腹腔内脏脂肪面积预测肥胖症行减重手术患者合并多重代谢危险因素的价值

张贵祥1; 杜潇1; 钟欢欢2; 赵爽2; 陈刚1; 彭柏强1; 李正正1; 陈亿1; 程中1

doi:10.3760/cma.j.cn115610-20200821-00571

腹腔内脏脂肪面积预测肥胖症行减重手术患者合并多重代谢危险因素的价值

Predictive value of visceral fat area for multiple metabolic risk factors in obese patients undergoing bariatric surgery

摘要

摘要: 目的:探讨腹腔内脏脂肪面积预测肥胖症行减重手术患者合并多重代谢危险因素的价值。
方法:采用回顾性病例对照研究方法。收集2015年6月至2020年5月四川大学华西医院收治的146例肥胖症行减重手术患者的临床资料；男57例，女89例；年龄为(33±9)岁，年龄范围为15～65岁。患者行多排螺旋CT检查，测量总腹部脂肪面积(TFA)，内脏脂肪面积(VFA)和皮下脂肪面积(SFA)。观察指标：(1)腹部脂肪面积CT检查结果及患者合并多重代谢危险因素情况。(2)不同临床指标预测多重代谢危险因素的受试者工作特征(ROC)曲线分析。(3)不同VFA与患者临床病理特征的关系。(4)影响患者合并多重代谢危险因素的相关因素分析。正态分布的计量资料以±s表示，组间比较采用独立样本t检验。偏态分布的计量资料以M(范围)表示，组间比较采用非参数秩和检验。计数资料以绝对数表示，组间比较采用x²检验。采用ROC曲线分析不同临床指标对患者合并多重代谢危险因素的预测价值。采用Logistics回归模型进行单因素和多因素分析。
结果:(1)腹部脂肪面积CT检查结果及患者合并多重代谢危险因素情况：146例患者CT检查结果显示VFA为(212±122)cm²，SFA为(419±147)cm²，内脏皮下脂肪比为0.60±0.54。146例患者收缩压为(131±16)mmHg(1 mmHg=0.133 kPa)，舒张压为(86±12)mmHg，空腹血糖为(6.4±2.5)mmol/L，三酰甘油为4.43mmol/L(1.23～9.99 mmol/L)，高密度脂蛋白胆固醇为(1.5± 1.3)mmol/L。146例患者中，85例有空腹血糖受损或糖尿病，82例有高血压病，139例有高甘油三酯血症，91例有低血清高密度脂蛋白胆固醇血症；128例患者合并多重代谢危险因素。(2)不同临床指标预测多重代谢危险因素的ROC曲线分析：ROC曲线显示VFA对预测或诊断患者合并多重代谢危险因素的能力更佳(风险比=0.617，95%可信区间为0.470～0.764，P<0.05)，通过ROC曲线计算约登指数得出VFA临界值为163.52 cm²。(3)不同VFA与患者临床病理特征的关系：根据ROC曲线VFA临界值163.52 cm²，146例患者中高VFA(≥163.52 cm²)和低VFA(<163.52 cm²)患者分别为49例和97例。高VFA患者高血压病、收缩压、空腹血糖受损或糖尿病、合并多重代谢危险因素分别为64例、(134±17)mmHg、63例、90例，低VFA患者上述指标分别为18例、(127± 13)mmHg、22例、38例，两者上述指标比较，差异均有统计学意义(x²=11.309，t=6.916， x²=5.380，6.988，P<0.05)。(4)影响患者合并多重代谢危险因素分析：单因素分析结果显示VFA是影响患者合并多重代谢危险因素的相关因素(风险比=3.722，95%可信区间为1.341～10.328，P<0.05)。多因素分析结果显示：VFA≥163.52 cm²是影响患者合并多重代谢危险因素的独立危险因素(风险比=5.182，95%可信区间为1.441～18.641，P<0.05)。
结论:VFA与高血压病、收缩压、空腹血糖受损或糖尿病相关。VFA≥163.52 cm²是影响肥胖症行减重手术患者合并多重代谢危险因素的独立危险因素。

Abstract: Objective:To investigate the predictive value of visceral fat area (VFA) on multiple metabolic risk factors in obese patients undergoing bariatric surgery.
Methods:The retrospective case-control study was conducted. The clinical data of 146 obese patients undergoing bariatric surgery in the West China Hospital of Sichuan University from June 2015 to May 2020 were collected. There were 57 males and 89 females, aged (33±9)years, with a range from 15 to 65 years. All patients underwent multi-slice spiral computed tomography (CT) examination, and the total fat area (TFA), VFA and subcutaneous fat area (SFA) were measured. Observation indicators: (1) CT findings of abdominal fat area and patients with multiple metabolic risk factors; (2) receiver operator characteristic(ROC) curve of different clinical indicators for predicting multiple metabolic risk factors; (3) relationship between different VFA and clinicopathological features in patients; (4) analysis of factors influencing multiple metabolic risk factors in patients. Measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was analyzed by independent sample t test. Measurement data with skewed distribution were expressed as M (range) and comparison between groups was analyzed by nonparametric rank sum test. Count data were represented as absolute numbers, and comparison between groups was analyzed using the chi-square test. The ROC curve was used to analyze the predictive value of different clinical indicators for multiple metabolic risk factors in patients. Logistic regression analysis was used for univariate and multivariate analysis.
Results:(1) CT findings of abdominal fat area and patients with multiple metabolic risk factors. CT findings of 146 patients showed that VFA was (212±122)m², SFA was (419± 147)m², visceral-to-subcutaneous fat ratio (VSR) was 0.60±0.54. The levels of systolic blood pressure (SBP), diastolic blood pressure, fasting blood glucose (FBG), triglyceride and highdensity lipoprotein cholesterol (HDL-C) were (131±16)mmHg(1 mmHg=0.133 kPa), (86±12)mmHg, (6.4±2.5)mmol / L, 4.43 mmol /L(range, 1.23-9.99 mmol/L), (1.5±1.3)mmol/L, respectively. Among the 146 patients, 85 had impaired FBG or diabetes, 82 had hypertension, 139 had high triglyceride, 91 had low serum HDL-C; 128 had multiple metabolic risk factors. (2) ROC curve analysis of different clinical indicators for predicting multiple metabolic risk factors: the ROC curve showed that VFA had better ability to predict or diagnose multiple metabolic risk factors in patients (hazard ratio=0.617, 95% confidence interval as 0.470-0.764, P<0.05). The cutoff value of VFA was 163.52 m² by calculating Yoden index in ROC curve. (3) Relationship between different VFA and clinicopathological features in patients: according to the cutoff value of 163.52 m² in ROC curve, 146 patients were divided into high VFA group (≥163.52 m²) and the low VFA group (<163.52 m²), with 49 cases and 97 cases respectively. Cases with hypertension, level of SBP, cases with impaired FBG or diabetes, cases with multiple metabolic risk factors were 64, (134±17)mmHg, 63, 90 for the high VFA group, versus 18, (127±13)mmHg, 22, 38 for the low VFA group; there were significant differences in above indicators between the two groups (x²=11.309, t=6.916, x²=5.380, 6.988, P<0.05). (4) Analysis of factors influencing multiple metabolic risk factors in patients: results of univariate analysis showed that VFA was a related factor for multiple metabolic risk factors in patients (hazard ratio=3.722, 95% confidence interval as 1.341-10.328, P<0.05). Results of multivariate analysis showed that the VFA≥163.52 m² was an independent rsik factcor or multiple metabolic risk factors in patients (hazard ratio=5.182, 95% confidence interval as 1.441-18.641, P<0.05).
Conclusions:VFA is positively correlated with hypertension, systolic blood pressure, impaired FBG and diabetes. VFA≥163.52 m² is an independent predictor for multiple metabolic risk factors in obese patients undergoing bariatric surgery.

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