摘要
目的:结合《黄帝内经》与临床实践,利用客观且易获取的人体测量学指标辨识肥胖亚型。方法:纳入2016年10月至2023年4月湖北省中医院就诊的健康体检者、超重/肥胖患者5926例,收集研究对象年龄、性别、人体测量学指标、肝功能、肾功能、血脂四项、尿酸、空腹血糖。结合《黄帝内经》膏人、脂人、肉人的肥胖分型和仝小林院士提出的脂膏人、小膏人概念,将体脂率、内脏脂肪面积、腰臀比作为肥胖亚型分类的划分变量,进行最优聚类数验证和K均值聚类。采用R软件进行组间比较,采用多因素无序多分类Logistic回归分析对肥胖亚型发生风险的影响。结果:K均值聚类分析可将超重/肥胖人群分为4类,同时,存在377例体重正常但人体测量学指标异常人群(即小膏人),表现为女性、年龄大为主。多重比较发现,膏人的肝功能异常率(55.20%)、尿酸异常率(58.85%)及空腹血糖异常率(39.41%)均高于其他亚型,脂人的血脂异常率(63.15%)均高于其他亚型,肉人的肾功能异常率(55.50%)均高于其他亚型,差异具有统计学意义(P<0.001)。多因素无序多分类Logistic回归分析显示,高UA水平[OR=2.408,95%CI(1.775~3.267),P<0.001]、高FPG水平[OR=1.488,95%CI(1.075~2.061),P<0.05]是发生脂膏人的风险因素。高ALT水平[OR=2.332,95%CI(1.363~3.989),P<0.001]、高GGT水平[OR=1.234,95%CI(0.794~1.918),P<0.05]、高TG水平[OR=2.837,95%CI(1.983~4.057),P<0.001]、高UA水平[OR=2.955,95%CI(2.045~4.268),P<0.001]、高FPG水平[OR=1.597,95%CI(1.065~2.395),P<0.05]是发生膏人的风险因素。高Cr水平[OR=2.627,95%CI(1.144~6.033),P<0.001]、高UA水平[OR=1.562,95%CI(1.265~1.930),P<0.001]是发生肉人的风险因素。高ALT[OR=1.578,95%CI(1.053~14.673),P<0.001]、TG[OR=2.143,95%CI(1.686~2.724),P<0.001]、高UA水平[OR=1.776,95%CI(1.380~2.285),P<0.001]是发生脂人的风险因素。女性[OR=1.290,95%CI(0.556~2.995),P<0.001]、年龄大[OR=1.021,95%CI(1.001~1.042),P<0.001]是发生小膏人的风险因素。结论:对膏人、肉人、脂人、脂膏人及小膏人进行了初步定量化判定可识别其代谢异常特征和风险因素。
Objective:Combining Huangdi Neijing with clinical practice,anthropometric indexes were used to identify the obesity subtypes.Methods:A total of 5926 subjects from Hubei Hospital of Traditional Chinese Medicine from October 2016 to April 2023 were included.Age,gender,anthropometric indicators,liver function,kidney function,blood lipids,uric acid and fasting blood glucose of the subjects were collected.Body fat percentage,visceral fat area and waist-hip ratio(WHR)were used as the classification variables of obesity subtypes by K-means clustering.R software was used to compare among groups,and multi-factor disordered multiple classification logistic regression was used to analyze the impact on the risk of obesity subtypes.Results:K-means cluster analysis can be used to divide overweight/obese objects into four categories.At the same time,there were 377 individuals with normal BMI but abnormal anthropometric indicators(Xiao-gao Ren),mainly female and older.The rate of abnormal liver function(55.20%),the rate of abnormal uric acid(58.85%)and fasting blood glucose(39.41%)in Gao Ren is higher than that in other subtypes;the rate of abnormal lipids in Zhi Ren(63.15%)is higher than that in other subtypes;the rate of abnormal renal function in Rou Ren(56.00%)is higher than that in other subtypes(P<0.001).Multivariate logistic regression analysis showed that high UA level[OR=2.408,95%CI(1.775,3.267),P<0.001],high FPG level[OR=1.488,95%CI(1.075,2.061)],high FPG level[OR=1.488,95%CI(1.075,2.061),P<0.001],high UA level[OR=2.408,95%CI(1.775,3.267),P<0.001],high FPG level[OR=1.488,95%CI(1.075),P<0.05]is a risk factor for the development of Zhi-gao Ren.High ALT level[OR=2.332,95%CI(1.363,3.989),P<0.001],high GGT level[OR=1.234,95%CI(0.794,1.918),P<0.05],high TG level[OR=2.837,95%CI(1.983,4.057),P<0.001],high UA level[OR=2.955,95%CI(2.045,4.268),P<0.001]and high FPG level[OR=1.597,95%CI(1.065,2.395),P<0.05]were risk factors for Gao Ren.High Cr level[OR=2.627,95%CI(1.144,6.033),P<0.001]and high UA level[OR=1.562,95%CI(1.265,1.93),P<0.001]were risk factors for the occurrence of Rou Ren.High ALT[OR=1.578,95%CI(1.053,14.673),P<0.001],TG[OR=2.143,95%CI(1.686,2.724),P<0.001],high UA[OR=1.776,95%CI(1.380,2.285),P<0.001]was a risk factor for developing Zhi Ren.Femal[OR=1.290,95%CI(0.556,2.995),P<0.001]and older age[OR=1.021,95%CI(1.001,1.042),P<0.001]were the risk factors for the development of Xiao-Gao Ren.Conclusion:The metabolic abnormal characteristics and risk factors of Gao Ren,Rou Ren,Zhi Ren,Zhi-gao Ren,Xiao-gao Ren were identified by preliminary quantitative determination.
作者
卢晨霞
朱绘
惠晨阳
陶军秀
肖明中
赵林华
李青伟
李晓东
仝小林
LU Chen-xia;ZHU Hui;HUI Chen-yang;LI Xiao-dong;TONG Xiao-lin(Institute of Liver Diseases,Hubei Key Laboratory of the theory and application research of liver and kidney in traditional Chinese medicine,Hubei Provincial Hospital of Traditional Chinese Medicine(Wuhan Hubei,430061),China.)
出处
《中西医结合肝病杂志》
CAS
2023年第8期682-687,共6页
Chinese Journal of Integrated Traditional and Western Medicine on Liver Diseases
基金
国家自然科学基金面上项目(No.82274352)
湖北省自然科学基金创新群体项目(No.2020CFA023)
。
关键词
肥胖
分类
《黄帝内经》
人体测量学
代谢异常
obesity
classification
Huangdi Neijing
anthropometry
metabolic abnormality
