慢性肾脏病患者腹部肥胖与冠状动脉钙化之间的关联
The Associations Between Abdominal Obesity and Coronary Artery Calcification in Chronic Kidney Disease Population.
作者信息
Liu Peng-Tzu, Chen Jong-Dar
机构信息
Department of Family Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei City, Taiwan.
Graduate Institute of Chemistry, Fu Jen Catholic University, New Taipei City, Taiwan.
出版信息
Int J Nephrol Renovasc Dis. 2024 Feb 1;17:39-45. doi: 10.2147/IJNRD.S446445. eCollection 2024.
BACKGROUND
Cardiovascular disease (CVD) is the primary cause of mortality in chronic kidney disease (CKD) patients, with metabolic disorders exacerbating this risk. Compared with body mass index, waist circumference (WC) has been proposed as a more effective indicator of abnormal visceral fat. However, the associations among CKD, abnormal WC, and CVD remain understudied.
MATERIAL AND METHODS
A cross-sectional study in Taiwan (July 2006 to May 2016) involved 10,342 participants undergoing self-paid health checkups at a single medical center. Physical examinations and blood samples were taken to assess metabolic parameters, and renal function was evaluated using the Chronic Kidney Disease Epidemiology Collaboration formula. Coronary artery calcification (CAC) scores were determined through coronary 256-slice multidetector computed tomography angiography, with a CAC score of >0 Agatston unit (AU) and ≥ 400 AU denoting positive CAC and severe CAC, respectively.
RESULTS
Sex-based comparisons were conducted between individuals with CKD and those without CKD. In the CKD group, both sexes exhibited significantly elevated levels for systolic blood pressure, serum fasting blood glucose (FBG), and hemoglobin A1c (HbA1c) as well as reduced serum high-density lipoprotein cholesterol. Examination of the associations of abnormal WC revealed that for both sexes, individuals with abdominal obesity (AO) were significantly older and had higher systolic/diastolic blood pressure, serum FBG, HbA1c, and lipid profiles compared with those without AO. Multiple logistic regression analysis revealed that CKD patients exhibited a more pronounced association with severe CAC scores compared with AO patients (odds ratios [ORs]: 2.7 and 1.4, respectively). Furthermore, the combined effects of AO and CKD (AO[+]/CKD[+]) resulted in increased risks of positive CAC (OR: 2.4, 95% confidence interval [CI]: 1.6-3.5) and severe CAC (OR: 4.4, 95% CI: 1.4-14.2).
CONCLUSION
Abdominal obesity significantly raised the odds of CAC and was associated to a 4.4-fold increased risk of severe CAC in CKD patients.
背景
心血管疾病（CVD）是慢性肾脏病（CKD）患者死亡的主要原因，代谢紊乱会加剧这种风险。与体重指数相比，腰围（WC）被认为是内脏脂肪异常的更有效指标。然而，CKD、WC异常和CVD之间的关联仍未得到充分研究。
材料与方法
在台湾进行的一项横断面研究（2006年7月至2016年5月）纳入了10342名在单一医疗中心进行自费健康检查的参与者。进行体格检查并采集血样以评估代谢参数，并使用慢性肾脏病流行病学合作公式评估肾功能。通过冠状动脉256层多排螺旋计算机断层血管造影确定冠状动脉钙化（CAC）评分，CAC评分>0阿加斯顿单位（AU）和≥400 AU分别表示阳性CAC和严重CAC。
结果
对患有CKD和未患有CKD的个体进行了基于性别的比较。在CKD组中，男女的收缩压、空腹血糖（FBG）、糖化血红蛋白（HbA1c）水平均显著升高，血清高密度脂蛋白胆固醇水平降低。对WC异常的关联进行检查发现，无论男女，与无腹型肥胖（AO）者相比，腹型肥胖者年龄显著更大，收缩压/舒张压、血清FBG、HbA1c和血脂水平更高。多因素logistic回归分析显示，与AO患者相比，CKD患者与严重CAC评分的关联更为显著（优势比[OR]分别为2.7和1.4）。此外，AO和CKD的联合作用（AO[+]/CKD[+]）导致阳性CAC（OR：2.4，95%置信区间[CI]：1.6 - 3.5）和严重CAC（OR：4.4，95%CI：1.4 - 14.2）风险增加。
结论
腹型肥胖显著增加了CKD患者CAC的几率，并与严重CAC风险增加4.4倍相关。
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