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Article(id=1241023932912947756, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023927812682133, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202411086, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1730995200000, receivedDateStr=2024-11-08, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773812762715, onlineDateStr=2026-03-18, pubDate=1739116800000, pubDateStr=2025-02-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773812762715, onlineIssueDateStr=2026-03-18, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773812762715, creator=13701087609, updateTime=1773812762715, updator=13701087609, issue=Issue{id=1241023927812682133, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='3', pageStart='385', pageEnd='576', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773812761500, creator=13701087609, updateTime=1773812858867, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241024336258200259, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023927812682133, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241024336258200260, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241023927812682133, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=565, endPage=570, ext={EN=ArticleExt(id=1241023933172994619, articleId=1241023932912947756, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Study on the association between systemic immune-inflammation index and adult obesity, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the association between the systemic immune-inflammation index (SII) and adult obesity, and to provide insights for the prevention and early diagnosis of obesity.

Methods

This study was based on the survey data of the National Health and Nutrition Examination Survey (NHANES). A binary logistic regression model was used to evaluate the relationship between the systemic immune-inflammation index and obesity (general obesity, central obesity) by calculating the odds ratio (OR) and its 95% confidence interval (CI). In addition, stratified analysis was performed by age (< 60 years old and ≥ 60 years old) and gender.

Results

After adjusting all covariates, when general obesity was taken as the outcome variable, compared with the subjects in the lowest quartile (Q1) of SII, the risk of general obesity in the subjects in the third quartile (Q3) increased by 0.374 times (OR=1.374, 95%CI: 1.111-1.699); the risk of general obesity in the subjects in the fourth quartile (Q4) increased by 0.843 times (OR=1.843, 95%CI: 1.490-2.281). When central obesity was taken as the outcome variable, compared with the subjects in Q1, the risk of central obesity in the subjects in Q3 increased by 0.542 times (OR=1.542, 95%CI: 1.189-2.000); the risk of central obesity in the subjects in Q4 increased by 1.036 times (OR=2.036, 95%CI: 1.553-2.670). In addition, the results of stratified analysis showed that the relationship between SII and obesity was different among different ages and was only significant in the population aged <60 years old.

Conclusion

SII is positively correlated with the risk of adult obesity, and the higher the SII, the higher the risk of obesity. In addition, the relationship between SII and obesity may be age-specific.

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目的

探讨系统性免疫炎症指数（systemic immune-inflammation index，SII）与成人肥胖之间的关联性，为肥胖的预防和早期诊断提供思路。

方法

本研究基于美国国家健康和营养调查（NHANES）的调查数据。采用二分类logistic回归模型通过计算比值比（OR）及其95%置信区间（CI）评估SII与肥胖（一般性肥胖、向心性肥胖）之间的关系。此外，按年龄（<60岁和≥ 60岁）和性别进行分层分析。

结果

调整所有协变量后。以一般性肥胖为结局变量时，与SII最低四分位数（Q1）的研究对象相比，第三分位数（Q3）研究对象患一般性肥胖的风险增加了0.374倍（OR=1.374，95%CI:1.111～1.699）；第四分位数（Q4）研究对象患一般性肥胖的风险增加了0.843倍（OR=1.843，95%CI:1.490～2.281）。以向心性肥胖为结局变量时，与Q1的研究对象相比，Q3研究对象患向心性肥胖的风险增加了0.542倍（OR=1.542，95%CI:1.189～2.000）；Q4研究对象患向心性肥胖的风险增加了1.036倍（OR=2.036，95%CI:1.553～2.670）。此外，分层分析结果显示：SII与肥胖的关系在不同年龄中存在差异，仅在年龄<60岁的人群中显著。

结论

SII与成人肥胖患病风险呈正相关，且SII越高，肥胖的患病风险越高。此外，SII与肥胖的关系可能具有年龄特异性。

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谢林伸，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=hivQmFel+DKQheH65hcEPQ==, magXml=vXTVVRtUKzYIHYBTbdanZA==, pdfUrl=null, pdf=xlNuKDShVtIvBwYdWVbUJA==, pdfFileSize=615994, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=aKVrEpmBFZcttq5V2C1E9g==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=+92Bs0COMSaA3U19QYxZNg==, mapNumber=null, authorCompany=null, fund=null, authors=

朱文与邹游为共同第一作者

朱文（2000—），男，硕士在读，研究方向：职业中毒；

邹游（2000—），男，硕士在读，研究方向：大气污染物暴露估计；

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Obesity Reviews, 2023, 24(2): e13534., articleTitle=Deciphering the "obesity paradox" in the elderly: A systematic review and meta-analysis of sarcopenic obesity, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1241023935853154959, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023932912947756, xref=null, ext=[AuthorCompanyExt(id=1241023935861543568, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023932912947756, companyId=1241023935853154959, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=West China School of Public Health / West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China), AuthorCompanyExt(id=1241023935869932177, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023932912947756, companyId=1241023935853154959, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=四川大学华西公共卫生学院/华西第四医院，四川 成都 610041)])], figs=[ArticleFig(id=1241023937908364092, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023932912947756, language=EN, label=Figure 1, caption=The flow chart of research object selection in NHANES database, 2017—2018, figureFileSmall=gq0E0O9gUzcF0B8zzyp8Ag==, figureFileBig=aKVrEpmBFZcttq5V2C1E9g==, tableContent=null), ArticleFig(id=1241023939414119244, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023932912947756, language=CN, label=图1, caption=2017—2018年NHANES数据库研究对象选择流程图, figureFileSmall=gq0E0O9gUzcF0B8zzyp8Ag==, figureFileBig=aKVrEpmBFZcttq5V2C1E9g==, tableContent=null), ArticleFig(id=1241023939665777509, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023932912947756, language=EN, label=Table 1, caption=

Baseline characteristics of study subjects (general obesity) ［M（IQR）, n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总样本（n=3 359）一般性肥胖χ2/t值P值
无（n=2016）有（n=1343）
年龄（岁）48.00(31.00)48.00(32.00)49.00(29.00)1.102<0.001
性别9.3070.002
男1 724(51.32)1 078(53.47)646(48.10)
女1 635(48.68)938(46.53)697(51.90)
种族113.155<0.001
墨西哥美国人442(13.16)236(11.71)206(15.34)
其他西班牙裔272(8.10)166(8.23)106(7.89)
非西班牙裔白人1 254(37.33)729(36.16)525(39.09)
非西班牙裔黑人714(21.26)365(18.11)349(25.99)
其他种族677(20.15)520(25.79)157(11.69)
婚姻状况2.6350.105
已婚2 124(63.23)1 297(64.34)827(61.58)
其他1 235(36.77)719(35.66)516(38.42)
教育程度3.0500.218
高中以下563(16.76)345(17.11)218(16.23)
高中或高中同等学历847(25.22)487(24.16)360(26.81)
高中以上1 949(58.02)1 184(58.73)765(56.96)
贫困收入2.27(3.05)2.38(3.34)2.17(2.77)2.183<0.001
吸烟状况19.166<0.001
从不吸烟1 981(58.98)1 226(60.81)755(56.22)
已戒烟789(23.49)421(20.88)368(27.40)
吸烟589(17.53)369(18.30)220(16.38)
饮酒状况8.1060.004
不饮酒473(14.08)312(15.48)161(11.99)
饮酒2 886(85.92)1 704(84.52)1 182(88.01)
体力活动（MET-min/wk）2 640.00(6480.00)2 640.00(6240.00)2 640.00(6760.00)0.4190.433
高血压110.587<0.001
否2 231(66.42)1 480(73.41)751(55.92)
是1 128(33.58)536(26.59)592(44.08)
糖尿病64.838<0.001
否2 917(86.84)1 828(90.67)1 089(81.09)
有442(13.16)188(9.33)254(18.91)
SII(四分位)44.149<0.001
Q1840(25.01)558(27.68)282(21.00)
Q2840(25.01)529(26.24)311(23.16)
Q3839(24.98)498(24.70)341(25.39)
Q4840(25.01)431(21.38)409(30.45)
), ArticleFig(id=1241023939816772461, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023932912947756, language=CN, label=表1, caption=

研究对象的基线特征（一般性肥胖）［M（IQR）, n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总样本（n=3 359）一般性肥胖χ2/t值P值
无（n=2016）有（n=1343）
年龄（岁）48.00(31.00)48.00(32.00)49.00(29.00)1.102<0.001
性别9.3070.002
男1 724(51.32)1 078(53.47)646(48.10)
女1 635(48.68)938(46.53)697(51.90)
种族113.155<0.001
墨西哥美国人442(13.16)236(11.71)206(15.34)
其他西班牙裔272(8.10)166(8.23)106(7.89)
非西班牙裔白人1 254(37.33)729(36.16)525(39.09)
非西班牙裔黑人714(21.26)365(18.11)349(25.99)
其他种族677(20.15)520(25.79)157(11.69)
婚姻状况2.6350.105
已婚2 124(63.23)1 297(64.34)827(61.58)
其他1 235(36.77)719(35.66)516(38.42)
教育程度3.0500.218
高中以下563(16.76)345(17.11)218(16.23)
高中或高中同等学历847(25.22)487(24.16)360(26.81)
高中以上1 949(58.02)1 184(58.73)765(56.96)
贫困收入2.27(3.05)2.38(3.34)2.17(2.77)2.183<0.001
吸烟状况19.166<0.001
从不吸烟1 981(58.98)1 226(60.81)755(56.22)
已戒烟789(23.49)421(20.88)368(27.40)
吸烟589(17.53)369(18.30)220(16.38)
饮酒状况8.1060.004
不饮酒473(14.08)312(15.48)161(11.99)
饮酒2 886(85.92)1 704(84.52)1 182(88.01)
体力活动（MET-min/wk）2 640.00(6480.00)2 640.00(6240.00)2 640.00(6760.00)0.4190.433
高血压110.587<0.001
否2 231(66.42)1 480(73.41)751(55.92)
是1 128(33.58)536(26.59)592(44.08)
糖尿病64.838<0.001
否2 917(86.84)1 828(90.67)1 089(81.09)
有442(13.16)188(9.33)254(18.91)
SII(四分位)44.149<0.001
Q1840(25.01)558(27.68)282(21.00)
Q2840(25.01)529(26.24)311(23.16)
Q3839(24.98)498(24.70)341(25.39)
Q4840(25.01)431(21.38)409(30.45)
), ArticleFig(id=1241023939950990201, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023932912947756, language=EN, label=Table 2, caption=

Baseline characteristics of study subjects (central obesity) ［M（IQR）, n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总样本（n=3 271）向心性肥胖χ2/t值P值
无（n=764）有（n=2 507）
年龄（岁）48.00(30.00)33.00(23.00)58.00(28.00)21.773<0.001
性别26.761<0.001
男1 685(51.51)331(43.32)1 354(54.01)
女1 586(48.49)433(56.68)1 153(45.99)
种族47.031<0.001
墨西哥美国人427(13.05)62(8.12)365(14.56)
其他西班牙裔263(8.04)52(6.54)213(8.50)
非西班牙裔白人1 224(37.42)261(34.16)963(38.41)
非西班牙裔黑人695(21.25)204(26.70)491(19.59)
其他种族662(20.24)187(24.48)475(18.95)
婚姻状况3.1560.076
已婚2 071(51.01)463(60.60)1 608(64.14)
其他1 200(48.99)301(39.40)899(35.86)
教育程度15.033<0.001
高中以下542(16.57)93(12.17)449(17.91)
高中或高中同等学历824(26.19)192(25.13)632(25.21)
高中以上1 905(58.24)479(62.70)1 426(56.88)
贫困收入2.28(3.04)2.47(3.41)2.20(2.96)1.5470.007
吸烟状况69.646<0.001
从不吸烟1 929(58.97%535(70.03)1 394(55.60)
已戒烟766(23.42)97(12.70)669(26.69)
吸烟576(17.61)132(17.28)444(17.71)
饮酒状况0.8190.366
不饮酒439(13.42)110(14.40)329(13.12)
饮酒2 832(86.58)654(85.60)2178(86.88)
体力活动（MET-min/wk）2 640.00(6600.00)3 360.00(6940)2 400.00(6360.00)0.7310.755
高血压176.147<0.001
否2 177(66.55)660(86.39)1 517(60.51)
是1 094(33.45)104(13.61)990(39.49)
糖尿病107.270<0.001
否2 846(87.01)749(98.04)2097(83.65)
有425(12.99)15(1.95)410(16.35)
SII(四分位)24.841<0.001
Q1818(25.01)226(29.58)592(23.61)
Q2850(25.99)217(28.40)633(25.25)
Q3786(24.03)175(22.91)611(24.37)
Q4817(24.98)146(19.11)671(26.77)
), ArticleFig(id=1241023940047459201, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023932912947756, language=CN, label=表2, caption=

研究对象的基线特征（向心性肥胖）［M（IQR）, n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
特征总样本（n=3 271）向心性肥胖χ2/t值P值
无（n=764）有（n=2 507）
年龄（岁）48.00(30.00)33.00(23.00)58.00(28.00)21.773<0.001
性别26.761<0.001
男1 685(51.51)331(43.32)1 354(54.01)
女1 586(48.49)433(56.68)1 153(45.99)
种族47.031<0.001
墨西哥美国人427(13.05)62(8.12)365(14.56)
其他西班牙裔263(8.04)52(6.54)213(8.50)
非西班牙裔白人1 224(37.42)261(34.16)963(38.41)
非西班牙裔黑人695(21.25)204(26.70)491(19.59)
其他种族662(20.24)187(24.48)475(18.95)
婚姻状况3.1560.076
已婚2 071(51.01)463(60.60)1 608(64.14)
其他1 200(48.99)301(39.40)899(35.86)
教育程度15.033<0.001
高中以下542(16.57)93(12.17)449(17.91)
高中或高中同等学历824(26.19)192(25.13)632(25.21)
高中以上1 905(58.24)479(62.70)1 426(56.88)
贫困收入2.28(3.04)2.47(3.41)2.20(2.96)1.5470.007
吸烟状况69.646<0.001
从不吸烟1 929(58.97%535(70.03)1 394(55.60)
已戒烟766(23.42)97(12.70)669(26.69)
吸烟576(17.61)132(17.28)444(17.71)
饮酒状况0.8190.366
不饮酒439(13.42)110(14.40)329(13.12)
饮酒2 832(86.58)654(85.60)2178(86.88)
体力活动（MET-min/wk）2 640.00(6600.00)3 360.00(6940)2 400.00(6360.00)0.7310.755
高血压176.147<0.001
否2 177(66.55)660(86.39)1 517(60.51)
是1 094(33.45)104(13.61)990(39.49)
糖尿病107.270<0.001
否2 846(87.01)749(98.04)2097(83.65)
有425(12.99)15(1.95)410(16.35)
SII(四分位)24.841<0.001
Q1818(25.01)226(29.58)592(23.61)
Q2850(25.99)217(28.40)633(25.25)
Q3786(24.03)175(22.91)611(24.37)
Q4817(24.98)146(19.11)671(26.77)
), ArticleFig(id=1241023940206842775, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023932912947756, language=EN, label=Table 3, caption=

Binomial logistic regression analysis of SII and obesity [OR(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1 a模型2 b模型3 c
以向心性肥胖为结局变量
Q11.001.001.00
Q21.114(0.896～1.384)1.266(0.993～1.614)1.235(0.965～1.581)
Q31.333(1.062～1.673)*1.594(1.234～2.059)***1.542(1.189～2.000)**
Q41.755(1.386～2.221)***2.215(1.699～2.887)***2.036(1.553～2.670)***
趋势P值P<0.001P<0.001P<0.001
以一般性肥胖为结局变量
Q11.001.001.00
Q21.11(0.90～1.38)1.21(0.95～1.53)1.154(0.934～1.427)
Q31.38(1.10～1.72)**1.59(1.24～2.03)***1.374(1.111～1.699)**
Q41.60(1.27～2.02)***1.97(1.53～2.54)***1.843(1.490～2.281)***
趋势P值P<0.001P<0.001P<0.001
), ArticleFig(id=1241023940324283305, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023932912947756, language=CN, label=表3, caption=

SII与肥胖的二分类logistic回归分析[OR(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1 a模型2 b模型3 c
以向心性肥胖为结局变量
Q11.001.001.00
Q21.114(0.896～1.384)1.266(0.993～1.614)1.235(0.965～1.581)
Q31.333(1.062～1.673)*1.594(1.234～2.059)***1.542(1.189～2.000)**
Q41.755(1.386～2.221)***2.215(1.699～2.887)***2.036(1.553～2.670)***
趋势P值P<0.001P<0.001P<0.001
以一般性肥胖为结局变量
Q11.001.001.00
Q21.11(0.90～1.38)1.21(0.95～1.53)1.154(0.934～1.427)
Q31.38(1.10～1.72)**1.59(1.24～2.03)***1.374(1.111～1.699)**
Q41.60(1.27～2.02)***1.97(1.53～2.54)***1.843(1.490～2.281)***
趋势P值P<0.001P<0.001P<0.001
), ArticleFig(id=1241023940420752307, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023932912947756, language=EN, label=Table 4, caption=

Correlation between SII and obesity in different age and gender populations [OR(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量Q1Q2Q3Q4P-交互
向心性肥胖
年龄（岁）<0.001
<601.001.169(0.901～1.517)1.488(1.131～1.957)**2.154(1.617～2.869)***
≥601.001.076(0.544～2.127)1.190(0.595～2.380)0.767(0.391～1.505)
性别0.799
男1.001.197(0.841～1.702)1.779(1.191～2.659)***2.130(1.389～3.265)***
女1.001.332(0.931～1.906)1.420(0.996～2.027)1.960(1.363～2.816)***
一般性肥胖
年龄（岁）<0.001
<601.001.505(1.156～1.960)**2.015(1.542～2.633)***2.751(2.104～3.598)***
≥601.000.722(0.507～1.087)0.682(0.466～0.991)*0.885(0.603～1.297)
性别0.580
男1.001.105(0.832～1.467)1.321(0.984～1.772)1.707(1.270～2.294)***
女1.001.262(0.911～1.750)1.498(1.091～2.056)*2.169(1.578～2.982)***
), ArticleFig(id=1241023940542387141, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241023932912947756, language=CN, label=表4, caption=

不同年龄、性别人群的SII与肥胖的关联性[OR(95%CI)]

, figureFileSmall=null, figureFileBig=null, tableContent=
变量Q1Q2Q3Q4P-交互
向心性肥胖
年龄（岁）<0.001
<601.001.169(0.901～1.517)1.488(1.131～1.957)**2.154(1.617～2.869)***
≥601.001.076(0.544～2.127)1.190(0.595～2.380)0.767(0.391～1.505)
性别0.799
男1.001.197(0.841～1.702)1.779(1.191～2.659)***2.130(1.389～3.265)***
女1.001.332(0.931～1.906)1.420(0.996～2.027)1.960(1.363～2.816)***
一般性肥胖
年龄（岁）<0.001
<601.001.505(1.156～1.960)**2.015(1.542～2.633)***2.751(2.104～3.598)***
≥601.000.722(0.507～1.087)0.682(0.466～0.991)*0.885(0.603～1.297)
性别0.580
男1.001.105(0.832～1.467)1.321(0.984～1.772)1.707(1.270～2.294)***
女1.001.262(0.911～1.750)1.498(1.091～2.056)*2.169(1.578～2.982)***
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系统性免疫炎症指数与成人肥胖之间的关联性研究
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朱文 , 邹游 , 谢林伸
现代预防医学 | 临床与预防 2025,52(3): 565-570
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现代预防医学 | 临床与预防 2025, 52(3): 565-570
系统性免疫炎症指数与成人肥胖之间的关联性研究
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朱文, 邹游, 谢林伸
作者信息
  • 四川大学华西公共卫生学院/华西第四医院，四川 成都 610041

    • 朱文（2000—），男，硕士在读，研究方向：职业中毒；

    邹游（2000—），男，硕士在读，研究方向：大气污染物暴露估计；

通讯作者:

谢林伸，E-mail:
Study on the association between systemic immune-inflammation index and adult obesity
Wen ZHU, You ZOU, Lin-shen XIE
Affiliations
  • West China School of Public Health / West China Fourth Hospital, Sichuan University, Chengdu, Sichuan 610041, China
出版时间: 2025-02-10 doi: 10.20043/j.cnki.MPM.202411086
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摘要
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目的

探讨系统性免疫炎症指数（systemic immune-inflammation index，SII）与成人肥胖之间的关联性，为肥胖的预防和早期诊断提供思路。

方法

本研究基于美国国家健康和营养调查（NHANES）的调查数据。采用二分类logistic回归模型通过计算比值比（OR）及其95%置信区间（CI）评估SII与肥胖（一般性肥胖、向心性肥胖）之间的关系。此外，按年龄（<60岁和≥ 60岁）和性别进行分层分析。

结果

调整所有协变量后。以一般性肥胖为结局变量时，与SII最低四分位数（Q1）的研究对象相比，第三分位数（Q3）研究对象患一般性肥胖的风险增加了0.374倍（OR=1.374，95%CI:1.111～1.699）；第四分位数（Q4）研究对象患一般性肥胖的风险增加了0.843倍（OR=1.843，95%CI:1.490～2.281）。以向心性肥胖为结局变量时，与Q1的研究对象相比，Q3研究对象患向心性肥胖的风险增加了0.542倍（OR=1.542，95%CI:1.189～2.000）；Q4研究对象患向心性肥胖的风险增加了1.036倍（OR=2.036，95%CI:1.553～2.670）。此外，分层分析结果显示：SII与肥胖的关系在不同年龄中存在差异，仅在年龄<60岁的人群中显著。

结论

SII与成人肥胖患病风险呈正相关，且SII越高，肥胖的患病风险越高。此外，SII与肥胖的关系可能具有年龄特异性。

肥胖  /  系统性免疫炎症指数  /  国家健康和营养调查
Objective

To explore the association between the systemic immune-inflammation index (SII) and adult obesity, and to provide insights for the prevention and early diagnosis of obesity.

Methods

This study was based on the survey data of the National Health and Nutrition Examination Survey (NHANES). A binary logistic regression model was used to evaluate the relationship between the systemic immune-inflammation index and obesity (general obesity, central obesity) by calculating the odds ratio (OR) and its 95% confidence interval (CI). In addition, stratified analysis was performed by age (< 60 years old and ≥ 60 years old) and gender.

Results

After adjusting all covariates, when general obesity was taken as the outcome variable, compared with the subjects in the lowest quartile (Q1) of SII, the risk of general obesity in the subjects in the third quartile (Q3) increased by 0.374 times (OR=1.374, 95%CI: 1.111-1.699); the risk of general obesity in the subjects in the fourth quartile (Q4) increased by 0.843 times (OR=1.843, 95%CI: 1.490-2.281). When central obesity was taken as the outcome variable, compared with the subjects in Q1, the risk of central obesity in the subjects in Q3 increased by 0.542 times (OR=1.542, 95%CI: 1.189-2.000); the risk of central obesity in the subjects in Q4 increased by 1.036 times (OR=2.036, 95%CI: 1.553-2.670). In addition, the results of stratified analysis showed that the relationship between SII and obesity was different among different ages and was only significant in the population aged <60 years old.

Conclusion

SII is positively correlated with the risk of adult obesity, and the higher the SII, the higher the risk of obesity. In addition, the relationship between SII and obesity may be age-specific.

Obesity  /  Systemic immune-inflammation index  /  National health and nutrition examination survey
朱文, 邹游, 谢林伸. 系统性免疫炎症指数与成人肥胖之间的关联性研究. 现代预防医学, 2025 , 52 (3) : 565 -570 . DOI: 10.20043/j.cnki.MPM.202411086
Wen ZHU, You ZOU, Lin-shen XIE. Study on the association between systemic immune-inflammation index and adult obesity[J]. Modern Preventive Medicine, 2025 , 52 (3) : 565 -570 . DOI: 10.20043/j.cnki.MPM.202411086
正文
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世界卫生组织数据显示，从1990—2022年，全球18岁及以上的成人肥胖率增加了一倍多，从7%增至16%[1]。由于肥胖的患病率不断上升及其与许多疾病的关联性（如高血压、糖尿病、心脑血管疾病、癌症以及各种精神卫生问题）[2]，肥胖已成为全球普遍关注的公共卫生问题之一[3]。BMI是国际上用来衡量肥胖程度的重要指标，然而BMI衡量的一般性肥胖无法直接准确的反映人体腹部脂肪分布情况。最近研究表明，向心性肥胖患者相比于一般性肥胖患者全死因与心血管疾病的死亡风险更高[4-5]，以及向心性肥胖会导致患抑郁症[6]与心力衰竭病人患心房颤动的风险增加[7]。因此在人群肥胖研究中，除了BMI指标，还需要引入腰臀比（WHR）来衡量向心性肥胖。
炎症可促进包括肥胖、代谢综合征、糖尿病和心血管疾病在内的许多慢性疾病的病理生理学过程[8-9]，并且持续的慢性应激暴露会导致慢性低度炎症[10]。系统性免疫炎症指数（systemic immune-inflammation index，SII），是一种广泛使用的、综合性的、创新性的炎症标志物，最初由Hu B等[11]学者提出，该指数最初被应用于研究各种癌症，例如肝细胞癌[11]、小细胞肺癌[12]等。近年来许多研究人员将SII用于研究各种慢性疾病，并发现SII与2型糖尿病[13]、糖尿病肾病[14]等疾病患病风险呈正相关。先前研究表明，肥胖被认为是机体的低度慢性炎症状态[15]，而SII作为炎症指标，可能与肥胖具有关联性。
因此，本研究拟利用NHANES数据库探讨SII与成年人肥胖的关联性，为肥胖的预防和早期诊断提供思路。
1　对象与方法
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1.1　数据来源
本研究的数据来自美国疾病控制和预防中心下属的国家卫生统计中心（NCHS）在美国进行的一项横断面调查项目NHANES[16]。
为了评估SII与肥胖之间的关系，纳入了参与NHANES 2017—2018年调查周期的9 254名参与者。排除标准:（1）年龄小于18岁以下的参与者（n=3 398）；（2）无完整的SII数据或异常值（n=589）；（3）存在协变量缺失的参与者（n=1 180）。根据肥胖结局指标的不同，将肥胖分为一般性肥胖与向心性肥胖，在排除了BMI相关数据缺失或异常的研究对象（n=28）以及WHR相关数据缺失或异常的研究对象（n=116）后，最终分别有3 359名研究对象和3 271名研究对象纳入后续分析。见图1。
1.2　暴露与结局变量
暴露变量为SII，使用Beckman UniCel DxC800 Synchron全自动生化分析仪分析血样。利用以下公式计算：
结局变量分别采用身体质量指数（BMI）与腰臀比（WHR）来衡量一般性肥胖与向心性肥胖。BMI ≥30 kg/m2定义为一般性肥胖；男性（WHR）>0.90，女性（WHR）>0.85定义为向心性肥胖[17]。
1.3　协变量
本研究考虑的协变量包括年龄、性别、种族、教育程度、婚姻状况、家庭贫困收入比、体力活动、吸烟状况、饮酒状况、高血压和糖尿病。
婚姻状况分为已婚、其他（未婚、丧偶、离婚、分居、与伴侣同居）。吸烟状况分为三类,包括从不吸烟、已戒烟和吸烟，其中吸烟定义为研究对象一生中吸烟超过100支。饮酒状况分为二类，包括不饮酒和饮酒，其中饮酒定义是在过去的一年内，至少每个月饮用了一杯含有酒精的饮料。
1.4　统计分析
对于服从正态分布的计量资料，采用（）表示，组间比较采用t检验；对于不服从正态分布的计量资料，采用M（IQR）表示，组间比较使用非参数秩和检验。计数资料采用绝对数和构成比表示，组间比较采用χ2检验。
采用二分类logistic回归模型评估SII与肥胖患病风险之间的关联。在logistic回归中，SII是基于四分位数转换为有序四分类变量，并以第一分位数作为参考纳入模型。同时，将每个类别中的中位数作为连续变量纳入回归模型进行线性趋势检验。总共创建了3个模型：模型1未对任何协变量进行调整；模型2调整了年龄、性别、种族和婚姻状况；模型3在模型2的基础上进一步调整了教育程度、贫困收入比、吸烟状况、饮酒状况、体力活动、高血压和糖尿病。此外，进一步按年龄（<60岁、≥ 60岁）和性别（男性、女性）进行分层分析，并采用似然比检验评估潜在的交互效应。
所有分析均采用SPSS 27.00统计软件进行。所有检验均采用双侧检验，检验水准α=0.05。
2　结果
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2.1　研究对象的基线特征
2.1.1　一般性肥胖为结局变量
最终纳入3 359名研究对象，有1 343（39.98%）名研究对象患有一般性肥胖。与未患有肥胖的相比，患有肥胖的研究对象年龄更大、女性、墨西哥美国人/非西班牙裔白人/非西班牙裔黑人、较低的家庭贫困收入比、已戒烟、饮酒、患有高血压和糖尿病（P<0.05）。
2.1.2　向心性肥胖为结局变量
最终纳入3 271名研究对象，有2 507名（76.64%）研究对象患有向心性肥胖。与未患有向心性肥胖患者相比，患有向心性肥胖的研究对象年龄更大、男性、墨西哥美国人/其他西班牙裔/非西班牙裔白人、已婚、高中及以下学历，较低的贫困收入比、已戒烟/吸烟、饮酒、患有高血压和糖尿病（P<0.05）。见表1、表2。
2.2　SII与肥胖的相关性
将SII基于四分位数转化为四分类有序分类变量（Q1，Q2，Q3，Q4）纳入logistic回归模型中，在三个不同协变量调整的模型中，与SII的最低四分位数（Q1）的研究对象相比，第三分位数与（Q3）第四分位数（Q4）研究对象的一般性肥胖与向心性肥胖两种结局变量的患病风险均增加（OR>1）。此外，趋势性检验结果显示，在三个不同协变量调整的模型中，随着SII程度的增加，一般性肥胖和向心性肥胖的患病风险均逐渐增加,呈线性趋势（所有P趋势 <0.001）。见表3。
2.3　年龄、性别分层分析
按年龄和性别进行分层分析，进一步探究SII与肥胖的关系。在按年龄分层的亚组分析中，SII与肥胖（一般性肥胖、向心性肥胖）的正相关在年龄<60岁的调查对象中显著。进一步交互项检验有统计学意义（P年龄交互<0.001），提示年龄对SII与肥胖的关系存在效应修饰作用。在按性别分层的亚组分析中，SII与肥胖的正相关在男、女性别的调查对象中均显著。交互结果表明分层因素性别在SII与肥胖的关联性上差异无统计学意义，提示性别对SII与肥胖的关系不存在效应修饰作用。见表4。
3　讨论
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本研究通过使用NHANES数据库中的数据，评估SII与成人肥胖之间的关系。本研究样本量充足，样本选择具有代表性，进行了亚组分析。为了得到更可信的结果，我们对混杂变量进行了调整。此外，本研究采用肥胖的两个结局指标，更加全面地探讨了炎症对肥胖的影响，且从炎症的角度分析SII对肥胖的结果，为肥胖的预防和早期干预提供科学依据。通过分析结果显示，SII与肥胖患病具有正向关联性，SII水平越高，肥胖的患病风险越高。此外，根据分层分析结果，提示SII与肥胖的相关性可能具有年龄差异。
SII与成人肥胖患病为何具有正向关联性的机制尚不清楚。以往的研究表明，肥胖与炎症有密不可分的联系，可能与脂肪细胞增生肥大、组织局部缺氧、内质网应激和巨噬细胞浸润等机制有关[18]。本研究中二分类logistic回归结果显示，SII与成人肥胖具有正相关，提示炎症可能在肥胖的发展中起重要作用。此外，SII是一种广泛使用、创新和综合的炎症标志物，结合了血小板计数、中性粒细胞计数和淋巴细胞计数，可以作为反映机体的全身炎症情况的可靠指标，与单个细胞计数相比，SII为解释炎症与肥胖的关系，提供了更加全面的信息[19]。因此，SII可以作为反应肥胖的指标，与本研究的SII与成人肥胖患病具有正相关性结论相符合，但SII和肥胖相关机制亟待进一步去研究发现。
研究表明，慢性炎症与慢性疾病的发生具有密切的联系。肥胖患者的脂肪组织具有功能障碍，单核细胞、淋巴细胞和巨噬细胞等免疫细胞在脂肪组织中积累[20]。而脂肪细胞分泌几种促炎细胞因子（如白细胞介素-1（IL-1）、肿瘤坏死因子-α（TNF-α）等），参与巨噬细胞的激活和聚集，导致慢性低度炎症[21]。促炎细胞因子主要来源于巨噬细胞，巨噬细胞影响脂肪细胞生长、血液供应减少、缺氧和组织坏死而浸润脂肪组织[22-23]。这些事件共同诱发全身性炎症，而全身性炎症本身就是肥胖相关并发症（如高血压、2型糖尿病等）发病机制的潜在触发因素[24]。因此，SII不仅可以作为综合性的炎症指标，反映机体的全身炎症情况，还可能作为评估肥胖与肥胖相关并发症的相关指标，在肥胖与肥胖并发症的预防和早期诊断发挥重要作用。
本研究分层分析结果提示SII与肥胖的患病风险之间的关联性可能存在年龄的差异。在按年龄分层的亚组分析中，仅在<60岁的调查对象SII水平与肥胖的具有显著统计学意义。根据以往研究结果，衰老与骨骼肌质量有关，随着年龄地增长骨骼肌开始损失，三十岁后肌肉质量，每十年大约下降3%～8%，并在60岁后更加明显，而总能量消耗减少，身体活动水平也会减少[25]。此外，在老年人群中，肥胖的患病率正在逐步上升[26]。因此，年龄的增长会影响肥胖的患病率，而肥胖的患病率可能会进一步影响SII，但年龄差异对肥胖的潜在影响机制还需要进一步研究讨论。
但本研究还存在一定的局限性。第一，由于横断面研究设计使研究无法建立SII和肥胖的因果关系。因此，未来的研究仍然需要更多的参与者和更准确的测量来定义因果关系。第二，尽管对几个相关的混杂因素进行了调整，但无法完全排除其他潜在的混杂变量的影响。第三，虽然SII在临床实践中很容易量化，但中性粒细胞计数、淋巴细胞计数以及血小板计数的丢失情况时常发生，可能导致选择偏差。
综上，SII和成人肥胖患病风险呈正相关，且SII越高，肥胖的患病风险越高。此外，SII与肥胖的关系可能具有年龄特异性。SII对于了解肥胖的进展和制定健康管理策略具有潜在益处，进行深入研究探讨其机制和作用，可能会有效降低人群肥胖的发病率，具有巨大的公共卫生价值。
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2025年第52卷第3期
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doi: 10.20043/j.cnki.MPM.202411086
  • 接收时间：2024-11-08
  • 首发时间：2026-03-18
  • 出版时间：2025-02-10
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  • 收稿日期：2024-11-08
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    四川大学华西公共卫生学院/华西第四医院，四川 成都 610041

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Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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