直接胆红素和血脂对颈动脉粥样硬化及颈动脉斑块发生风险的交互作用  

The interaction between direct bilirubin and blood lipids on carotid atherosclerosis and carotid plaque

作　　者：范为群[1] 罗文良 邵布勒 余运贤[2] FAN Weiqun;LUO Wenliang;SHAO Bule;YU Yunxian(Hangzhou Wuyunshan Sanatorium,Hangzhou,Zhejiang 310008,China;不详)

机构地区：[1]杭州市五云山疗养院,浙江杭州310008 [2]浙江大学公共卫生学院

出　　处：《预防医学》2020年第6期563-568,共6页CHINA PREVENTIVE MEDICINE JOURNAL

摘　　要：目的分析直接胆红素和血脂对颈动脉粥样硬化及颈动脉斑块发生风险的交互作用。方法选取2016年3月-2018年12月在杭州市五云山疗养院健康体检者为研究对象,收集人口学资料、生化检测和颈动脉超声检查资料,采用多因素多分类Logistic回归模型分析直接胆红素、血脂以及直接胆红素和血脂交互作用对颈动脉粥样硬化和颈动脉斑块发生的影响。结果共纳入分析8308人,其中颈动脉粥样硬化616例,占7.41%;颈动脉斑块2409例,占29.00%。多因素多分类Logistic回归分析结果显示,直接胆红素升高是颈动脉粥样硬化(OR=0.701,95%CI:0.537~0.916)和颈动脉斑块(OR=0.647,95%CI:0.527~0.795)的保护因素;TC升高(OR=1.335,95%CI:1.106~1.611)和LDL-C升高(OR=1.338,95%CI:1.098~1.629)和HDL-C降低(OR=1.431,95%CI:1.148~1.783)是颈动脉粥样硬化的危险因素;TC升高(OR=1.325,95%CI:1.151~1.525)和LDL-C升高(OR=1.311,95%CI:1.130~1.520)是颈动脉斑块的危险因素。直接胆红素和TC、直接胆红素和LDL-C均对颈动脉斑块发生风险存在交互作用(P<0.05);与直接胆红素升高且TC正常组比较,直接胆红素正常且TC升高组颈动脉斑块发生风险增加(OR=1.831,95%CI:1.438~2.333);与直接胆红素升高且LDL-C正常组比较,直接胆红素正常且LDL-C升高组颈动脉斑块发生风险增加(OR=1.814,95%CI:1.427~2.306)。结论TC、LDL-C与直接胆红素对颈动脉斑块发生风险存在交互作用,对于直接胆红素水平正常而TC或LDL-C升高患者更应加强血脂控制以预防颈动脉斑块。Objective To learn the interaction of serum direct bilirubin and blood lipids on the risk of carotid atherosclerosis and carotid plaque.Methods The subjects were selected from Hangzhou Wuyunshan Sanatorium from March 2016 to December 2018.Demographic information,laboratory testing results and carotid intima-media thickness(IMT)were collected.The logistic regression model was employed for the association of direct bilirubin,blood lipids and their interaction with the risk of carotid atherosclerosis and carotid plaque.Results Totally 8308 subjects were recruited.Among them,626(7.41%)subjects had carotid atherosclerosis,and 2409(29.00%)subjects had plaques.The results of multivariate and multinomial logistic regression analysis showed that high level of direct bilirubin was associated with decreased risks of carotid atherosclerosis(OR=0.701,95%CI:0.537-0.916)and carotid plaque(OR=0.647,95%CI:0.527-0.795);high TC level(OR=1.335,95%CI:1.106-1.611),high LDL-C level(OR=1.338,95%CI:1.098-1.629)and low HDL-C level(OR=1.431,95%CI:1.148-1.783)were associated with increased risks of carotid atherosclerosis;high TC level(OR=1.325,95%CI:1.151-1.525)and high LDL-C(OR=1.311,95%CI:1.130-1.520)were associated with increased risks of carotid plaque.There were interactions between direct bilirubin and TC or LDL-C on the risk of carotid plaque(P<0.05).Compared with the subjects with high level of direct bilirubin and normal level of TC,the subjects with normal level of direct bilirubin and high level of TC had significantly higher risk of carotid plaque(OR=1.831,95%CI:1.438-2.333);compared with the subjects with high level of direct bilirubin and normal level of LDL-C,the subjects with normal level of direct bilirubin and high level of LDL-C had significantly higher risk of carotid plaque(OR=1.814,95%CI:1.427-2.306).Conclusion The interactions between direct bilirubin and TC or LDL-C increase the risk of carotid plaque.It is important to strengthen blood lipid control in the patients with normal level of direct bilirubin and hyperlip

关 键 词：颈动脉粥样硬化 颈动脉斑块 直接胆红素 血脂 交互作用 

分 类 号：R445[医药卫生—影像医学与核医学]