儿童青少年心肺适能和代谢综合征关联性的Meta分析

张开 陈培友 夏浩博 黄颖妹

摘    要：系統综述儿童青少年心肺适能（CRF）和代谢综合征（MS）关联性的流行病学文献，旨在明确CRF是否为儿童青少年MS的独立影响因子，以及肥胖的混杂偏倚是否会影响儿童青少年CRF与MS的关联性。方法：在PubMed、Embase、Cochrane图书馆、Web of Science、中国知网（CNKI）、万方数据库和维普网中搜索2010-2020年发表的相关文献。将各项研究中CRF与MS的关联性统计结果，依据肥胖是否被归为混杂变量分别编入模型2与模型1，并采用“RevMan 5.2”软件进行Meta分析。结果：1）共纳入19项研究，适宜进行Meta分析的有6项。模型1中93%（13/14）、模型2中32%（6/19）的研究结果显示儿童青少年的CRF与MS具有显著相关性;有79%（11/14）的研究结果显示，相较模型1，模型2中的CRF与MS的关联强度减弱甚至消失。2）模型2的Meta分析结果表明，低CRF是儿童青少年MS的风险因子[OR=1.80，95%CI：（1.44，2.26），p<0.000 1]。3）性别和年龄是CRF与MS之间关联性的重要影响因素。结论：1）现有文献无法确定心肺适能是儿童青少年代谢综合征的独立影响因子，肥胖的混杂偏倚会减弱CRF与MS的关联强度。2）男生代谢综合征的患病风险受心肺适能的影响比女生更强;与青春期前的儿童相比，青春期少年的心肺适能更适宜预测其代谢综合征的罹患风险。3）儿童青少年心肺适能影响代谢综合征的发病机制仍不完全明确，不同人群心肺适能与代谢综合征的关联程度的差异有待更深入地探究。

关键词：心肺适能;儿童青少年;代谢综合征;肥胖;Meta分析

中图分类号：G 804.5          学科代码：040302           文献标识码：A

Abstract：Epidemiological investigations on the relationship between cardiorespiratory fitness（CRF） and metabolic syndrome （MS） in children and adolescents were systematically reviewed to explicate whether CRF is an independent factor of MS in children and adolescents and whether adiposity will impact the relationship between CRF and MS. Methods： Articles published in PubMed， Embase， Cochrane library， Web of Science， CNKI， Wan Fang and VIP during 2010-2020 were retrieved. According to whether adiposity was included in the model or not， the correlation results were coded into “Model 2” and “Model 1”， respectively. Meta-analysis was also conducted by RevMan 5.2 software. Results： 1） 19 articles were identified， among which 6 are suitable for meta-analysis. 93%（13/14） studies in model 1 and 32%（6/19） in model 2 showed significant correlation between CRF and MS; 79% （11/14） studies showed that the correlation strength between CRF and MS in model 2 decreased or disappeared compared with that in model 1; 2）  meta-analysis of model 2 showed that low CRF was significantly associated with the risk of MS in children and adolescents [OR=1.80，95%CI：（1.44，2.26），p<0.000 1]; 3） Gender and age are important factors influencing the relavance formed between CRF and MS. Conclusions： 1） Present literature cannot confirm whether CRF is an independout impact factor of MS in children and adolescents， the relevance strength between CRF and MS was attenuated after adjusting adiposity as a confounder. 2） The risk of MS in boys is more affected by CRF than girls， CRF is a suitable predictor of MS in adolescents than in children; 3） The biomechanism of CRF affecting MS in children and adolescents is still not fully clear， the differences in the correlation between CRF and MS in different populations also need to be further explored.

Keywords： cardiorespiratory fitness; children and adolescents; metabolic syndrome; adiposity; Meta-analysis

近年来，世界各地儿童青少年的肥胖率和肥胖程度增势迅猛，并且这种趋势预计在未来几年内仍旧会持续[1]。……