26 655例体检人群中肥胖指数与慢性肾脏病联系的横断面调查

目的：探讨大样本体检人群中慢性肾脏病(chronic kidney disease，CKD)与肥胖指数(体质量指数，腰围，腰围身高比)之间的联系。方法：按规定标准纳入2013年6月至2014年2月在中南大学湘雅三医院健康管理中心参加健康体检的26 655例个体，收集相关人体学资料及生化指标，进行logistic回归分析等统计学分析。结果：男性及女性个体中CKD的流行率分别是9.6%及3.1%。多因素logistic回归分析显示在糖尿病及高血压男性人群中，体质量指数、腰围、腰围/身高是CKD的独立危险因素。而在女性人群中，肥胖指数并非CKD的独立危险因素(P<0.01)。受试者工作特征(receiver operating characteristic，ROC)曲线分析显示在糖尿病男性人群中体质量指数、腰围、腰围/身高截点值分别为28.7 kg/m2，90.7 cm及0.56时预测CKD的敏感性分别是24.8%，58.5%，45.5%，特异性分别是83.3%，54.4%，69.6%，其曲线下面积分别为0.56，0.57，0.59。而在高血压男性人群中体质量指数、腰围、腰围/身高截点值分别为27.0 kg/m2， 91.2 cm及0.54时预测CKD的敏感性分别是41.0%，47.0%，50.1%，特异性分别是68.0%，63.0%，61.4%，其曲线下面积分别为0.54，0.56，0.57。结论：在糖尿病及高血压男性人群中，体质量指数，腰围，腰围/身高与CKD风险增加相关，然而肥胖指数预测CKD的效应有限。

Obesity indices for prediction of chronic kidney disease: a cross-sectional study in 26 655 Chinese adults

Objective: To investigate the associations between chronic kidney disease (CKD) and body mass index (BMI), waist circumference(WC), waist-to-height ratio (WheiR) in Chinese adults. Methods: A total of 26 655 participants, who voluntarily attended annual health examination at the Health Management Center in the Third Xiangya Hospital of Central South University from June 2013 to February 2014, were enrolled for this study. Logistic regression and receiver operating characteristic (ROC) curve analysis were performed. Results: The prevalence rate of CKD was 9.6% and 3.1% in male and female subjects, respectively. Multivariate logistic regression analysis showed that BMI, WC and WheiR were independent risk factors for CKD in diabetic male and hypertensive male subjects (P<0.01). However, no association between these obesity indices and CKD was found in women after multivariate adjustment. In diabetic male subjects, when BMI≥28.7 kg/m2, WC=90.7 cm and WheiR=0.56, the sensitivity and specificity prediction for CKD was 24.8%, 58.5%, 45.5% and 83.3%, 54.4%, 69.6%, respectively. In hypertensive male subjects, when the optimum cut-off points for BMI, WC and WheiR were ≥ 27.0 kg/m2, 91.2 cm and 0.54, the sensibility prediction for CKD were 41.0%, 47.0% and 50.1%, respectively, while the specificity prediction were 68.0%, 63.0% and 61.4%, respectively. The area under the ROC curve of BMI, WC, WheiR for CKD prediction were 0.56, 0.57, 0.59 in diabetic male subjects and 0.54, 0.56, 0.57 in hypertensive male subjects, respectively. Conclusion: BMI, WC and WheiR are associated with the increased risk for CKD in diabetic or hypertensive male subjects. However, the value for these obesity indices is limited in screening CKD.