摘要
背景 非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值(NHHR)作为新型的复合脂质指标,是评估心血管疾病风险的潜在生物标志物,但其与左心室肥厚(LVH)的关系尚未明确。目的 探讨农村高血压患者NHHR与LVH之间的相关性。方法 本研究为基于农村地区的横断面研究,于2004—2005年采取分层整群抽样方法,在河南省某县22个乡镇中使用简单随机数字表法抽取7个乡镇,在其下辖的180个村庄中随机抽取63个村庄,在40~75岁长住农村居民中进行筛选,最终纳入4 551例高血压患者。根据NHHR四分位数将患者分为Q1组(NHHR≤2.05)、Q2组(2.06≤NHHR≤2.58)、Q3组(2.59≤NHHR≤3.20)及Q4组(NHHR≥3.21),比较4组患者的临床资料。使用Logistic回归分析探讨NHHR与LVH之间的关系。使用亚组分析证实两者关联的一致性。结果 4组患者的BMI、舒张压(DBP)、丙氨酸氨基转移酶(ALT)、空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、血尿酸(SUA)、血清肌酐(Scr)、脑卒中史、冠心病史以及糖尿病史比较,差异均有统计学意义(P<0.05)。完全调整的模型中,NHHR与LVH风险相关,与Q1组相比,Q3组、Q4组发生LVH的风险增加,OR值分别为1.346(95%CI=1.102~1.644,P=0.004)、1.344(95%CI=1.053~1.717,P=0.018);在控制除分组变量外的所有协变量后,亚组分析中,这种关系在女性、<60岁、≥60岁、无冠心病史、无脑卒中史、有无糖尿病史亚组中仍然显著(P<0.05)。结论 本研究基于农村地区高血压患者,采用横断面研究揭示了高水平的NHHR与高血压患者发生LVH独立相关,且在女性及老年亚组中关联性更强,提示NHHR可用于识别高血压人群中的LVH高危患者,为LVH高危人群的分层管理提供依据。
Background Non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol(HDL-C)ratio(NHHR),a novel composite lipid index,is a potential biomarker for assessing cardiovascular disease risk.Still,its relationship with left ventricular hypertrophy(LVH)is unclear.Objectives To explore the correlation between NHHR and LVH in hypertensive patients.Methods This is a cross-sectional study based on rural areas,and a stratified whole cluster sampling method was adopted in 2004-2005,in which 7 out of 22 townships in a county in Henan Province were selected using the simple random number method,and 63 out of the 180 villages under its jurisdiction were chosen randomly,and screening was performed among the long-staying rural residents aged 40-75 years,and finally 4551 patients with hypertension were integrated.Patients were categorized into Q1(NHHR≤2.05),Q2(2.06≤NHHR≤2.58),Q3(2.59≤NHHR≤3.20)and Q4(NHHR≥3.21)groups according to NHHR quartiles.The clinical data of the patients in the four groups were compared.Logistic regression analysis was used to explore the association between NHHR and LVH.The consistency of the associations was confirmed using subgroup analyses.Results The differences were statistically significant in the comparison of BMI,diastolic blood pressure(DBP),alanine aminotransferase(ALT),fasting blood glucose(FBG),total cholesterol(TC),triglycerides(TG),HDL-C,low-density lipoprotein cholesterol(LDL-C),serum uric acid(SUA),serum creatinine(Scr),stroke history,coronary heart disease history and diabetes history indicators in the four groups(P<0.05).In the fully adjusted model,NHHR was associated with the risk of LVH,with the probability of LVH risk in groups Q3,and Q4 compared with group Q1 being 1.346(95%CI=1.102 to 1.644,P=0.004)and 1.344(95%CI=1.053 to 1.717,P=0.018);after controlling for all covariates except grouping variables,this relationship remained significant in subgroup analyses in the subgroups of females,<60 years of age,≥60 years of age,no history of coronary artery disease,no history of stroke,and history of diabetes mellitus(P<0.05).Conclusion This study,based on hypertensive patients in rural areas and using cross-sectional studies,revealed that high levels of NHHR were independently associated with LVH in hypertensive patients.The association was stronger in women and older subgroups,suggesting that NHHR can be used to identify patients at high risk of LVH in hypertensive populations and provide a basis for stratified management of those at high risk of LVH.
作者
秦邦国
孙瑾
李曼
邱娇娇
程柏凯
朱平
王曙霞
QIN Bangguo;SUN Jin;LI Man;QIU Jiaojiao;CHENG Bokai;ZHU Ping;WANG Shuxia(Department of Geriatrics,the Second Medical Centre,Chinese PLA General Hospital,Beijing 100853,China;Medical School of Chinese PLA,Beijing 100853,China)
出处
《中国全科医学》
北大核心
2025年第30期3753-3760,共8页
Chinese General Practice
基金
国家重点研发计划(2020YFC2008900)。
