身体圆度指数与2型糖尿病患者颈动脉内膜增厚的相关性分析

doi:10.3969/j.issn.1004-583X.2025.10.008

摘要/Abstract

摘要：

目的本研究旨在探讨身体圆度指数(body roundness Index, BRI)与2型糖尿病患者颈动脉内膜增厚(endothelial thickening of carotid artery, cIMT)之间的相关性,并评估BRI作为预测指标的有效性。方法本研究为回顾性分析,纳入2018年1月-2024年12月期间来自沧州市人民医院的1136例2型糖尿病患者。通过多因素logistic回归分析评估BRI与cIMT之间的关系,此外并采用广义加性模型拟合平滑曲线,观察BRI与cIMT之间存在的关系。使用受试者工作特征(ROC)曲线评估BRI的预测效能,并与传统肥胖指标身体质量指数(body mass index, BMI)的预测价值进行比较。此外,进行亚组分析。探讨BRI在不同人群中与2型糖尿病患者颈动脉内膜增厚的相关性。结果共有608例患者出现cIMT。BRI四分位数分组后,随着BRI的增加,cIMT的发生率显著上升(P<0.01)。调整混杂因素后,多因素logistic回归分析结果显示,BRI是2型糖尿病患者cIMT的独立危险因素(OR=1.35,95%CI:1.11~1.65,P=0.003);以BRI最低四分位数(Q1)作为参照组相比,BRI为第二、三、四分位数的患者发生cIMT的风险分别增加了1.23倍(OR=2.23,95%CI: 1.53~3.24,P<0.01)、2.44倍(OR=3.44,95%CI: 2.17~5.44,P<0.01)和2.96倍(OR=3.96,95%CI: 2.03~7.42,P<0.01)。ROC曲线分析显示,BRI预测cIMT的曲线下面积为0.70,敏感度和特异度分别为74.20%和61.70%。同时,BRI预测价值明显高于BMI(Z=2.398,P=0.017)。亚组分析显示,BRI与糖尿病病程之间存在显著交互作用(交互P<0.05)。结论 BRI是2型糖尿病患者cIMT的有效预测指标,有助于识别高风险患者并指导早期干预。

关键词: 糖尿病, 2型, 身体圆度指数, 颈动脉疾病, 颈动脉内中膜厚度

Abstract:

Objective To investigate the association between the body roundness index (BRI) and carotid intima-media thickness (cIMT) in patients with type 2 diabetes mellitus (T2DM), and to evaluate the predictive value of BRI. Methods This retrospective study included 1, 136 patients with T2DM treated at Cangzhou People's Hospital between January 2018 and December 2024. Multivariable logistic regression was used to examine the association between BRI and cIMT. A generalized additive model (GAM) was employed to fit smooth curves and visualize the exposure-response relationship. Predictive performance was evaluated using receiver operating characteristic (ROC) curve and compared with body mass index (BMI). Subgroup analysis was used to evaluate the correlation between BRI and cIMT in T2DM patients in different populations. Results Overall, 608 patients met criteria for cIMT thickening. Across BRI quartiles, the incidence of cIMT increased significantly with higher BRI (P<0.01). After adjustment for potential confounders, multivariate logistic regression analysis showed that BRI remained an independent risk factor for cIMT (OR=1.35; 95%CI: 1.11-1.65; P=0.003). Compared with the lowest quartile (Q1), adjusted odds ratios for Q2, Q3, and Q4 were 2.23(95%CI: 1.53-3.24; P<0.01), 3.44(95%CI: 2.17-5.44; P<0.01), and 3.96(95%CI: 2.03-7.42; P<0.01), respectively. ROC curve analysis showed that the area under the curve (AUC) for BRI in predicting cIMT was 0.70, with sensitivity and specificity of 74.2% and 61.7%, respectively, and BRI outperformed BMI (Z=2.398; P=0.017). Subgroup analysis showed significant interactions with diabetes duration (interaction P<0.05). Conclusion BRI is an effective predictor of cIMT in T2DM patients, which helps to identify high-risk patients and guide early intervention.

Key words: type 2 diabetes mellitus, body roundness index, carotid artery disease, carotid intima-media thickness

中图分类号:

R587.1

杨晓东, 于骁, 马瑞雪, 佟玺, 刘建凤. 身体圆度指数与2型糖尿病患者颈动脉内膜增厚的相关性分析[J]. 临床荟萃, 2025, 40(10): 923-929.

Yang Xiaodong, Yu Xiao, Ma Ruixue, Tong Xi, Liu Jianfeng. Association between the body roundness index and carotid intima-media thickness in patients with type 2 diabetes mellitus[J]. Clinical Focus, 2025, 40(10): 923-929.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2025.10.008

https://www.lchc.cn/CN/Y2025/V40/I10/923

图/表 6

参考文献 25

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项目	总体	Q1(<3.19)	Q2(3.19~3.90)	Q3(3.90~4.76)	Q4(>4.76)	P值
例数	1136	284	284	284	284
年龄(岁)	53.00(44.00~61.00)	51.00(43.00~59.00)	50.00(41.00~58.00)	52.00(42.50~59.50)	57.00(51.00~66.00)	<0.01
性别[例(%)]
女男	428(37.7) 708(62.3)	0 284(100.0)	0 284(100.0)	144(50.7) 140(49.3)	284(100.0) 0	<0.01
冠心病[例(%)]
无有	958(84.3) 178(15.7)	244(85.9) 40(14.1)	254(89.4) 30(10.6)	227(79.9) 57(20.1)	233(82.0) 51(18.0)	0.010
高血压[例(%)]
无有	613(54.0) 523(46.0)	193(68.0) 91(32.0)	145(51.1) 139(48.9)	152(53.5) 132(46.5)	123(43.3) 161(56.7)	<0.01
慢性肾脏病[例(%)]
无有	850(74.8) 286(25.2)	224(78.9) 60(21.1)	197(69.4) 87(30.6)	213(75.0) 71(25.0)	216(76.1) 68(23.9)	0.066
脂肪肝[例(%)]
无有	582(51.2) 554(48.8)	167(58.8) 117(41.2)	129(45.4) 155(54.6)	140(49.3) 144(50.7)	146(51.4) 138(48.6)	0.013
脑卒中[例(%)]
无有	773(68.1) 363(32.0)	193(68.0) 91(32.0)	182(64.1) 102(35.9)	202(71.1) 82(28.9)	196(69.0) 88(31.0)	0.332
饮酒史[例(%)]
无有	877(77.2) 259(22.8)	191(67.3) 93(32.8)	193(68.0) 91(32.0)	225(79.2) 59(20.8)	268(94.4) 16(5.6)	<0.01
吸烟史[例(%)]
无有	916(80.6) 220(19.4)	215(75.7) 69(24.3)	196(69.0) 88(31.0)	227(79.9) 57(20.1)	278(97.9) 6(2.1)	<0.01
cIMT[例(%)]
无有	528(46.5) 608(53.5)	204(71.8) 80(28.2)	155(54.4) 130(45.6)	102(35.9) 182(64.1)	67(23.7) 216(76.3)	<0.01
T2DM病程[例(%)]
<1年	222(19.5)	93(32.7)	56(19.6)	41(14.4)	32(11.3)
1~5年	267(23.5)	116(40.8)	68(23.9)	59(20.8)	24(8.5)	<0.01
5~10年	225(19.8)	50(17.6)	67(23.5)	67(23.6)	41(14.5)
≥10年	422(37.1)	25(8.8)	94(33.0)	117(41.2)	186(65.7)
ALB(g/L)	44.00(41.60~46.45)	44.00(41.40~46.40)	44.00(41.85~46.25)	43.95(41.60~46.65)	43.90(41.55~46.50)	0.936
TBiL(μmol/L)	11.60(8.50~15.40)	12.00(8.92~15.74)	12.20(9.25~16.15)	11.40(8.10~15.71)	10.45(8.00~13.80)	<0.01
ALT(U/L)	20.00(14.00~31.00)	18.00(13.00~26.00)	18.00(14.00~30.00)	21.55(15.00~38.00)	21.00(14.00~35.00)	<0.01
AST(U/L)	17.00(14.00~23.70)	16.00(13.00~21.00)	16.00(14.00~22.50)	18.00(14.00~26.00)	18.00(14.00~25.00)	0.002
UREA(mmol/L)	5.30(4.30~6.25)	5.30(4.50~6.20)	5.30(4.40~6.30)	5.10(4.20~6.00)	5.30(4.30~6.60)	0.216
SCr(μmol/L)	63.00(53.00~72.25)	64.00(53.00~73.50)	65.00(55.50~74.00)	61.00(51.00~70.00)	63.00(52.00~71.50)	0.008
SUA(μmol/L)	296.00(244.00~365.00)	308.00(257.00~368.00)	289.50(225.50~363.50)	285.00(239.00~360.00)	300.00(254.00~372.00)	0.065
TC(mg/dl)	182.14(154.68~213.66)	191.42(158.74~221.78)	178.27(153.33~209.01)	178.66(152.17~209.59)	180.40(156.81~213.27)	0.041
TG(mg/dl)	154.07(99.62~240.40)	153.19(97.84~239.07)	133.26(88.55~208.09)	167.80(102.27~252.35)	173.55(110.24~269.18)	<0.01
HDL-C(mg/dl)	40.22(34.03~48.34)	40.22(34.03~51.43)	40.99(34.80~50.27)	40.03(34.03~46.79)	39.44(33.07~46.79)	0.235
LDL-C(mg/dl)	106.73(80.63~133.41)	115.05(83.34~142.89)	103.25(81.21~128.38)	106.15(79.27~132.06)	105.96(79.47~130.71)	0.074
FBG(mg/dl)	160.92(127.40~221.65)	172.99(133.08~234.80)	153.17(120.37~213.00)	160.38(125.60~213.00)	164.52(131.28~225.25)	0.007
FINS(μU/ml)	9.30(5.55~14.70)	8.50(4.50~14.15)	9.15(5.30~12.70)	9.15(5.80~15.00)	10.55(6.50~16.85)	0.002
CP(ng/ml)	2.42(1.66~3.31)	2.25(1.42~3.13)	2.44(1.68~3.14)	2.52(1.74~3.35)	2.58(1.79~3.51)	0.017
HbA₁c(%)	8.50(7.20~10.20)	8.65(7.25~10.55)	8.50(7.00~10.10)	8.40(7.30~10.10)	8.60(7.20~10.55)	0.261
WBC(×10⁹/L)	6.22(5.26~7.46)	6.11(5.21~7.31)	6.13(5.15~7.26)	6.07(5.01~7.27)	6.70(5.64~8.19)	<0.01
RBC(×10¹²/L)	4.50(4.84~4.84)	4.87(4.52~5.24)	4.83(4.52~5.18)	4.81(4.49~5.19)	4.87(4.50~5.25)	0.663
HGB(g/L)	147.00(135.00~157.00)	148.50(136.00~158.00)	148.00(137.00~157.00)	146.00(134.25~156.75)	146.00(134.00~156.00)	0.313
MONO#(×10⁹/L)	0.36(0.29~0.44)	0.36(0.30~0.45)	0.35(0.27~0.43)	0.36(0.29~0.44)	0.37(0.31~0.45)	0.071
LYM#(×10⁹/L)	1.88(1.50~2.32)	1.90(1.45~2.29)	1.78(1.43~2.22)	1.84(1.53~2.36)	2.00(1.63~2.40)	<0.01
ANC(×10⁹/L)	3.83(2.99~4.70)	3.79(2.89~4.60)	3.83(2.98~4.56)	3.60(2.86~4.65)	4.15(3.28~5.03)	<0.01
CRP(mg/L)	3.76(1.07~19.70)	3.17(8.92~78.58)	6.92(2.63~26.34)	2.88(1.23~6.86)	0.68(0.44~1.35)	<0.01
GFR(ml/min)	111.09(88.67~135.20)	109.00(87.74~132.46)	103.91(84.55~125.97)	112.94(91.63~139.07)	118.91(94.59~144.78)	<0.01
BMI(kg/m²)	26.97(24.88~29.44)	25.32(23.50~27.82)	26.24(24.49~28.18)	27.17(25.35~29.41)	29.45(26.83~32.81)	<0.01

项目	总体	Q1(<3.19)	Q2(3.19~3.90)	Q3(3.90~4.76)	Q4(>4.76)	P值
例数	1136	284	284	284	284
年龄(岁)	53.00(44.00~61.00)	51.00(43.00~59.00)	50.00(41.00~58.00)	52.00(42.50~59.50)	57.00(51.00~66.00)	<0.01
性别[例(%)]
女男	428(37.7) 708(62.3)	0 284(100.0)	0 284(100.0)	144(50.7) 140(49.3)	284(100.0) 0	<0.01
冠心病[例(%)]
无有	958(84.3) 178(15.7)	244(85.9) 40(14.1)	254(89.4) 30(10.6)	227(79.9) 57(20.1)	233(82.0) 51(18.0)	0.010
高血压[例(%)]
无有	613(54.0) 523(46.0)	193(68.0) 91(32.0)	145(51.1) 139(48.9)	152(53.5) 132(46.5)	123(43.3) 161(56.7)	<0.01
慢性肾脏病[例(%)]
无有	850(74.8) 286(25.2)	224(78.9) 60(21.1)	197(69.4) 87(30.6)	213(75.0) 71(25.0)	216(76.1) 68(23.9)	0.066
脂肪肝[例(%)]
无有	582(51.2) 554(48.8)	167(58.8) 117(41.2)	129(45.4) 155(54.6)	140(49.3) 144(50.7)	146(51.4) 138(48.6)	0.013
脑卒中[例(%)]
无有	773(68.1) 363(32.0)	193(68.0) 91(32.0)	182(64.1) 102(35.9)	202(71.1) 82(28.9)	196(69.0) 88(31.0)	0.332
饮酒史[例(%)]
无有	877(77.2) 259(22.8)	191(67.3) 93(32.8)	193(68.0) 91(32.0)	225(79.2) 59(20.8)	268(94.4) 16(5.6)	<0.01
吸烟史[例(%)]
无有	916(80.6) 220(19.4)	215(75.7) 69(24.3)	196(69.0) 88(31.0)	227(79.9) 57(20.1)	278(97.9) 6(2.1)	<0.01
cIMT[例(%)]
无有	528(46.5) 608(53.5)	204(71.8) 80(28.2)	155(54.4) 130(45.6)	102(35.9) 182(64.1)	67(23.7) 216(76.3)	<0.01
T2DM病程[例(%)]
<1年	222(19.5)	93(32.7)	56(19.6)	41(14.4)	32(11.3)
1~5年	267(23.5)	116(40.8)	68(23.9)	59(20.8)	24(8.5)	<0.01
5~10年	225(19.8)	50(17.6)	67(23.5)	67(23.6)	41(14.5)
≥10年	422(37.1)	25(8.8)	94(33.0)	117(41.2)	186(65.7)
ALB(g/L)	44.00(41.60~46.45)	44.00(41.40~46.40)	44.00(41.85~46.25)	43.95(41.60~46.65)	43.90(41.55~46.50)	0.936
TBiL(μmol/L)	11.60(8.50~15.40)	12.00(8.92~15.74)	12.20(9.25~16.15)	11.40(8.10~15.71)	10.45(8.00~13.80)	<0.01
ALT(U/L)	20.00(14.00~31.00)	18.00(13.00~26.00)	18.00(14.00~30.00)	21.55(15.00~38.00)	21.00(14.00~35.00)	<0.01
AST(U/L)	17.00(14.00~23.70)	16.00(13.00~21.00)	16.00(14.00~22.50)	18.00(14.00~26.00)	18.00(14.00~25.00)	0.002
UREA(mmol/L)	5.30(4.30~6.25)	5.30(4.50~6.20)	5.30(4.40~6.30)	5.10(4.20~6.00)	5.30(4.30~6.60)	0.216
SCr(μmol/L)	63.00(53.00~72.25)	64.00(53.00~73.50)	65.00(55.50~74.00)	61.00(51.00~70.00)	63.00(52.00~71.50)	0.008
SUA(μmol/L)	296.00(244.00~365.00)	308.00(257.00~368.00)	289.50(225.50~363.50)	285.00(239.00~360.00)	300.00(254.00~372.00)	0.065
TC(mg/dl)	182.14(154.68~213.66)	191.42(158.74~221.78)	178.27(153.33~209.01)	178.66(152.17~209.59)	180.40(156.81~213.27)	0.041
TG(mg/dl)	154.07(99.62~240.40)	153.19(97.84~239.07)	133.26(88.55~208.09)	167.80(102.27~252.35)	173.55(110.24~269.18)	<0.01
HDL-C(mg/dl)	40.22(34.03~48.34)	40.22(34.03~51.43)	40.99(34.80~50.27)	40.03(34.03~46.79)	39.44(33.07~46.79)	0.235
LDL-C(mg/dl)	106.73(80.63~133.41)	115.05(83.34~142.89)	103.25(81.21~128.38)	106.15(79.27~132.06)	105.96(79.47~130.71)	0.074
FBG(mg/dl)	160.92(127.40~221.65)	172.99(133.08~234.80)	153.17(120.37~213.00)	160.38(125.60~213.00)	164.52(131.28~225.25)	0.007
FINS(μU/ml)	9.30(5.55~14.70)	8.50(4.50~14.15)	9.15(5.30~12.70)	9.15(5.80~15.00)	10.55(6.50~16.85)	0.002
CP(ng/ml)	2.42(1.66~3.31)	2.25(1.42~3.13)	2.44(1.68~3.14)	2.52(1.74~3.35)	2.58(1.79~3.51)	0.017
HbA₁c(%)	8.50(7.20~10.20)	8.65(7.25~10.55)	8.50(7.00~10.10)	8.40(7.30~10.10)	8.60(7.20~10.55)	0.261
WBC(×10⁹/L)	6.22(5.26~7.46)	6.11(5.21~7.31)	6.13(5.15~7.26)	6.07(5.01~7.27)	6.70(5.64~8.19)	<0.01
RBC(×10¹²/L)	4.50(4.84~4.84)	4.87(4.52~5.24)	4.83(4.52~5.18)	4.81(4.49~5.19)	4.87(4.50~5.25)	0.663
HGB(g/L)	147.00(135.00~157.00)	148.50(136.00~158.00)	148.00(137.00~157.00)	146.00(134.25~156.75)	146.00(134.00~156.00)	0.313
MONO#(×10⁹/L)	0.36(0.29~0.44)	0.36(0.30~0.45)	0.35(0.27~0.43)	0.36(0.29~0.44)	0.37(0.31~0.45)	0.071
LYM#(×10⁹/L)	1.88(1.50~2.32)	1.90(1.45~2.29)	1.78(1.43~2.22)	1.84(1.53~2.36)	2.00(1.63~2.40)	<0.01
ANC(×10⁹/L)	3.83(2.99~4.70)	3.79(2.89~4.60)	3.83(2.98~4.56)	3.60(2.86~4.65)	4.15(3.28~5.03)	<0.01
CRP(mg/L)	3.76(1.07~19.70)	3.17(8.92~78.58)	6.92(2.63~26.34)	2.88(1.23~6.86)	0.68(0.44~1.35)	<0.01
GFR(ml/min)	111.09(88.67~135.20)	109.00(87.74~132.46)	103.91(84.55~125.97)	112.94(91.63~139.07)	118.91(94.59~144.78)	<0.01
BMI(kg/m²)	26.97(24.88~29.44)	25.32(23.50~27.82)	26.24(24.49~28.18)	27.17(25.35~29.41)	29.45(26.83~32.81)	<0.01

变量	模型1		模型2
变量	OR值(95%CI)	P值	OR值(95%CI)	P值
BRI	1.37(1.12~1.67)	0.002	1.35(1.11~1.65)	0.003
BRI四分位分组
Q1	1.00(参照组)	-	1.00(参照组)	-
Q2	2.34(1.61~3.38)	<0.01	2.23(1.53~3.24)	<0.01
Q3	3.48(2.21~5.50)	<0.01	3.44(2.17~5.44)	<0.01
Q4	4.16(2.13~8.13)	<0.01	3.96(2.03~7.42)	<0.01

变量	模型1		模型2
变量	OR值(95%CI)	P值	OR值(95%CI)	P值
BRI	1.37(1.12~1.67)	0.002	1.35(1.11~1.65)	0.003
BRI四分位分组
Q1	1.00(参照组)	-	1.00(参照组)	-
Q2	2.34(1.61~3.38)	<0.01	2.23(1.53~3.24)	<0.01
Q3	3.48(2.21~5.50)	<0.01	3.44(2.17~5.44)	<0.01
Q4	4.16(2.13~8.13)	<0.01	3.96(2.03~7.42)	<0.01

项目	AUC	标准误	P值	95%CI		敏感度	特异度	界值
项目	AUC	标准误	P值	下限	上限	敏感度	特异度	界值
BMI	0.66	0.0161	<0.01	0.63	0.68	82.40%	39.60%	25.155
BRI	0.70	0.0157	<0.01	0.67	0.73	74.20%	61.70%	3.700