目的 探讨中国中老年人群不同肥胖类型与心血管代谢共病（cardiometabolic multimorbidity,CMM）的关系，并分析C-反应蛋白-甘油三酯葡萄糖指数（C-reactive protein-triglyceride glucose index,CTI）在二者之间的中介作用。方法 基于2011-2020年中国健康与养老追踪调查（China health and retirement longitudinal study,CHARLS）数据库中4217名中老年人的数据，采用Cox回归分析肥胖和CMM的关系，采用Spearman相关分析探讨肥胖、CTI和CMM之间的相关性,并使用Mplus软件分析CTI在肥胖和CMM间的中介效应。结果 CMM发生率为20.68%。与非肥胖人群相比，外周型肥胖（HR：2.030，95%CI:1.757~2.347）和中心型肥胖（HR：1.752，95%CI:1.514~2.027）均显著增加CMM的发生风险。中介分析显示，CTI在外周型肥胖与CMM之间具有显著的中介效应，效应占比18.22%；CTI在中心型肥胖与CMM之间也存在显著的中介效应，效应占比21.66%。结论 中国中老年人肥胖与CMM发生密切相关，CTI在二者间发挥中介作用，提示应将肥胖纳入CMM早期风险筛查，同时采取针对性干预措施改善肥胖，降低胰岛素抵抗及炎症水平。

Objective To explore the relationship between different obesity types and cardiometabolic multimorbidity (CMM) in the middle-aged and elderly population in China,and to analyze the mediating role of the C-reactive protein-triglyceride glucose index (CTI) between them.Methods Based on data from 4,217 middle-aged and elderly individuals in the China Health and Retirement Longitudinal Study (CHARLS) database (2011-2020),Cox regression analysis was used to examine the relationship between obesity and CMM.Spearman correlation analysis was employed to explore the correlations amongobesity,CTI,and CMM,and the mediating effect of CTI between obesity and CMM was analyzed using Mplus software.Results The incidence of CMM was 20.68%.Compared with non-obese individuals,both peripheral obesity (HR:2.030,95%CI:1.757-2.347) and central obesity (HR:1.752,95%CI:1.514-2.027) significantly increased the risk of CMM.Mediation analysis showed that CTI had a significant mediating effect between peripheral obesity and CMM,accounting for 18.22% of the total effect;CTI also demonstrated a significant mediating effect between central obesity and CMM,accounting for 21.66% of the total effect.Conclusions Obesity in the middle-aged and elderly population in China is closely associated with the development of CMM,with CTI playing a mediating role.This suggests that obesity should be incorporated into early risk screening for CMM,and targeted intervention should be implemented to improve obesity status and reduce insulin resistance and inflammation levels.

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2022 年江苏省老年病预防与转化重点实验室开放课题（KJS2223）