儿童青少年超重和肥胖与全血细胞计数衍生炎症指标及心血管危险因素关系的研究

Study on the Relationship between Overweight/Obesity and Complete Blood Cell Count-Derived Inflammatory Indices with Cardiovascular Risk Factors among Children and Adolescents

摘要: 目的：探讨儿童青少年超重和肥胖与全血细胞计数衍生炎症指标的相关性，评估超重和肥胖对儿童青少年心血管危险因素的影响。方法：回顾性分析2022年1月至2024年12月山东大学齐鲁医院儿科460例患者资料，其中肥胖及超重儿童330例，正常体重指数儿童即对照组130例。在中国0~18岁儿童青少年体重指数(Body Mass Index, BMI)生长参照值的基础上，采用与成年人界值点接轨法(BMI₂₄, BMI₂₈)获得的中国2~18岁儿童青少年超重、肥胖筛查BMI界值点作为超重及肥胖标准。收集所有患儿的基础信息、血常规及生化检验结果，并计算炎症指标，包括单核细胞与淋巴细胞比(MLR)、中性粒细胞–淋巴细胞比(NLR)等，采用Spearman相关分析评估炎症指标与BMI等指标的相关性，并采用逻辑回归分析超重、肥胖对高血压、血脂等心血管危险因素的影响。结果：肥胖及超重儿童炎症指标MLR、NLR、dNLR、MHR、SII、SIRI水平均显著高于对照组(P < 0.05)，且与BMI呈显著正相关(r = 0.154~0.243, P < 0.05)，而与HDL呈负相关(r = −0.621~−0.141, P < 0.05)，其中MHR与TG呈显著正相关(r = 0.257, P < 0.001)，ALT与MHR、MLR、SIRI均呈正相关(r = 0.12~0.179，P均 < 0.05)。在心血管危险因素方面，超重及肥胖儿童较正常儿童更易出现血压升高、血脂异常等问题。Logistic逻辑回归显示，与对照组相比，超重及肥胖组发生任意心血管危险因素的风险分别增加1.7倍(OR = 1.692, P < 0.05)及2.7倍(OR = 2.700, P < 0.05)。若同时存在2~3项危险因素，风险分别提高至对照组的2.9倍(OR = 2.884, P < 0.05)和10.3倍(OR = 10.348, P < 0.05)。结论：儿童青少年超重或肥胖状态下，全血细胞计数衍生炎症指标显著升高，并与甘油三酯等代谢指标显著相关。超重或肥胖可促进多项心血管危险因素产生聚集效应。

Abstract: Objective: To investigate the correlation between overweight/obesity and complete blood cell count (CBC)-derived inflammatory indices in children and adolescents, and to evaluate the impact of overweight/obesity on cardiovascular risk factors. Methods: A retrospective analysis was conducted on clinical data from 460 pediatric patients treated at Qilu Hospital of Shandong University between January 2022 and December 2024, comprising 330 overweight/obese children and 130 normal body mass index (BMI) children serving as the control group. Overweight and obesity were defined using the Chinese screening BMI cut-off points for children and adolescents aged 2~18 years, which were established based on the Chinese BMI growth reference values for the 0~18-year age group and obtained through the adult threshold-connecting method (BMI ≥ 24 kg/m² for overweight, BMI ≥ 28 kg/m² for obesity). Basic patient information, complete blood count (CBC) results, and biochemical test results were collected. Inflammatory indices including monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), etc., were calculated. Spearman correlation analysis was employed to evaluate correlations between inflammatory indices and indicators such as BMI. Logistic regression analysis was used to analyze the impact of overweight/obesity on cardiovascular risk factors including hypertension and dyslipidemia. Results: The levels of inflammatory indices MLR, NLR, dNLR, MHR, SII, and SIRI were significantly higher in overweight/obese children compared to the control group (P < 0.05). These indices showed significant positive correlations with BMI (r = 0.154~0.243, P < 0.05) and significant negative correlations with HDL (r = −0.621~−0.141, P < 0.05). Specifically, MHR demonstrated a significant positive correlation with TG (r = 0.257, P < 0.001), while ALT showed positive correlations with MHR, MLR, and SIRI (r = 0.12~0.179, all P < 0.05). Regarding cardiovascular risk factors, overweight/obese children were more prone to elevated blood pressure and dyslipidemia compared to normal-weight children. Logistic regression analysis showed that compared to the control group, the overweight group had a 1.7-fold increased risk of developing any cardiovascular risk factor (OR = 1.692, P < 0.05), while the obesity group had a 2.7-fold increased risk (OR = 2.700, P < 0.05). When 2~3 risk factors coexisted, the risk increased to 2.9 times that of the control group in the overweight group (OR = 2.884, P < 0.05) and 10.3 times that of the control group in the obesity group (OR = 10.348, P < 0.05). Conclusion: In children and adolescents with overweight or obesity, CBC-derived inflammatory indices are significantly elevated and show significant correlations with metabolic markers such as triglycerides (TG). Overweight or obesity promotes the clustering of multiple cardiovascular risk factors.