体质量指数变异性对心脑血管事件的影响  

Effect of body mass index variability on cardio-and cerebrovascular events

作　　者：蔡泽锋 陈泽凯 崔皓哲 郑梦伊 陈冠之 吴炜强[2] 陈志超 吴寿岭[5] 陈有仁[2] CAI Ze-feng;CHEN Ze-kai;CUI Hao-zhe;ZHENG Meng-yi;CHEN Guan-zhi;WU Wei-qiang;CHEN Zhi-chao;WU Shou-lin;CHEN You-ren(Shantou University Medical College,Department of Cardiology,Second Affiliated Hospital of Shantou University Medical College,Shantou Guangdong 515000,China;不详)

机构地区：[1]汕头大学医学院,广东汕头515000 [2]汕头大学医学院第二附属医院心血管内科,广东汕头515000 [3]华北理工大学研究生院 [4]中国医科大学 [5]开滦总医院心血管内科

出　　处：《中华高血压杂志》2020年第4期337-347,共11页Chinese Journal of Hypertension

基　　金：国家自然科学基金(81870312)。

摘　　要：目的探究体质量指数(BMI)变异性对心脑血管事件的影响。方法采用回顾性研究方法,以参加2006-2007年健康体检后,至少参加2008-2009、2010-2011年任一次体检的开滦研究人群作为研究队列,最终入选75012例观察对象,计算随访间BMI变异性(2次或3次体检间的BMI变异性),并根据BMI标准差(BMI-SD)的四分位数将观察对象分成4组,分别为Q1:BMI-SD≤0.51,Q2:>0.51~0.91,Q3:>0.91~1.47,Q4:>1.47 kg/m^2。以末次体检时间为随访起点,每年由经过培训的医务人员查阅观察对象在开滦集团所属各医院及市医保定点医院的住院诊断并记录终点事件的情况。随访至2017-12-31。以随访期间的心脑血管事件作为终点事件。采用Kaplan-Meier法计算不同组别终点事件的累积发生率,并用Log-Rank检验比较各组终点事件累积发生率的差异;用Cox比例风险模型分析BMI-SD对心脑血管事件的影响。结果75012例观察对象平均随访7.01年,发生心脑血管事件者共3569例。Q1、Q2、Q3、Q4组的7年心脑血管事件累积发生率分别为4.13%、4.36%、4.73%、5.32%,脑卒中累积发生率分别为3.28%、3.47%、3.80%、4.21%,心肌梗死累积发生率分别为0.95%、0.93%、1.01%、1.22%。经Log-Rank检验,各组间终点事件累积发生率差异有统计学意义(均P<0.05)。Cox回归分析显示,校正其他混杂因素后,与Q1组相比,Q4组发生心脑血管事件、脑卒中、心肌梗死的HR值(95%CI)分别为1.20(1.09~1.32)、1.15(1.04~1.28)、1.36(1.10~1.67);根据BMI变化斜率分层后,BMI正向变异(BMI变化斜率>0)和负向变异(BMI变化斜率≤0)人群中Q4组发生心脑血管事件的HR值(95%CI)分别为1.19(1.03~1.36)、1.19(1.04~1.36)。结论在开滦研究队列人群中,BMI变异性是心脑血管事件发病风险的独立危险因素。心脑血管事件发病风险随着BMI变异性的增加而增加。Objective To investigate the effect of body mass index(BMI)variability on cardiovascular and cerebrovascular events.Methods A prospective cohort study was conducted in participants from Kailuan Study who participated in the 2008-2009 and/or 2010-2011 physical examination after participating in the 2006-2007 physical examination.Totally 75012 subjects were finally included.The variability of BMI during follow-up was calculated,and the subjects were divided into four groups according to the standard deviation of BMI(BMI-SD)as follow,Q1:BMI-SD≤0.51,Q2:>0.51-0.91,Q3:>0.91-1.47,Q4:>1.47 kg/m^2.The date of the last physical examination was taken as the starting point of follow-up.The trained medical staff checked the diagnostic records of hospitalization in hospitals affiliated to Kailuan Group and other medicare designated hospitals.And they recorded the endpoint events every year.The subjects were followed until December 31,2017.Cardiovascular and cerebrovascular events during follow-up were used as the endpoint.Kaplan-Meier and Log-Rank test was used to calculate and compare the cumulative incidence of endpoint events in different groups respectively.And the Cox proportional hazards model was used to analyze the impact of BMI-SD on cardiovascular and cerebrovascular events.Results There were 3569 cases of cardiovascular and cerebrovascular events during an average follow-up of 7.01 years among 75012 subjects.The cumulative incidence of cardiovascular and cerebrovascular events in Q1,Q2,Q3 and Q4 groups was 4.13%,4.36%,4.73%and 5.32%,respectively.The cumulative incidence of stroke was 3.28%,3.47%,3.80%and 4.21%,and the cumulative incidence of myocardial infarction was 0.95%,0.93%,1.01%and 1.22%respectively in Q1,Q2,Q3 and Q4 groups.Log-Rank test showed that there was significant difference in the cumulative incidence of endpoint events among the four groups(P<0.05).Cox regression analysis indicated that the hazard ratio(HR)values(95%CI)of cardiovascular and cerebrovascular events,stroke and myocardial infarction in

关 键 词：体质量指数 体质量指数变异性 心脑血管事件 开滦队列 

分 类 号：R54[医药卫生—心血管疾病]