目的 探讨中国内脏脂肪指数(CVAI)与结直肠癌(CRC)发病风险之间的关联。 方法 选取 2006 年度参加开滦集团 健康体检的在职及退休员工为研究对象,最终纳入 98 311 例观察对象。 根据 CVAI 三分位水平将研究对象分为 CVAI1 组(≤ 75. 36)、CVAI2 组(75. 36~ 108. 30)、CVAI3 组(>108. 30)。 以参加体检为随访起点,对研究对象进行随访,以新发 CRC 为结局 事件,以发生结局事件、死亡或随访时间结束为随访终点。 利用 Kaplan-Meier 法计算 CRC 在各组的发病率并绘制发病曲 线,采用 log-rank 检验进行组间比较。 采用 Cox 比例风险回归模型分析不同 CVAI 对 CRC 发病的 HR 及 CI。 建立受试者操作 特征曲线(ROC 曲线),通过计算 CVAI、内脏脂肪指数(VAI)、体质指数(BMI)、腰围(WC)的 ROC 曲线下面积(AUC),比较 CVAI 与传统肥胖指标对 CRC 的预测能力。 结果 随着 CVAI 增高,CRC 发病率呈上升趋势,经 log-rank 检验差异具有统计学 意义(χ 2 = 72. 84,P<0. 001)。 多因素 Cox 比例风险回归模型分析结果显示,校正相关混杂因素后,与 CVAI1 组相比,CVAI3 组 的 CRC 发病风险增加 1. 27 倍( 95% CI = 1. 02 ~ 1. 58)。 AUCCVAI = 0. 66( 0. 64 ~ 0. 68)、AUCWC = 0. 65( 0. 63 ~ 0. 66)、AUCBMI = 0. 65(0. 63~ 0. 66)、AUCVAI = 0. 65(0. 63 ~ 0. 66)。 AUCCVAI >AUCWC 、AUCVAI、AUCBMI。 结论 高水平 CVAI 暴露是 CRC 的独立危 险因素,随着 CVAI 的增加,CRC 的发病率也呈上升趋势;CVAI 对 CRC 的预测能力略高于 VAI、BMI、WC。

Objective To investigate the association between Chinese visceral adiposity index CVAI and the risk of colorectal cancer CRC . Method In-service and retired employees who participated in the health checkup of Kailuan Group in 2006 were selected for this study and 98 311 participants were finally included. According to the tertile of CVAI the study subjects were divided into CVAI1 group ≤75. 36 CVAI2 group 75. 36~ 108. 30 and CVAI3 group >108. 30 . Participation in a physical examination was used as the starting point for follow-up and study participants were followed up with newly diagnosed CRC as the outcome event and the occurrence of the outcome event death or the end of the follow-up time as the follow-up endpoint. The cumulative incidence of CRC in each group was calculated using the Kaplan-Meier method and the incidence curves were plotted and the log-rank test was used for comparison between groups. The Cox proportional risk regression model was used to analyze the hazard ratio HR and 95% confidence interval CI of CRC incidence by different CVAI. The receiver operating characteristic curve ROC of the subjects was established and the predictive performnce of CVAI and traditional obesity indices for CRC was compared by calculating the area under the ROC curve AUC of CVAI visceral adiposity index VAI body mass index BMI and waist circumference WC . Result As the CVAI increased the cumulative incidence of CRC increased and the difference was statistically significant by log-rank test χ 2 = 72. 84 P< 0. 001 . The results of multivariable Cox proportional hazard regression model analysis showed that after correcting for relevant confounders the risk of CRC incidence was increased by 1. 27-fold 95%CI = 1. 02 ~ 1. 58 in the CVAI3 group compared with that in the CVAI1 group respectively. AUCCVAI = 0. 66 0. 64~ 0. 68 AUCWC = 0. 65 0. 63~ 0. 66 AUCBMI = 0. 65 0. 63 ~ 0. 66 AUCVAI = 0. 65 0. 63 ~ 0. 66 AUCCVAI > AUCWC AUCVAI AUCBMI . Conclusion Higher CVAI level is an independent risk factor for CRC and the risk of CRC increases with increasing CVAI CVAI has a higher predictive ability for CRC than VAI BMI and WC.