相对脂肪量指数与糖尿病或糖尿病前期患者全因死亡率和心血管疾病死亡率的关系

doi:10.6040/j.issn.1671-7554.0.2025.0820

摘要/Abstract

摘要： 目的探究糖尿病或糖尿病前期患者中相对脂肪量(relative fat mass, RFM)指数与全因死亡率及心血管疾病死亡率之间的关联。方法纳入来自美国国家健康与营养检查调查(National Health and Nutrition Examination Survey, NHANES)数据库(1999—2018年)的11 852例糖尿病或糖尿病前期患者。将研究对象按RFM指数四分位数分为Q1(9.63~29.75)、Q2(29.75~35.54)、Q3(35.54~44.05)、Q4(44.05~58.41)四组。应用多因素Cox比例风险回归模型,将RFM指数分别作为连续变量和分类变量纳入分析,探究其对全因死亡率和心血管疾病死亡率的影响。采用限制性立方样条分析与阈值效应分析探究潜在非线性关系,并进行亚组分析和敏感性分析。结果在平均103.94个月的随访期间,11 852例糖尿病及糖尿病前期患者中,发生全因死亡2 039例(17.20%)、心血管死亡661例(5.58%)。在完全调整模型中,当RFM指数作为连续变量分析时,RFM指数每增加一个单位,全因死亡风险增加1.6%(HR=1.016, 95% CI: 1.002~1.030, P=0.029),心血管死亡风险增加3.6%(HR=1.036, 95% CI: 1.007~1.066, P=0.005)。当RFM指数作为分类变量分析时,与Q1组相比,在Q3组和Q4组中,全因死亡风险分别增加58.8%(HR=1.588, 95% CI: 1.286~1.961, P<0.001)及61.3%(HR=1.613, 95% CI: 1.229~2.116, P=0.001);心血管死亡风险分别增加79.8%(HR=1.798, 95% CI: 1.238~2.610, P=0.002)及124.8%(HR=2.248, 95% CI: 1.355~3.729, P=0.002)。绘制限制性立方样条后发现,RFM指数与全因死亡率之间呈现非线性U型曲线,而心血管疾病死亡率则随RFM指数的增加而呈线性上升趋势。亚组分析结果显示受教育程度对RFM指数与全因死亡率及心血管疾病死亡率的关联均具有显著的效应修饰作用。敏感性分析结果与主分析结果一致。结论在糖尿病或糖尿病前期患者中,RFM指数与全因死亡率及心血管疾病死亡率的增加有关。

关键词: 相对脂肪量指数, NHANES, 糖尿病, 糖尿病前期, 死亡率

Abstract: Objective To investigate the association between the relative fat mass(RFM)index and all-cause mortality as well as cardiovascular mortality in patients with diabetes or prediabetes. Methods A total of 11,852 patients with diabetes or prediabetes from the American National Health and Nutrition Examination Survey(NHANES)database(1999-2018)were included. The study participants were divided into four groups according to the quartiles of the RFM index: Q1(9.63-29.75), Q2(29.75-35.54), Q3(35.54-44.05), and Q4(44.05-58.41). Multivariable Cox proportional hazards regression models were applied to evaluate the associations of RFM index, treated both as a continuous variable and as a categorical variable, with all-cause mortality and cardiovascular mortality. Restricted cubic spline and threshold effect analyses were applied to explore potential nonlinear relationships. Additionally, subgroup and sensitivity analyses were conducted. Results During a mean follow-up of 103.94 months, a total of 2,039 all-cause deaths(17.20%)and 661 cardiovascular deaths(5.58%)occurred among the 11,852 participants with diabetes or prediabetes. In the fully adjusted model, when RFM index was analyzed as a continuous variable, each unit increase in RFM index was associated with a 1.6% increase in all-cause mortality risk(HR=1.016, 95%CI: 1.002-1.030, P=0.029)and a 3.6% increase in cardiovascular mortality risk(HR=1.036, 95%CI: 1.007-1.066, P=0.005). When the RFM index was analyzed as a categorical variable, compared to the Q1 group, the Q3 and Q4 groups showed a 58.8%(HR=1.588, 95%CI: 1.286-1.961, P<0.001)and 61.3%(HR=1.613, 95%CI: 1.229-2.116, P=0.001)increase in all-cause mortality risk, respectively, and a 79.8%(HR=1.798, 95%CI: 1.238-2.610, P=0.002)and 124.8%(HR=2.248, 95%CI: 1.355-3.729, P=0.002)increase in cardiovascular mortality risk, respectively. Restricted cubic spline analysis revealed a nonlinear U-shaped curve between RFM index and all-cause mortality, while cardiovascular mortality showed a linear increasing trend with higher RFM index. Subgroup analysis indicated that education level significantly modified the associations of RFM index with both all-cause and cardiovascular mortality. Sensitivity analyses yielded results consistent with the main findings. Conclusion In patients with diabetes or prediabetes, a higher RFM index is associated with increased risks of both cardiovascular mortality and all-cause mortality.

Key words: Relative fat mass index, National Health and Nutrition Examination Survey, NHANES, Diabetes, Prediabetes, Mortality

中图分类号:

R587.1

李爱婧,韦茂英,吴婵,郭景宜,孙安宁,顾鑫,龚燕冰. 相对脂肪量指数与糖尿病或糖尿病前期患者全因死亡率和心血管疾病死亡率的关系[J]. 山东大学学报 (医学版), 2026, 64(9): 68-77.

LI Aijing, WEI Maoying, WU Chan, GUO Jingyi, SUN Anning, GU Xin, GONG Yanbing. Association between relative fat mass index and all-cause mortality and cardiovascular mortality among individuals with diabetes and prediabetes[J]. Journal of Shandong University (Health Sciences), 2026, 64(9): 68-77.

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