老年人心脏代谢指数与心血管代谢性共病的关联:尿酸的中介作用及联合预测价值

doi:10.3969/j.issn.1003-9198.2026.06.010

摘要/Abstract

摘要： 目的分析老年体检人群心脏代谢指数(cardiometabolic index, CMI)与心血管代谢性共病(cardiometabolic multimorbidity, CMM)的关联,探讨血清UA中介作用的总体效应及性别差异,并评价CMI与UA联合模型对CMM的判别效能。方法采用回顾性横断面设计,纳入2024年1—12月≥60岁且体检资料完整的受检者11 336例。采用多因素logistic回归分析探讨CMI与CMM的关联;采用限制性立方样条(RCS)检验其剂量-反应关系;采用中介模型分析UA在CMI与CMM之间的间接效应并进行性别分层;采用ROC曲线评价CMI、UA及其联合模型对CMM的判别效能。结果 CMM患病率为5.5%。多因素logistic回归分析显示,校正混杂因素后,CMI与CMM呈独立正相关(OR=1.28,95%CI:1.11～1.44);RCS分析显示,CMI与CMM患者风险呈非线性关联(非线性 P=0.03),在CMI较低水平(<0.522)时,CMM的风险随CMI增加而上升的趋势更为显著。中介分析揭示,UA在CMI与CMM关联中表现为不一致中介/抑制效应:CMI对CMM的直接效应为正(β=0.324, 95%CI:0.216～0.432),而经UA通路的间接效应为负(β=-0.082, Bootstrap 95%CI:-0.118～-0.050),且该效应在男性中更为显著。ROC曲线分析显示,CMI与UA单项指标的判别效能有限(AUC分别为0.551和0.531),而纳入CMI、UA及基础协变量的综合预测模型AUC提升至0.709(95%CI:0.689～0.729),显著优于单一指标模型(DeLong 检验 P<0.001)。结论在老年体检人群中,CMI与CMM独立相关,且呈非线性关系。UA在CMI与CMM关联中表现为不一致中介/抑制效应,但该路径应主要理解为统计关联,因果性仍需进一步研究。CMI联合UA及基础协变量对CMM具有一定判别价值。

关键词: 心脏代谢指数, 心血管代谢性共病, 老年人, 尿酸, 中介分析

Abstract: Objective To examine the association between cardiometabolic index (CMI) and cardiometabolic multimorbidity (CMM) in older adults undergoing health examinations, and to explore the mediating role of serum uric acid (UA), both overall and stratified by gender, and to evaluate the discriminative performance of a combined model including CMI and UA for identifying CMM. Methods In this retrospective cross-sectional study, 11 336 adults aged ≥60 years who underwent health examinations from January to December 2024 were included. Multivariable logistic regression was used to assess the association between CMI and CMM. Restricted cubic spline (RCS) analysis was performed to examine the dose-response relationship. Mediation analysis was used to estimate the indirect effect of UA on the association between CMI and CMM, with sex-stratified analyses. Receiver operating characteristic (ROC) curves were used to assess the discriminative performance of CMI, UA, and the combined model. Results The prevalence of CMM was 5.5%. After adjustment for potential confounders, CMI was independently associated with CMM (OR=1.28, 95%CI: 1.111.44). RCS analysis indicated a nonlinear association between CMI and the risk of CMM (P for nonlinearity=0.03), with a steeper increase in risk at lower CMI levels (<0.522). Mediation analysis showed an inconsistent mediation/suppression effect of UA: the direct effect of CMI on CMM was positive (β=0.324, 95%CI: 0.2160.432), whereas the indirect effect through UA was negative (β=-0.082, bootstrap 95%CI: -0.118-0.050), and this pattern was more pronounced in men. ROC curve analysis showed limited discriminative ability for CMI and UA alone [the area under the curve (AUC) was 0.551 and 0.531, respectively)], while the combined model including CMI, UA, and basic covariates achieved an AUC of 0.709(95%CI: 0.6890.729), which was significantly higher than that of either single-indicator model (both P<0.001). Conclusions In older adults undergoing health examinations, CMI is independently and nonlinearly associated with CMM. UA shows an inconsistent mediation/suppression effect in the association between CMI and CMM, which should be interpreted primarily as a statistical association rather than causality. The combined model including CMI, UA, and basic covariates showed moderate discriminative value for identifying CMM.

Key words: cardiometabolic index, cardiometabolic multimorbidity, aged, uric acid, mediation analysis

中图分类号:

R 54

郑卉, 王颖, 戴卉. 老年人心脏代谢指数与心血管代谢性共病的关联:尿酸的中介作用及联合预测价值[J]. 实用老年医学, 2026, 40(6): 591-596.

ZHENG Hui, WANG Ying, DAI Hui. Association between the cardiometabolic index and cardiometabolic multimorbidity in older adults: uric acid as a potential mediator and combined predictive value[J]. Practical Geriatrics, 2026, 40(6): 591-596.

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