不同肥胖代谢表型对颈动脉硬化患病风险的影响：一项基于7 354例成人的横断面研究-现代医学

不同肥胖代谢表型对颈动脉硬化患病风险的影响：一项基于7 354例成人的横断面研究

单位：西安交通大学第二附属医院全科医学科, 陕西西安 710000

分类号：R589.25;R543.4

出版年·卷·期（页码）：2026·45·第四期（577-582）

摘要：

目的： 探讨不同肥胖代谢表型与颈动脉硬化间的关系，以期为精准预防和治疗提供依据。方法： 采用横断面研究设计，纳入7 354例健康体检者，依据体质指数(BMI)和代谢异常项数将研究对象分为代谢健康非肥胖(MHNO)、代谢健康肥胖(MHO)、代谢异常非肥胖(MUNO)及代谢异常肥胖(MUO)4组，结合标准化测量及颈动脉超声评估，通过多因素Logistic回归模型分析不同肥胖代谢表型对颈动脉硬化的影响。结果： MUNO组(60.4%)及MUO组(54.1%)的颈动脉硬化患病率显著高于MHNO组(32.2%)及MHO组(37.1%)。以不同肥胖代谢表型作为自变量，颈动脉硬化作为因变量，在校正性别、年龄、血压、血糖、血尿酸后，多因素Logistic回归分析显示，与 MHNO 组比较，MHO组、MUNO组、MUO组的OR依次为1.29(95%CI 1.09～1.54)、2.55(95%CI 2.06～3.16)、3.13(95%CI 2.67～3.68)。结论： 本研究系统分析了肥胖代谢表型对颈动脉硬化的影响，强调仅以BMI界定肥胖并不足以全面评估心脑血管疾病风险，提示需综合考虑个体的代谢状态。这一发现为高危人群的早期识别和干预提供了重要的临床依据，并为未来个体化健康管理策略的制定奠定了基础。

Objective: To explore the association between distinct obesity-related metabolic phenotypes and carotid atherosclerosis, so as to provide evidence for precision prevention and treatment. Methods: A cross-sectional study design was adopted. A total of 7 354 healthy adults who underwent physical examination were enrolled. According to body mass index(BMI) and the number of metabolic abnormalities, subjects were assigned to four groups: metabolically healthy non-obesity(MHNO), metabolically healthy obesity(MHO), metabolically unhealthy non-obesity(MUNO), or metabolically unhealthy obesity(MUO) groups. Base on standardized measurements and carotid ultrasound assessment, a multivariate Logistic regression model was used to analyze the effect of different obesity-metabolic phenotypes on carotid atherosclerosis. Results: The prevalence of carotid atherosclerosis was 60.4% in the MUNO group and 54.1% in the MUO group, significantly higher than 32.2% in the MHNO group and 37.1% in the MHO groups. With obesity-metabolic phenotype as the independent variable and carotid atherosclerosis as the dependent variable, after adjusting for gender, age, blood pressure, blood glucose, and serum uric acid, multivariate Logistic regression analysis showed that compared with that in the MHNO group, the OR of MHO, MUNO, and MUO group were 1.29(95%CI 1.09-1.54), 2.55(95%CI 2.06-3.16), and 3.13(95%CI 2.67-3.68), respectively. Conclusion: This study systematically demonstrates that metabolic phenotype substantially modifies the obesity-atherosclerosis relationship. Relying on BMI alone is insufficient for comprehensive cardiometabolic risk assessment; metabolic status must also be considered. These findings offer important clinical basis for early identification and intervention in high-risk individuals and provide a basis for future personalized health-management strategies.

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