【摘要】 目的 研究发现身体质量指数（BMI）定义的肥胖是膝骨关节炎（KOA）发生的独立危险因素。而内脏脂肪代谢评分（METS-VF）作为一种新型的肥胖评估指标，其与KOA之间的相关性尚未揭示。本研究旨在探讨中国中老年人群METS-VF与KOA的关系。方法 本研究纳入了2011年和2015年参加中国健康与养老追踪调查（CHARLS）的3 017名45岁及以上人群。首先，通过有向无环图（DAG）确定合适的协变量调整集。采用多重调整Cox比例风险回归模型，分别分析METS-VF及其四分位分组与KOA发病风险之间的关联性。随后，采用限制性立方样条（RCS）分析METS-VF与KOA之间的剂量-反应关系。最后，进行亚组分析和敏感性分析。结果在四年的随访中，共有277名参与者发生KOA，累积发病率为9.2%。调整所有协变量后，METS-VF每增加1个单位，KOA发生风险增加80%(HR=1.80,95%CI:1.37～2.38)。在METS-VF水平最高的四分位组中，KOA的发生风险较最低四分位组增加2.29倍（HR=2.29, 95%CI:1.55～3.39）。RCS曲线显示，METS-VF与新发KOA之间呈线性相关（非线性趋势检验P=0.331）。亚组分析显示，METS-VF与血脂异常之间存在交互作用（P=0.026）。敏感性分析结果与主分析结果保持一致。结论 较高的METS-VF水平与中老年人群KOA发病风险增加存在显著关联，METS-VF可作为识别KOA较高风险人群的潜在指标。但由于本研究为回顾性队列研究，结果仅提示关联性，仍需进一步的前瞻性研究予以验证。更多还原

【Abstract】 Objective Previous studies have identified obesity defined by BMI as an independent risk factor for knee osteoarthritis(KOA). However, the association between metabolic score for visceral fat(METS-VF), a novel obesity assessment index, and KOA has not been explored. This study aims to investigate the relationship between METS-VF and KOA in middle-aged and elderly Chinese populations.Methods This study included 3 017 individuals aged 45 years and older who participated in the China Health and Retirement Longitudinal Study(CHARLS) in 2011 and 2015. First, a directed acyclic graph(DAG) was used to determine an appropriate set of covariates for adjustment. Multivariable Cox proportional hazards regression models were employed to analyze the association between METS-VF and its quartile groups with the risk of KOA incidence. Subsequently, a restricted cubic spline(RCS) analysis was conducted to assess the dose-response relationship between METS-VF and KOA. Finally, subgroup analyses were performed to assess consistency across different subgroups, and sensitivity analyses were conducted to validate model robustness. Results During four years of follow-up, 277 participants developed KOA, resulting in a cumulative incidence rate of 9. 2%. After adjusting for all covariates, each unit increase in METS-VF was associated with an 80% increased risk of KOA(HR=1. 80, 95%CI: 1. 37-2. 38). In the highest quartile of METS-VF, the risk of KOA was 2. 29 times greater compared to the lowest quartile(HR=2. 29, 95%CI: 1. 55-3. 39). The RCS curve indicated a linear relationship between METS-VF and new-onset KOA(P for non-linear=0. 331). Subgroup analysis revealed an interaction between METS-VF and dyslipidemia(P=0. 026). Sensitivity analyses showed consistent results with the primary analysis. Conclusion Higher METS-VF levels were significantly associated with increased risk of KOA in middle-aged and elderly populations, suggesting METS-VF may serve as a potential indicator for identifying individuals at higher risk of KOA. However, since this retrospective cohort study only shows an association, further prospective studies are needed to validate these findings.更多还原