2026 年第 9 期 第 21 卷

脂肪分布与2型糖尿病患者颈动脉内膜中层增厚的关系研究

Study on the relationship between fat distribution and carotid intima-media thickening in patients with type 2 diabetes mellitus

作者：王琪1盛佳曦1王亚坤1阚芳芳1吴乃君1齐亚娟2

英文作者：Wang Qi1 Sheng Jiaxi1 Wang Yakun1 Kan Fangfang1 Wu Naijun1 Qi Yajuan2

单位：1华北理工大学附属医院内分泌与代谢病科，唐山063210；2华北理工大学基础医学院，唐山063210

英文单位：1Department of Endocrinology and Metabolism North China University of Science and Technology Affiliated Hospital Tangshan 063210 China; 2School of Basic Medicine North China University of Science and Technology Tangshan 063210 China

关键词：2型糖尿病；颈动脉内膜中层厚度；脂肪分布；内脏脂肪面积；全身免疫炎症指数

英文关键词：Type2diabetesmellitus;Carotidintima-mediathickness;Fatdistribution;Visceralfatarea;Systemicimmune-inflammationindex

• 摘要：

• 目的 探讨脂肪分布和炎症反应与2型糖尿病（T2DM）患者颈动脉内膜中层厚度（CIMT）增厚的关系。方法 选取2023年9月至2024年9月于华北理工大学附属医院内分泌与代谢病科住院的474例T2DM患者作为研究对象。根据CIMT测量值将患者分为对照组（122例，CIMT<1.0 mm）和观察组（352例，CIMT≥1.0 mm）。收集所有患者的一般临床资料，使用生物电阻抗法测量脂肪分布参数，并计算全身免疫炎症指数（SII）。采用单因素及多因素Logistic回归分析CIMT增厚的独立危险因素，利用受试者工作特征（ROC）曲线评估各指标的预测效能，并应用Bootstrap法（重复抽样5 000次）检验SII在脂肪分布与CIMT增厚关系中的中介效应。结果 2组患者年龄、高血压病、冠状动脉粥样硬化性心脏病、降压药、降脂药使用比例、收缩压、舒张压、体重指数、腰臀比、内脏脂肪面积(VFA)、体脂率、躯干脂肪百分比、上肢脂肪百分比、下肢脂肪百分比、低密度脂蛋白胆固醇、SII比较，差异均有统计学意义（均P＜0.05）。多因素Logistic回归分析显示年龄［比值比（OR）=1.077，95%置信区间（CI）:1.048~1.107,P<0.001］、低密度脂蛋白胆固醇（OR=1.501，95%CI=1.141~1.976，P=0.004）、躯干脂肪百分比（OR=1.176，95%CI=1.018~1.358，P=0.027）、VFA（OR=1.034，95%CI=1.014~1.054，P<0.001）、SII（OR=1.002，95%CI=1.000~1.003，P=0.014）是CIMT增厚的独立危险因素。中介效应分析提示，SII在VFA与CIMT增厚的关系中起部分中介作用，中介效应值占总效应的6.5%。ROC曲线分析显示VFA、SII、躯干脂肪百分比、VFA联合SII的曲线下面积分别为0.695、0.579、0.620、0.707，VFA联合SII预测效能优于各单一指标。结论 VFA、躯干脂肪百分比和SII是T2DM患者发生CIMT增厚的独立危险因素，SII部分介导了VFA对CIMT的不利影响。

• Objective To investigate the relationship between fat distribution, inflammatory response and carotid intima-media thickness (CIMT) thickening in patients with type 2 diabetes mellitus (T2DM). Methods A total of 474 T2DM patients hospitalized in the Department of Endocrinology and Metabolism, North China University of Science and Technology Affiliated Hospital from September 2023 to September 2024 were enrolled. According to CIMT measurements, patients were divided into control group (122 cases, CIMT<1.0 mm) and observation group (352 cases, CIMT≥1.0 mm). General clinical data were collected, fat distribution parameters were measured by bioelectrical impedance analysis, and systemic immune-inflammation index (SII) was calculated. Univariate and multivariate Logistic regression analyses were used to identify independent risk factors for CIMT thickening. Receiver operating characteristic (ROC) curve was applied to evaluate the predictive efficacy of each indicator, and Bootstrap method (5 000 resamplings) was used to test the mediating effect of SII in the relationship between fat distribution and CIMT thickening. Results There were significant differences between the two groups in age, hypertension, coronary atherosclerotic heart disease, usage rates of antihypertensive drugs and lipid-lowering drugs, systolic blood pressure, diastolic blood pressure, body mass index, waist-to-hip ratio, visceral fat area (VFA), body fat percentage, trunk fat percentage, upper limb fat percentage, lower limb fat percentage, low-density lipoprotein cholesterol and SII (all P<0.05). Multivariate Logistic regression analysis showed that age ［odds ratio (OR)=1.077, 95% confidence interval (CI): 1.048-1.107, P<0.001］, low-density lipoprotein cholesterol (OR=1.501, 95%CI: 1.141-1.976, P=0.004), trunk fat percentage (OR=1.176, 95%CI: 1.018-1.358, P=0.027), VFA (OR=1.034, 95%CI: 1.014-1.054, P<0.001) and SII (OR=1.002, 95%CI: 1.000-1.003, P=0.014) were independent risk factors for CIMT thickening. Mediation effect analysis indicated that SII played a partial mediating role in the relationship between VFA and CIMT thickening, with the mediating effect accounting for 6.5% of the total effect. ROC curve analysis showed that the areas under the curve of VFA, SII, trunk fat percentage, and VFA combined with SII were 0.695, 0.579, 0.620 and 0.707, respectively, and the predictive efficacy of VFA combined with SII was superior to that of each single indicator. Conclusion VFA, trunk fat percentage and SII are independent risk factors for CIMT thickening in T2DM patients, and SII partially mediates the adverse effect of VFA on CIMT.