methods A prospective cohort study design was used to investigate the epidemiological baseline of 4 128 adults in Guanlin and Xushe towns of Yixing City, Jiangsu Province in 2009. A total of 2012 hypertensive cases were excluded at baseline and 2116 non-hypertensive subjects were followed up until July 2020. According to the weight and metabolic status, all subjects were grouped into four groups, metabolically healthy and normal weight (MHNW), metabolically healthy overweight/obesity (MHO), metabolically unhealthy and normal weight (MUNW) and metabolically unhealthy overweight/obesity (MUO). Cox proportional risk regression model was used for correlation analysis between metabolic obesity and hypertension. Stratified analysis, heterogeneity test, additive and multiplicative interaction analysis were further carried out. We also conducted sensitivity analyses for the population with developing hypertension in the first year of follow-up and the thin individuals excluded. Results 637 participants developed hypertension during followed-up. The population attributable risk (PAR) and its percentage (PAR%) of obesity and metabolically unhealthy were 17.4% and 57.93%, respectively. Compared with MHNW, the MHO, MUNW and MUO groups had significantly increased risk of hypertension, and the adjusted HR(95% CI) were 1.29 (1.08-1.56), 1.48 (1.09-2.01) and 1.70 (1.37-2.11), respectively, with increasing trends (P < 0.001). The results of stratified analysis and heterogeneity test showed that the risk of hypertension in women (adjusted HR: 2.14) was higher than that in men (adjusted HR: 1.22), and P for heterogeneity test was 0.017. There was a multiplicative interaction between gender and metabolic status, and the adjusted HR(95% CI) was 1.53 (1.06-2.22), P=0.024. No significant change was detected for the association in the sensitivity analysis. Conclusions The metabolically unhealthy obesity significantly increased the risk of hypertension and particularly in women. Therefore, the initiative health intervention for the population with overweight, obesity and metabolic disorders may effectively reduce the risk of hypertension. |
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