| 姚 磊,张 也,冯 祥,等.基于江苏省扬中市胃镜筛查人群的新型肥胖相关指标与胃部疾病的关联性分析[J].肿瘤学杂志,2026,32(8):667-676. |
| 基于江苏省扬中市胃镜筛查人群的新型肥胖相关指标与胃部疾病的关联性分析 |
| Association Between Novel Obesity-Related Indices and Gastric Diseases in a Gastroscopy Screening Population in Yangzhong City， Jiangsu Province |
| 投稿时间：2026-03-03 |
| DOI：10.11735/j.issn.1671-170X.2026.08.B006 |
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| 中文关键词: 肥胖 新型肥胖相关指标 胃肿瘤 胃炎 上皮内瘤变 筛查 |
| 英文关键词:obesity novel obesity-related indices gastric neoplasms gastritis intraepithelial neoplasia screening |
| 基金项目:江苏省预防医学课题面上项目 （YM2023031） |
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| 中文摘要: |
| 摘 要：［目的］ 分析5种新型肥胖相关指标（novel obesity-related indices，NORI）与胃部疾病的关联。［方法］ 基于扬中市的上消化道癌人群筛查及食管癌专病队列基线数据（分别于2006年和2017年启动），2017年11月至2022年12月，共有10 698名居民完成了筛查登记，最终纳入分析9 243名数据完整的参与者（中位年龄55.00岁）。采用无序多分类Logistic回归模型，分别探讨脂质蓄积指数（lipid accumulation product，LAP）、内脏脂肪指数（visceral adiposity index，VAI）、中国内脏脂肪指数（Chinese visceral adiposity index，CVAI）、腰部甘油三酯指数（waist triglyceride index，WTI）和心脏代谢指数（cardiometabolic index，CMI）与胃癌、癌前病变（高级别/低级别上皮内瘤变）及癌前疾病（萎缩性胃炎/肠上皮化生）的独立关联。［结果］ 9 243名研究对象中，经病理确诊的胃癌、癌前病变、癌前疾病患病率分别为0.48%、1.95%和36.59%。无序多分类Logistic回归分析结果显示，在整体人群中，与LAP和CVAI的第1四分位组（1st quartile group，Q1）人群相比，LAP和CVAI的第4四分位组（4th quartile group，Q4）人群患癌前疾病的风险分别降低13.6%［比值比（odds ratio，OR）=0.864，95%置信区间（confidence interval，CI）：0.761~0.981］和16.1%（OR=0.839，95%CI：0.736~0.957）。同时，LAP、VAI、CVAI和CMI每增加一个标准差，癌前疾病的风险分别降低5.1%［OR=0.949，95%CI：0.905~0.994、5.1%（OR=0.949，95%CI：0.904~0.995）、6.2%（OR=0.938，95%CI：0.896~0.983）和4.9%（OR=0.951，95%CI：0.906~0.998）］。未发现WTI与胃部疾病存在显著关联（P均＞0.05）。然而，与CMI的Q1人群相比，CMI的Q4人群患胃癌的风险显著升高（OR=3.262，95%CI：1.133~9.397）。分层分析显示，VAI和CVAI仅是非贲门部位癌前疾病的显著保护因素（P均<0.05），CMI仅是贲门部位胃癌的显著危险因素（P<0.05）。［结论］ 在扬中市40~69岁筛查人群中，LAP、VAI、CVAI及CMI水平升高与癌前疾病风险降低独立相关，但CMI水平过高会增加胃癌风险，且不同NORI对胃部疾病的影响存在部位特异性。 |
| 英文摘要: |
| Abstract：［Objective］ To analyze the associations between five novel obesity-related indices (NORI) and gastric diseases. ［Methods］ This study was based on data from the upper gastrointestinal cancer screening and the esophageal cancer-specific cohort (initiated in 2006 and 2017) in Yangzhong City， Jiangsu Province. A total of 10 698 residents completed screening registration between November 2017 and December 2022. A total of 9 243 participants with complete data (median age 55.00 years old) were included in the final analysis. Multinomial Logistic regression models were used to examine the independent associations of lipid accumulation product (LAP)， visceral adiposity index (VAI)， Chinese visceral adiposity index (CVAI)， waist triglyceride index (WTI)， and cardiometabolic index (CMI) with gastric cancer， precancerous lesions (high-grade/low-grade intraepithelial neoplasia)， and precancerous diseases (atrophic gastritis/intestinal metaplasia). ［Results］ Among 9 243 participants， the prevalence of histopathologically confirmed gastric cancer， precancerous lesions， and precancerous diseases was 0.48%， 1.95%， and 36.59%， respectively. Multinomial Logistic regression showed that， compared with participants in the 1st quartile group (Q1) of LAP and CVAI， those in the 4th quartile group (Q4) had a 13.6%［odds ratio(OR)=0.864， 95% confidence interval (CI)： 0.761-0.981］ and 16.1% (OR=0.839，95%CI： 0.736-0.957) lower risk of precancerous diseases， respectively. For each one-standard-deviation increase in LAP， VAI， CVAI， and CMI， the risk of precancerous diseases decreased by 5.1% (OR=0.949， 95%CI：0.905-0.994)， 5.1%(OR=0.949， 95%CI： 0.904-0.995)， 6.2%(OR=0.938， 95%CI： 0.896-0.983)， and 4.9%(OR=0.951， 95%CI： 0.906-0.998)， respectively. No significant association was found between WTI and gastric diseases (all P>0.05). However， participants in Q4 of CMI had a significantly higher risk of gastric cancer compared with Q1(OR=3.262， 95%CI： 1.133-9.397). Stratified analysis showed that VAI and CVAI were significant protective factors against non-cardia precancerous diseases (both P<0.05)， while CMI was a significant risk factor for cardia gastric cancer (P<0.05). ［Conclusion］ In this screening population aged 40-69 years old in Yangzhong City， elevated levels of LAP， VAI， CVAI， and CMI were independently associated with a decreased risk of precancerous diseases； however， markedly elevated CMI was associated with an increased risk of gastric cancer. Moreover， different NORI exhibit site-specific effects on gastric diseases. |
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