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中国全科医学

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高血压患者新型肥胖指标与心血管疾病发病风险的关联研究

热伊莱·麦麦提1，周燚然1，武云2，刘稹诚1，卢耀勤1，3*，吴海燕3*   

  1. 1.830017 新疆维吾尔自治区乌鲁木齐市，新疆医科大学公共卫生学院；2.830011 新疆维吾尔自治区乌鲁木齐市，新疆医科大学第一附属医院全科医学科；3.830002 新疆维吾尔自治区乌鲁木齐市，新疆维吾尔自治区疾病预防控制中心
  • 收稿日期:2025-10-31 接受日期:2025-12-10
  • 通讯作者: 卢耀勤，研究员/主任医师；吴海燕，主任医师；
  • 基金资助:
    国家自然科学基金杰出青年科学基金（2024D01E29）

Association between Novel Obesity Indicators and Cardiovascular Disease Risk in Hypertensive Patients

REYILAI·Maimaiti1, ZHOU Yiran1, WU Yun2, LIU Zhencheng1, LU Yaoqin1, 3*, WU Haiyan3*   

  1. 1.Department of Epidemiology and Health Statistics, School of Public Health, Xinjiang Medical University, Urumqi 830017, China；2.Department of General Medicine, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830011, China；3.Xinjiang Uygur Autonomous Region Center for Disease Control and Prevention, Urumqi 830002, China
  • Received:2025-10-31 Accepted:2025-12-10
  • Contact: LU Yaoqin, Researcher／Chief Physician; WU Haiyan, Chief Physician

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摘要： 背景　高血压是心血管疾病（CVD）的重要危险因素，传统肥胖评估指标 BMI 在识别高危患者时存在不足，而新型肥胖指标在高血压人群中的预测价值尚待明确。目的　探讨中国人内脏脂肪指数（CVAI）、身体圆度指数（BRI）、相对脂肪质量指数（RFM）、体重调整腰围指数（WWI）、三酰甘油葡萄糖指数（TyG）及其相关指数TyG-BMI、TyG－腰围（TyG-WC）、TyG-腰高比（TyG-WHtR）等新型肥胖指标与高血压患者CVD发病风险的关联，并比较其预测性能，为高血压人群的心血管疾病防治提供依据。方法　采用回顾性队列研究设计，纳入2016—2022年乌鲁木齐市69 627名高血压人群作为研究对象。构建Cox比例风险回归模型和限制性立方样条模型评估不同指标与心血管疾病的发病风险。采用时间依赖性C指数和受试者工作特征（ROC）曲线下面积（AUC）比较不同指标的预测性能。结果　平均随访3.47年，共2 466例（3.54%）发生CVD。多因素Cox回归分析显示，在调整混杂因素后，CVAI（HR=1.122，95%CI=1.072~1.75）、BRI（HR=1.104，95%CI=1.061~1.149）、RFM（HR=1.236，95%CI=1.141~1.338）、WWI（HR=1.073，95%CI=1.029~1.118）、TyG-BMI（HR=1.099，95%CI=1.054~1.146）、TyG-WC（HR=1.105，95%CI=1.058~1.154）、TyG-WHtR（HR=1.113，95%CI=1.066~1.161）均与心血管疾病风险升高相关。限制性立方样条分析显示，RFM与CVD风险之间存在显著的非线性剂量-反应关系（Pnonlinear<0.05）。时间依赖性C指数分析显示，各指标判别能力随随访时间总体稳定。ROC曲线分析显示，TyG、CVAI、BRI、WWI、TyG-BMI、TyG-WC和TyG-WHtR预测CVD发生风险的AUC分别为0.512、0.568、0.558、0.566、0.518、0.531和0.553。亚组分析结果显示，BRI、RFM、WWI和TyG-WHtR表现出明显的性别交互作用（Pinteraction<0.05）。结论　在高血压人群中，CVAI和WWI等新型肥胖指标是CVD风险的强预测因子，其预测效能优于单一的TyG指数及其相关指数TyG-BMI、TyG-WC及TyG-WHtR。

关键词: 高血压, 新型肥胖指标, 心血管疾病, 队列研究

Abstract: Background　Hypertension is an important risk factor for cardiovascular disease (CVD). Traditional body mass index (BMI) has limitations in identifying high-risk patients, and the predictive value of new obesity indicators in the hypertensivepopulation remains to be clarified. Objective　To explore the relationship between novel obesity indicators, such as the Chinese Visceral Adiposity Index (CVAI), Body Roundness Index (BRI), Relative Fat Mass Index (RFM), Weight-Adjusted Waist Index (WWI), Triglyceride-Glucose Index (TyG), and its related indices TyG-BMI, TyG-Waist circumference (TyG-WC), TyG-waist-to-height ratio (TyG-WHtR) and the risk of cardiovascular disease (CVD) in patients with hypertension, and to compare their predictive performance, thereby providing a basis for the prevention and management of cardiovascular disease in the hypertensive population. Methods　A retrospective cohort study design was adopted, including 69 627 hypertensive individuals in Urumqi from 2016 to 2022 as the study population. Cox proportional hazards regression models and restricted cubic spline models were constructed to assess the risk of cardiovascular disease associated with different indicators. Time-dependent C indices and the area under the ROC curve (AUC) were used to compare the predictive performance of different indicators. Results　During an average follow-up of 3.47 years, a total of 2 466 (3.54%) individuals developed CVD. Multivariate Cox regression analysis showed that after adjusting for confounding factors, the following indicators were associated with an increased risk of cardiovascular disease: CVAI (HR=1.122, 95%CI=1.072-1.75), BRI (HR=1.104, 95%CI=1.061-1.149), RFM (HR=1.236, 95%CI=1.141-1.338), WWI (HR=1.073, 95%CI=1.029-1.118), TyG-BMI (HR=1.099, 95%CI=1.054-1.146), TyG-WC (HR=1.105, 95%CI=1.058-1.154), TyG-WHtR (HR=1.113, 95%CI=1.066-1.161). Restricted cubic spline analysis indicated a significant nonlinear dose-response relationship between RFM and CVD risk (Pnonlinear<0.05). Time-dependent C-index analysis showed that the discriminative ability of each indicator remained generally stable over the follow-up period. ROC curve analysis showed that the AUCs of TyG, CVAI, BRI, WWI, TyG-BMI, TyG-WC and TyG-WHtR in predicting the risk of CVD were 0.512, 0.568, 0.558, 0.566, 0.518, 0.531 and 0.553, respectively. Subgroup analysis showed that BRI, RFM, WWI and TyG-WHtR showed obvious sex interaction (Pinteraction<0.05). Conclusion　In people with hypertension, new obesity indicators such as CVAI and WWI are strong predictors of CVD risk, and their predictive effectiveness is significantly superior to that of a single TyG index and its related indices TyG-BMI, TyG-WC, and TyG-WHtR.

Key words: Hypertension, Novel obesity indicators, Cardiovascular disease, Cohort study

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