首页资讯肥胖及相关代谢指标与膝骨关节炎的关联: 基于中国中老年人群的横断面研究

肥胖及相关代谢指标与膝骨关节炎的关联: 基于中国中老年人群的横断面研究

来源：泰然健康网时间：2026年02月10日 11:07

摘要:

目的

基于中国健康与养老追踪调查(China Health and Retirement Longitudinal Study, CHARLS)数据, 分析肥胖及相关代谢指标与中老年人群(≥45岁)膝骨关节炎(knee osteoarthritis, KOA)发病风险的关系。

方法

提取CHARLS数据库中2011—2012年和2015—2016年2个调查周期的数据, 收集肥胖指标[体质量指数(body mass index, BMI)、腰围(waist circumference, WC)、腰高比(waist-to-height ratio, WHtR)、内脏脂肪指数(visceral adiposity index, VAI)、体型指数(a body shape index, ABSI)、体圆指数(body roundness index, BRI)、脂质积累指数(lipid accumulation product, LAP)、圆锥指数(conicity index, CI)、中国内脏脂肪指数(Chinese visceral adiposity index, CVAI)]和代谢指标[甘油三酯-葡萄糖指数(triglyceride glucose index, TyG)、TyG-BMI、TyG-WC、TyG-WHtR]以及协变量(包括一般人口学特征、生活方式、健康状况)资料, 采用多因素Logistic回归分析构建3种模型, 根据性别亚组分析关联异质性, 构建受试者工作特征(receiver operating characteristic, ROC)曲线并计算曲线下面积(area under the curve, AUC), 评估各项指标对KOA的诊断效能。

结果

共纳入受试者9527名, KOA患病率为9.59%(914/9527)。线性回归校正混杂因素后发现, BMI(OR=1.02, 95% CI: 1.00~1.04, P=0.048)、BRI(OR=1.06, 95% CI: 1.01~1.13, P=0.030)、LAP(OR=1.03, 95% CI: 1.00~1.05, P=0.020)、TyG-BMI(OR=1.02, 95% CI: 1.00~1.05, P=0.020)和TyG-WHtR(OR=1.13, 95% CI: 1.02~1.25, P=0.020) 与KOA存在显著正相关。亚组分析显示, 在女性受试者中, BMI(OR=1.03, 95% CI: 1.01~1.06, P=0.020)、WHtR(OR=1.18, 95% CI: 1.02~1.36, P=0.020)、BRI(OR=1.08, 95% CI: 1.01~1.16, P=0.020)、LAP(OR=1.03, 95% CI: 1.01~1.06, P=0.020)、CVAI(OR=1.04, 95% CI: 1.01~1.07, P=0.009)、TyG-BMI(OR=1.03, 95% CI: 1.01~1.06, P=0.006)、TyG-WC(OR=1.10, 95% CI: 1.01~1.19, P=0.020)、TyG-WHtR(OR=1.18, 95% CI: 1.04~1.34, P=0.010)与KOA的发生均呈显著正相关; 而在男性受试者中, 所有指标与KOA均不存在显著关联(P均＞0.05)。检验性别与肥胖及代谢指标的交互作用发现, WC(P=0.010)、CVAI(P=0.002)和TyG-WC(P=0.020)与KOA之间的关联在男女之间存在显著差异。ROC诊断效能评估显示, 各项指标的诊断效能均有限[BRI(AUC=0.547, 95% CI: 0.526~0.567)、TyG-WHtR(AUC=0.544, 95% CI: 0.524~0.564)、其余AUC值均≤0.530]。

结论

BMI、BRI、LAP、TyG-BMI、TyG-WHtR可作为中老年女性人群KOA风险评估的辅助指标, 但其独立筛查价值有限, 需结合临床评估和其他风险因素综合判断。

关键词: 膝骨关节炎 / 肥胖 / 代谢 / 性别差异 / 中国人群

Abstract:

Objective

To investigate the association between obesity-related metabolic indices and the risk of knee osteoarthritis(KOA) in middle-aged and older Chinese adults(≥45 years) using data from the China Health and Retirement Longitudinal Study(CHARLS).

Methods

Data from two CHARLS survey waves(2011—2012 and 2015—2016) were analyzed. Obesity indices—including body mass index(BMI), waist circumference(WC), waist-to-height ratio(WHtR), visceral adiposity index(VAI), a body shape index(ABSI), body roundness index(BRI), lipid accumulation product(LAP), conicity index(CI), and Chinese visceral adiposity index(CVAI)-and metabolic indices-triglyceride glucose index(TyG), TyG-BMI, TyG-WC, and TyG-WHtR-were collected. Covariates comprised demographic characteristics, lifestyle factors, and health status. Three multivariate logistic regression models were constructed. Sex-subgroup analyses assessed heterogeneity, and receiver operating characteristic(ROC) curves with area under the curve(AUC) were used to evaluate diagnostic performance.

Results

Among 9527 participants, the prevalence of KOA was 9.59%(914/9527). After adjusting for confounders, linear regression revealed significant positive associations between KOA and BMI(OR=1.02, 95% CI: 1.00-1.04, P=0.048), BRI(OR=1.06, 95% CI: 1.01-1.13, P=0.030), LAP(OR=1.03, 95% CI: 1.00-1.05, P=0.020), TyG-BMI(OR=1.02, 95% CI: 1.00-1.05, P=0.020), and TyG-WHtR(OR=1.13, 95% CI: 1.02-1.25, P=0.020). Sex-stratified analyses showed that in women, BMI(OR=1.03, 95% CI: 1.01-1.06, P=0.020), WHtR(OR=1.18, 95% CI: 1.02-1.36, P=0.020), BRI(OR=1.08, 95% CI: 1.01-1.16, P=0.020), LAP(OR=1.03, 95% CI: 1.01-1.06, P=0.020), CVAI(OR=1.04, 95% CI: 1.01-1.07, P=0.009), TyG-BMI(OR=1.03, 95% CI: 1.01-1.06, P=0.006), TyG-WC(OR=1.10, 95% CI: 1.01-1.19, P=0.02), and TyG-WHtR(OR=1.18, 95% CI: 1.04-1.34, P=0.010) were positively associated with KOA, whereas no significant associations were observed in men(P > 0.05 for all indices). Significant sex interactions were found for WC(P=0.010), CVAI(P=0.002), and TyG-WC(P=0.020). ROC analysis indicated limited diagnostic utility for all indices[BRI(AUC=0.547, 95% CI: 0.526-0.567), TyG-WHtR(AUC=0.544, 95% CI: 0.524-0.564), others ≤0.530].

Conclusions

BMI, BRI, LAP, TyG-BMI, and TyG-WHtR may serve as auxiliary indicators for KOA risk assessment in middle-aged and older women, but their standalone screening value remains modest. Clinical evaluation and integration with other risk factors are recommended for comprehensive risk stratification.

图 1 受试者筛选流程图

KOA(knee osteoarthritis): 膝骨关节炎

Figure 1. Subject screening flowchart

表 1 肥胖代谢指标计算公式及标准化处理

Table 1 Formulas and Standardized Table for Obesity Metabolic Indicators

指标计算公式标准化处理肥胖指标 WC 直接测量[16] WC×10 BMI 体重/身高[17] - WHtR WC/身高[18] WHtR×10 VAI 男性: [WC/(39.68+1.88×BMI)]×(TG/1.03)×(1.31/HDL)[12] VAI×100 女性: [WC/(36.58+1.89×BMI)]×(TG/0.81)×(1.52/HDL)[12] ABSI WC/[BMI(2/3)×身高(1/2)][19] ABSI×100 BRI 364.2-365.5×sqrt〔1-[(WC/(2π)]2/(0.5×身高)2)〕[12] - LAP 男性: (WC-65)×TG[12] LAP /10 女性: (WC-58)×TG[12] CI WC/(0.109×sqrt(体重/身高)[12] CI×10 CVAI 男性: -267.93+0.68×年龄+0.03×BMI+4.00×WC+22.00×log10(TG)-16.32×HDL[20] CVAI/10 女性: -187.32+1.71×年龄+4.32×BMI+1.12×WC+39.76×log10(TG)-11.66×HDL[20] 代谢指标 TyG ln(TG×葡萄糖/2)[12] - TyG-BMI TyG×BMI[18] TyG-BMI /10 TyG-WC TyG×WC[18] - TyG-WHtR TyG×WHtR[18] - WC(waist circumference)：腰围；BMI(body mass index)：体质量指数；WHtR(waist-to-height ratio)：腰高比；VAI(visceral adiposity index)：内脏脂肪指数；ABSI(a body shape index)：体型指数；BRI(body roundness index)：体圆指数；LAP(lipid accumulation product)：脂质积累指数；CI(conicity index)：圆锥指数；CVAI(chinese visceral adiposity index)：中国内脏脂肪指数；HDL(high-density lipoprotein cholesterol)：高密度脂蛋白胆固醇；TyG(triglyceride glucose index)：甘油三酯-葡萄糖指数

表 2 9527名受试者的基线特征比较

Table 2 Comparison of baseline characteristics among 9527 participants

指标无膝骨关节炎
(n=8613) 膝骨关节炎
(n=914) P值年龄(x±s, 岁) 58.97±9.36 60.04±8.67 ＜0.001 性别[n(%)] ＜0.001 女性 4461(51.79) 614(67.18) 男性 4152(48.21) 300(32.82) 受教育程度[n(%)] ＜0.001 高中及以上 939(10.90) 38(4.16) 初中 1818(21.11) 129(14.11) 小学 1950(22.64) 198(21.66) 小学以下 3906(45.35) 549(60.07) 婚姻状况[n(%)] 0.004 其他 986(11.45) 135(14.77) 已婚 7627(88.55) 779(85.23) 居住地[n(%)] ＜0.001 城市 3209(37.26) 220(24.07) 农村 5404(62.74) 694(75.93) 运动状态[n(%)] 0.020 不锻炼 5222(60.63) 539(58.97) 轻度锻炼 888(10.31) 73(7.99) 中度锻炼 1153(13.39) 131(14.33) 重度锻炼 1350(15.67) 171(18.71) 饮酒状态[n(%)] ＜0.001 从不饮酒 4959(57.58) 584(63.89) 过去饮酒 728(8.45) 99(10.83) 现在饮酒 2926(33.97) 231(25.27) 吸烟状态[n(%)] ＜0.001 从不吸烟 5165(59.97) 626(68.49) 过去吸烟 809(9.39) 72(7.88) 现在吸烟 2639(30.64) 216(23.63) 糖尿病[n(%)] ＜0.001 无 8110(94.16) 832(91.03) 有 503(5.84) 82(8.97) 卒中[n(%)] 0.003 无 8417(97.72) 878(96.06) 有 196(2.28) 36(3.94) WC(x±s, cm) 85.03±9.36 84.94±9.88 0.80 BMI(x±s, kg/m2) 23.43±3.28 23.58±3.54 0.230 WHtR(x±s) 0.54±0.06 0.55±0.07 ＜0.001 VAI(x±s) 2.07±1.80 2.29±2.01 0.002 ABSI*(x±s) 0.08±0.01 0.08±0.01 0.049 BRI(x±s) 4.17±1.24 4.38±1.34 ＜0.001 LAP(x±s) 35.87±29.41 39.19±32.20 0.003 CI(x±s) 1.28±0.08 1.29±0.09 0.030 CVAI(x±s) 96.73±36.98 98.71±36.92 0.120 TyG(x±s) 8.66±0.59 8.71±0.60 0.030 TyG-BMI(x±s, kg/m2) 203.53±35.09 205.94±37.86 0.070 TyG-WC(x±s, cm) 738.32±107.73 741.46±113.07 0.420 TyG-WHtR(x±s) 4.67±0.69 4.78±0.74 0.020*ABSI：两组数据分别是0.08278(0.00525)和0.08316(0.00570)；WC、BMI、WHtR、VAI、ABSI、BRI、LAP、CI、CVAI、TyG、TyG-BMI、TyG-WC、TyG-WHtR：见表 1

表 3 13种肥胖及相关代谢指标与膝骨关节炎发病风险的相关性

Table 3 The association between 13 obesity and metabolic indicators and the risk of knee osteoarthritis incidence

指标 OR(95% CI) P值模型1 模型2 模型3 OR(95% CI) P值 OR(95% CI) P值 OR(95% CI) P值肥胖指标 WC 0.99(0.92~1.06) 0.780 1.04(0.97~1.12) 0.270 1.05(0.97~1.13) 0.20 1.03(0.96~1.11) 0.430 BMI 1.01(0.99~1.03) 0.20 1.03(1.004~1.05) 0.020 1.03(1.01~1.05) 0.010 1.02(1.00~1.04) 0.048 WHtR 1.29(1.15~1.44) ＜0.001 1.14(1.02~1.29) 0.030 1.15(1.03~1.30) 0.020 1.13(0.999~1.27) 0.052 VAI 1.06(1.03~1.10) ＜0.001 1.04(1.002~1.08) 0.040 1.04(1.01~1.08) 0.020 1.03(0.997~1.07) 0.070 ABSI 1.15(1.01~1.31) 0.040 0.98(0.86~1.12) 0.770 0.98(0.86~1.12) 0.770 0.98(0.86~1.12) 0.740 BRI 1.14(1.08~1.20) ＜0.001 1.07(1.01~1.14) 0.010 1.08(1.02~1.14) 0.009 1.06(1.01~1.13) 0.030 LAP 1.04(1.01~1.06) 0.001 1.03(1.01~1.05) 0.009 1.03(1.01~1.06) 0.004 1.03(1.00~1.05) 0.020 CI 1.10(1.02~1.20) 0.020 1.02(0.94~1.11) 0.590 1.02(0.94~1.11) 0.590 1.01(0.93~1.10) 0.780 CVAI 1.01(0.996~1.03) 0.120 1.01(0.99~1.04) 0.110 1.02(0.996~1.04) 0.110 1.01(0.99~1.03) 0.290 代谢指标 TyG 1.13(1.01~1.27) 0.030 1.15(1.02~1.29) 0.020 1.16(1.03~1.30) 0.020 1.10(0.98~1.24) 0.110 TyG-BMI 1.02(0.96~1.09) 0.050 1.03(1.01~1.05) 0.004 1.03(1.01~1.05) 0.002 1.02(1.00~1.05) 0.020 TyG-WC 1.03(0.96~1.09) 0.40 1.07(0.99~1.14) 0.051 1.07(1.01~1.15) 0.030 1.05(0.98~1.12) 0.170 TyG-WHtR 1.25(1.13~1.37) ＜0.001 1.16(1.05~1.28) 0.005 1.17(1.06~1.30) 0.003 1.13(1.02~1.25) 0.020 模型1校正年龄、性别、教育程度、婚姻状况和居住地；模型2在模型1的基础上校正了运动状态、饮酒和吸烟状态；模型3在模型2的基础上校正了糖尿病和卒中；WC、BMI、WHtR、VAI、ABSI、BRI、LAP、CI、CVAI、TyG、TyG-BMI、TyG-WC、TyG-WHtR：同表 1

表 4 不同性别13种肥胖及相关代谢指标与膝骨关节炎的相关性分析[OR(95% CI)]

Table 4 Associations between 13 obesity and metabolic indicators and knee osteoarthritis across different sexes[OR(95% CI)]

指标男性(n=4452) 女性(n=5075) P值肥胖指标 WC 0.92(0.80~1.05) 1.09(0.99~1.19) 0.010 BMI 0.99(0.96~1.04) 1.03(1.01~1.06)* 0.130 WHtR 1.02(0.81~1.28) 1.18(1.02~1.36)* 0.130 VAI 1.02(0.94~1.11) 1.04(0.99~1.08) 0.580 ABSI 0.88(0.68~1.14) 1.02(0.87~1.20) 0.160 BRI 1.02(0.9~1.14) 1.08(1.01~1.16)* 0.150 LAP 1.01(0.96~1.06) 1.03(1.01~1.06)* 0.220 CI 0.93(0.79~1.09) 1.05(0.95~1.16) 0.070 CVAI 0.98(0.95~1.01) 1.04(1.01~1.07)* 0.002 代谢指标 TyG 1.01(0.82~1.24) 1.15(0.99~1.34) 0.170 TyG-BMI 1.00(0.97~1.04) 1.03(1.01~1.06)* 0.090 TyG-WC 0.95(0.85~1.08) 1.10(1.01~1.19)* 0.020 TyG-WHtR 1.03(0.85~1.25) 1.18(1.04~1.34)* 0.10 模型校正了年龄、性别、教育程度、婚姻状况、居住地、运动状态、饮酒和吸烟状态、糖尿病和卒中等协变量；* P＜0.05；P值为多因素Logistic回归模型中交互项(指标×性别)系数的Wald检验结果

表 5 部分肥胖及相关代谢指标对膝骨关节炎的诊断效能评估

Table 5 ROC curve analysis results of obesity and related metabolic indicators for knee osteoarthritis prediction

指标 AUC(95% CI) 最佳
截断值敏感度
(%) 特异度
(%) BRI 0.547(0.526~0.567) 4.392 48.5 59.9 TyG-WHtR 0.544(0.524~0.564) 4.602 58.3 48.9 LAP 0.530(0.510~0.550) 4.079 36.9 68.8 TyG-BMI 0.515(0.495~0.535) 20.847 44.7 58.9 BMI 0.510(0.489~0.531) 24.879 35.7 68.4 AUC(area under the curve)：曲线下面积；BRI、TyG-WHtR、LAP、TyG-BMI、BMI：同表 1 [1]

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