两种模型预测的心血管病发病风险与动脉僵硬度的相关性  

Relationship between arterial stiffness and cardiovascular risk scores predicted by two different models

作　　者：王庭俊[1,2,3] 蔡晓琪 张玲玉[1] 沈逸华[1] 谢群芳[1,2,3] 徐国焱[1,2,3] 谢良地 WANG Ting-jun;CAI Xiao-qi;ZHANG Ling-yu;SHEN Yi-hua;XIE Qun-fang;XU Guo-yan;XIE Liang-di(Department of Geriatrics,,Department of General Medicine,The First Affiliated Hospital of Fujian Medical University;Fujian Hypertension Research Institute,Fuzhou Fujian 350005,China;不详)

机构地区：[1]福建医科大学附属第一医院老年医学科 [2]福建医科大学附属第一医院全科医学科 [3]福建省高血压研究所,福建福州350005

出　　处：《中华高血压杂志》2020年第8期736-743,共8页Chinese Journal of Hypertension

基　　金：国家自然科学基金(81870316);福建省卫生计生委中青年骨干基金(2017-ZQN-44)。

摘　　要：目的分别应用汇总队列公式(PCE)和中国人动脉粥样硬化性心血管病(ASCVD)风险预测(China-PAR)模型预测受检者的10年ASCVD风险,比较两种模型预测的心血管病发病风险与动脉僵硬度的相关性。方法本研究为横断面临床研究,选择2016年2月-2018年12月期间行颈股动脉脉搏波传导速度(cfPWV)检查的患者1090例,所有受检者均来源于福建医科大学附属第一医院全科医学科或老年医学科,年龄30~75岁。根据cfPWV<10和≥10 m/s将受检者分为动脉僵硬度正常组和动脉僵硬度增高组。分别应用PCE和China-PAR模型预测受检者的10年ASCVD风险。结果与动脉僵硬度正常组相比,动脉僵硬度增高组中两种模型预测的ASCVD风险均增加[PCE:16.5%(8.6%~28.3%)比6.3%(2.7%~12.3%);China-PAR:8.8%(6.1%~12.4%)比3.9%(2.1%~6.6%),均P<0.001]。与PCE相比,China-PAR预测的ASCVD风险与cfPWV的相关性更强(相关系数0.573比0.503,z=5.272,P<0.001)。多元线性回归分析显示,PCE预测的ASCVD风险(β=0.475,P<0.001)、腰围(β=0.092,P=0.001)是cfPWV的相关因素,但将PCE换成China-PAR,腰围不再是cfPWV的相关因素,只有ASCVD风险(β=0.573,P<0.001)是cfPWV的相关因素。受试者工作特征曲线显示:与PCE相比,China-PAR预测的ASCVD风险对动脉僵硬度的识别效能更高(曲线下面积0.814比0.767,z=4.992,P<0.001)。分层分析显示,China-PAR识别效能的优势主要来源于男性。结论China-PAR和PCE预测的10年ASCVD风险均与动脉僵硬度相关。应用China-PAR预测时,两者的相关性更强,在男性中尤为明显。Objective To investigate the relationship between arterial stiffness and 10-year atherosclerotic cardiovascular disease(ASCVD)risk predicted by the models of Pooled Cohort Equations(PCE)or ASCVD Risk in China(China-PAR).Methods A cross-sectional clinical study was carried out,in which clinical data were collected from 1090 subjects aged 30-75 years who were admitted to the departments of general medicine or geriatrics of the First Affiliated Hospital of Fujian Medical University from February 2016 to December 2018.Arterial stiffness was examined by carotid-femoral pulse wave velocity(cfPWV).All subjects were divided into two groups:normal arterial stiffness(cfPWV<10 m/s)and elevated arterial stiffness(cfPWV≥10 m/s).Ten-year ASCVD risk was predicted by either PCE or China-PAR.Results ASCVD risks predicted by two models in the group of elevated arterial stiffness were higher than those in the group of normal arterial stiffness[PCE:16.5%(8.6%-28.3%)vs 6.3%(2.7%-12.3%);China-PAR:8.8%(6.1%-12.4%)vs 3.9%(2.1%-6.6%),both P<0.001].The correlation coefficient between cfPWV and ASCVD risk predicted by China-PAR was greater than that by PCE(0.573 vs 0.503,z=5.272,P<0.001).Multivariate linear regression analysis showed that 10-year ASCVD risk predicted by PCE model(β=0.475,P<0.001)and waist circumference(β=0.092,P=0.001)correlated with cfPWV.However,when PCE model was replaced with China-PAR,only ASCVD risk(β=0.573,P<0.001),not waist circumference,was associated with arterial stiffness.Receiver operation characteristic curve showed that the discrimination of 10-year ASCVD risk predicted by China-PAR for arterial stiffness was better than PCE(area under curve 0.814 vs 0.767,z=4.992,P<0.001).Stratification analysis displayed that the better discrimination by China-PAR mainly came from male.Conclusion Ten-year ASCVD risks predicted by China-PAR or PCE are both associated with arterial stiffness.The association is stronger when the risk is predicted by China-PAR,especially in males.

关 键 词：动脉粥样硬化 心血管病 风险评估 动脉僵硬度 脉搏波传导速度 

分 类 号：R543.5[医药卫生—心血管疾病]