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中国全科医学

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相位角与超重/肥胖患者糖脂代谢异常的相关性研究及预测价值

李纪新，邱林杰，任燕，李美洁，邹姹姹，吴梓敬，王文茹，杨振宇，刘峰兆，张晋*   

  1. 100091 北京市，中国中医科学院西苑医院
  • 收稿日期:2025-04-15 修回日期:2025-05-27 接受日期:2025-06-05
  • 通讯作者: 张晋，主任医师；E-mail：jin_zhang2000@hotmail.com
  • 基金资助:
    北京薪火传承3+3项目（2023-SZ-A51）；国家重点研发计划子课题（2018YFC2000600）；中国中医科学院科技创新工程（CI2021A03005）；中国中医科学院西苑医院具有知识产权的医疗机构制剂和中药新药的研发与转化专项任务（XYZY0301-16）

Study on the Correlation between Phase Angle and Abnormal Glucose and Lipid Metabolism in Overweight/Obese Population and Its Predictive Value

LI Jixin, QIU Linjie, REN Yan, LI Meijie, ZOU Chacha, WU Zijing, WANG Wenru, YANG Zhenyu, LIU Fengzhao, ZHANG Jin*   

  1. Xiyuan Hospital, China Academy of Traditional Chinese Medicine, Haidian District, Beijing 100091, China
  • Received:2025-04-15 Revised:2025-05-27 Accepted:2025-06-05
  • Contact: ZHANG Jin, Chief Physician; E-mail: jin_zhang2000@hotmail.com

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摘要： 背景　超重/肥胖人群易伴有糖脂代谢紊乱，并会进一步诱发心脑血管疾病，因此寻找简便效廉的超重/肥胖人群糖脂代谢异常的早期识别方法具有重要意义。相位角（PhA）因其无创、简便、可反映健康水平而具有潜在临床价值。目的　探究PhA与超重/肥胖患者糖脂代谢异常的相关性及其预测价值。方法　纳入2021—2024年在中国中医科学院西苑医院参加健康体检的1 034例超重/肥胖患者为研究对象。根据超重/肥胖患者是否合并2型糖尿病（T2DM）、血脂异常将其分为非T2DM组（736例）和T2DM组（298例），非血脂异常组（382例）和血脂异常组（652例），收集患者资料并比较。采用Logistic回归和线性回归模型分析PhA与T2DM患病风险及空腹血糖（FPG）水平的相关性，以及PhA与血脂异常患病风险及总胆固醇（TC）、三酰甘油（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）水平的相关性，依据性别、年龄、吸烟史、饮酒史进行交互作用检验。运用ROC曲线评估PhA对于超重/肥胖患者T2DM和血脂异常患病风险的预测效能。结果　本研究共纳入1 034例超重/肥胖患者，其中546例（47.19%）、女488例（52.81%），平均年龄（51.8±15.3）岁，包含T2DM患者298例，血脂异常患者652例。不同糖脂代谢异常分组患者性别、年龄、体重、BMI、收缩压、舒张压、LDL-C、FPG、TG、TC、HDL-C、PhA、血脂异常病史、吸烟史、饮酒史比例比较，差异均有统计学意义（P<0.05）。调整相关变量后，Logistic回归分析结果显示，超重/肥胖患者PhA每上升1个单位，T2DM、血脂异常患病风险降低为原来的37%（OR=0.37，95%CI=0.31~0.46，P<0.01）和42%（OR=0.42，95%CI=0.35~0.52，P<0.01）。线性回归分析结果显示，超重/肥胖患者PhA每上升1个单位，FPG水平降低0.39个单位（β=-0.39，95%CI=-0.48~-0.29，P<0.01），TC、TG、LDL-C水平分别降低0.15（β=-0.15，95%CI=-0.22~-0.09）、0.42（β=-0.42，95%CI=-0.49~-0.35）、0.12（β=-0.12，95%CI=-0.23~-0.01）（P<0.05）。亚组分析结果显示，升高PhA水平对≥52岁及不饮酒的患者在改善糖脂代谢方面获益更多（P交互<0.05）。PhA预测超重/肥胖患者T2DM、血脂异常患病风险的ROC曲线下面积（AUC）分别为0.737（95%CI=0.702~0.772）、0.662（95%CI=0.628~0.696），最佳截断值分别为4.15和5.15。结论　PhA与超重/肥胖患者T2DM、血脂异常患病风险呈负相关，且对糖脂代谢异常具有较好的预测效能，可用于超重/肥胖患者T2DM和血脂异常的早期识别。

关键词: 超重；肥胖症；相位角；糖尿病, 2 型；血脂异常；相关性研究；预测价值

Abstract: Background　Overweight/obese individuals are prone to concomitant glucose and lipid metabolism disorders, which may further induce cardiovascular and cerebrovascular diseases. Therefore, identifying simple, effective, and cost-efficient methods for early detection of glucose and lipid metabolism abnormalities in overweight/obese populations is of significant importance. Phase angle (PhA) holds potential clinical value due to its non-invasive nature, simplicity, and ability to reflect health status. Objective　To investigate the correlation between PhA and glucose/lipid metabolism abnormalities in overweight/obese patients, as well as its predictive value. Methods　A total of 1 034 overweight/obese patients undergoing health examinations at Xiyuan Hospital of China Academy of Chinese Medical Sciences from 2021 to 2024 were enrolled. Participants were categorized based on the presence of type 2 diabetes mellitus (T2DM) and dyslipidemia: non-T2DM group (n=736), T2DM group (n=298), non-dyslipidemic group (n=382), and dyslipidemic group (n=652). Patient data were collected and compared. Logistic regression and linear regression models were employed to analyze the correlation between PhA and the risk of T2DM, as well as its association with fasting plasma glucose (FPG) levels. Additionally, the relationship between PhA and the risk of dyslipidemia, along with its correlation with total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) levels. Interaction tests were performed based on gender, age, smoking history, and alcohol consumption history. ROC curves were used to evaluate the predictive efficacy of PhA for T2DM and dyslipidemia risk in overweight/obese patients. Results　This study included 1 034 overweight/obese patients, comprising 546 males (47.19%) and 488 females (52.81%), with a mean age of (51.8±15.3) years. Among them, 298 patients had T2DM and 652 had dyslipidemia. Comparisons of gender, age, weight, BMI, systolic blood pressure, diastolic blood pressure, LDL-C, FPG, TG, TC, HDL-C, PhA, history of dyslipidemia, smoking history, and drinking history between different glucose and lipid metabolism abnormality groups showed statistically significant differences (P<0.05). After adjusting for relevant variables, logistic regression analysis revealed that for each unit increase in PhA among overweight/obese patients, the risk of T2DM and dyslipidemia decreased to 37% (OR=0.37, 95%CI=0.31-0.46, P<0.01) and 42% (OR=0.42, 95%CI=0.35-0.52, P<0.01). Linear regression analysis revealed that for each unit increase in PhA among overweight/obese patients, FPG levels decreased by 0.39 units (β=-0.39, 95%CI=-0.48 to -0.29, P<0.01), while TC, TG, and LDL-C levels decreased by 0.15 (β=-0.15, 95%CI=-0.22 to -0.09), 0.42 (β=-0.42, 95%CI=-0.49 to -0.35), and 0.12 (β=-0.12, 95%CI=-0.23 to -0.01) (P<0.05), respectively. Subgroup analysis revealed that elevated PhA levels conferred greater benefits in improving glucose and lipid metabolism among patients aged ≥ 52 years and non-drinkers (Pinteraction<0.05). The area under the ROC curve (AUC) for PhA in predicting T2DM and dyslipidemia risk in overweight/obese patients was 0.737 (95%CI=0.702-0.772) and 0.662 (95%CI=0.628-0.696), respectively, with optimal cutoff values of 4.15 and 5.15. Conclusion　PhA negatively correlates with the risk of T2DM and dyslipidemia in overweight/obese patients and demonstrates good predictive efficacy for abnormal glucose and lipid metabolism. It can be used for early identification of T2DM and dyslipidemia in overweight/ obese patients.

Key words: Overweight, Obesity, Phase angle, Diabetes mellitus, type 2, Dyslipidemia, Correlation study, Predictive value

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