Objective: To investigate the relationship between different obesity metabolic phenotypes and the incidence of new carotid artery plaque. Methods: The present study is a retrospective cohort study, collecting individuals from the Health Management Center of the Second Affiliated Hospital of Dalian Medical University who had two or more cervical vascular color ultrasound examinations and met the inclusion criteria from 2014 to 2022, and collected their baseline clinical data. According to whether the subjects were obese and had metabolic syndrome, they were divided into metabolically healthy non-obese group, metabolically unhealthy non-obese group, metabolically healthy obese group, and metabolically unhealthy obese group. The first physical examination time of the subjects was taken as the starting point of follow-up, and cervical vascular color ultrasound was performed during the follow-up physical examination, with the outcome event being carotid artery plaque. Kaplan-Meier survival curve analysis was used to analyze the cumulative incidence of carotid artery plaques in the four groups and log-rank test was performed, and a multifactorial Cox proportional hazards model was used to analyze the relationship between different obesity metabolic phenotypes and the risk of carotid artery plaque incidence. Results: A total of 4 890 subjects were enrolled, aged (45.4±9.6) years, and 2 754 (56.3%) males. The follow-up time was 1.14(0.93, 2.20) years. Compared with the other 3 obesity metabolic phenotypes, the incidence of carotid plaques in the metabolically unhealthy obesity group was the highest (15.4% (286/1 861)). Kaplan-Meier survival curve analysis showed that the cumulative incidence of carotid plaques in metabolically unhealthy obese subjects was about 2.962 times that of metabolically healthy non-obese subjects (log-rank P<0.001). Multivariate Cox regression results showed that the risk of carotid plaque in metabolically unhealthy obese subjects was 1.650 times that of metabolically healthy non-obese subjects (95%CI: 1.203-2.264, P=0.002). Conclusion: Metabolically unhealthy obesity phenotype is an independent risk factor for carotid plaque.
目的： 探讨不同肥胖代谢表型与新发颈动脉斑块之间的关联性。 方法： 本研究为回顾性队列研究，收集2014—2022年大连医科大学附属第二医院健康管理中心具有2次及以上颈部血管彩色超声检查信息且符合纳入标准的常规体检者，收集其基线临床资料。根据研究对象是否肥胖及是否有代谢综合征，将其分为代谢健康非肥胖组、代谢不健康非肥胖组、代谢健康肥胖组和代谢不健康肥胖组。以研究对象首次体检时间为随访起点，在后续体检中行颈部血管彩色超声检查，结局事件为颈动脉斑块。采用Kaplan-Meier生存曲线分析4组人群颈动脉斑块的累积发病率并进行log-rank检验，采用多因素Cox比例风险模型分析不同肥胖代谢表型与颈动脉斑块发病风险的关系。 结果： 共纳入4 890名受试者，年龄（45.4±9.6）岁，男性2 754人（56.3%）。随访时间1.14（0.93，2.20）年，与其他3种肥胖代谢表型相比，代谢不健康肥胖组的颈动脉斑块发病率最高，为15.4%（286/1 861）。Kaplan-Meier生存曲线分析结果显示，代谢不健康肥胖者颈动脉斑块的累积发病率约为代谢健康非肥胖者的2.962倍（log-rank P<0.001）。多因素Cox回归结果表明，代谢不健康肥胖者发生颈动脉斑块的风险为代谢健康非肥胖者的1.650倍（95%CI：1.203~2.264，P=0.002）。 结论： 代谢不健康肥胖表型是颈动脉斑块的独立危险因素。.