中国人内脏脂肪指数与血压变异性的关联研究进展

Research Progress on the Association between Chinese Visceral Adiposity Index and Blood Pressure Variability

摘要: 内脏脂肪较皮下脂肪更易诱发代谢紊乱与心血管疾病，中国学者提出更适合中国人群的中国人内脏脂肪指数(Chinese visceral adiposity index, CVAI)以简便评估内脏肥胖。血压变异性(Blood pressure variability, BPV)可分为极短期、短期、中期与长期，研究表明BPV可独立预测靶器官损害，其中短期BPV与靶器官损害关系更直接，探明CVAI与短期BPV关联可加深对高血压病理的认识。大规模队列证实高CVAI显著提高高血压风险，社区研究也提示CVAI升高与长期BPV递增相关。本文聚焦CVAI与短期BPV：内脏脂肪经交感激活、肾素–血管紧张素–醛固酮系统(Renin‑angiotensin‑aldosterone system, RAAS)亢进、胰岛素抵抗、炎症、动脉僵硬及阻塞性睡眠呼吸暂停，可能加剧日内血压波动。综合证据与生物学合理性提示，CVAI除预测平均血压外，亦可能指示短期BPV恶化；提示在血压管理中纳入内脏肥胖评估与干预，可望降低心血管事件发生，亟需以短期BPV为终点的前瞻性研究验证。本文主要围绕CVAI与短期BPV的关联，以及两者间潜在病理生理机制的研究进展进行综述。

Abstract: Visceral fat is more likely than subcutaneous fat to cause metabolic disorders and cardiovascular diseases. Chinese scholars have proposed the Chinese Visceral Adiposity Index (CVAI) as a simplified method for assessing visceral obesity in the Chinese population. Blood pressure variability (BPV) can be divided into very-short-term, short-term, mid-term, and long-term. Studies indicate that BPV serves as an independent predictor of target organ damage, among which short-term BPV is more directly related to target organ damage, and investigating the relationship between CVAI and BPV could enhance understanding of hypertension pathology. Large-scale cohort studies have demonstrated that high CVAI significantly increases hypertension risk, while community-based research also further indicates that elevated CVAI is positively associated with long-term BPV increments. This article focuses on CVAI and short-term BPV: visceral fat, through sympathetic activation, overactivity of the renin-angiotensin-aldosterone system (RAAS), insulin resistance, inflammation and arterial stiffness, and obstructive sleep apnea, may exacerbate within-day blood pressure fluctuations. The totality of evidence and biological plausibility suggest that, in addition to predicting average blood pressure, CVAI may also indicate worsening of short-term BPV; highlighting the potential of incorporating visceral obesity assessment and intervention into blood pressure management to reduce cardiovascular events, and prospective studies with short-term BPV as the endpoint are urgently needed for verification. This article reviews the association between CVAI and short-term BPV, as well as recent advances in understanding the potential pathophysiological mechanisms underlying this relationship.