不同心率水平人群基线人类软骨糖蛋白-39与高血压发病关系的前瞻性研究  

A prospective study of the association between baseline human cartilage glycoprotein-39 and hypertension incidence among different heart rate population

作　　者：徐添[1] 仲崇科 王艾丽[2] 郭志荣[2] 卜晓青[2] 周逸鹏[2] 田芸凡 皇甫新凤 朱正保[2] 张永红[2] XU Tian;ZHONG Chongke;WANG Aili;GUO Zhirong;BU Xiaoqing;ZHOU Yipeng;TIAN Yunfan;HUANGFU Xinfeng;ZHU Zhengbao;ZHANG Yonghong(Department of Neurology,the Affiliated Hospital of Nantong University,Nantong 226001;Department of Epidemiology,School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases,Medical College of Soochow University)

机构地区：[1]南通大学附属医院神经内科,南通226001 [2]苏州大学医学部公共卫生学院流行病学教研室,江苏省老年病预防与转化重点实验室

出　　处：《南通大学学报（医学版）》2021年第2期111-115,共5页Journal of Nantong University(Medical sciences)

基　　金：国家自然科学基金资助项目(81502867,82073627);南通市科技计划项目社会民生科技面上项目(MS12019014);中国博士后科学基金资助项目(2020M671564);江苏省博士后科学基金资助项目(2020Z039);江苏省科教强卫工程青年医学重点人才项目(QNRC2016694);南通市第五期226高层次人才培养工程。

摘　　要：目的:针对不同心率水平人群中人类软骨糖蛋白-39(YKL-40)水平与高血压发病的关系进行前瞻性研究。方法:基于一项中国人群的前瞻性队列,开展包含性别、年龄匹配的700例高血压病例及700例对照的巢式病例对照研究。其中,423对病例对照在性别、年龄匹配的基础上还具有可比的静息心率状态(心率≥80次/min或心率<80次/min)。采用多因素条件Logistic回归分别计算不同心率状态组中YKL-40水平与高血压发病的关系,并计算YKL-40水平与心率对高血压发病风险的交互作用,采用净重新分类指数(net reclassification improvement,NRI)和整体鉴别指数(integrated discrimination improvement,IDI)评价YKL-40对高血压发病风险的预测效力。结果:在心率≥80次/min组中,新发高血压病例在基线时具有更高的体质量指数和血压水平,YKL-40高水平者随访时血压水平更高,发生高血压的风险显著高于YKL-40低水平者[比值比(odds ratio,OR)=4.39,95%可信区间(confidence intervals,CI):1.24~15.48],且YKL-40水平与高血压发病风险之间存在显著剂量反应关系(P=0.04),在传统危险因素的基础上增加YKL-40水平,能显著提高对高血压发病的预测效力(NRI=16.13%,P=0.04;IDI=4.29%,P<0.01)。在心率<80次/min组中并未发现YKL-40水平与高血压发病的关系。YKL-40水平与心率之间对高血压发病风险存在显著的交互作用(P=0.01)。结论:在高心率人群中,YKL-40水平升高与高血压发病风险显著相关,YKL-40有可能成为高心率人群中预测高血压发病的新型生物标志物,这一发现有待大样本前瞻性的队列研究加以验证。Objective:To investigate the prospective association between human cartilage glycoprotein-39(YKL-40)and the incidence of hypertension among different heart rate populations.Methods:In a 1∶1 matched case-control study of 700 pairs nested in a prospective cohort of initially healthy Chinese subjects,423 pairs additionally have matched baseline heart rate status(heart rate≥80 beats/m or heart rate<80 beats/m).Multivariable conditional Logistic regression was used to calculate the risk of hypertension associated with YKL-40 levels in both high and low heart rate subgroups as well as the interaction between YKL-40 and heart rate on hypertension risk.Net reclassification improvement(NRI)and integrated discrimination improvement(IDI)were used to evaluate the predictive effect of YKL-40 on the incidence of hypertension.Results:In heart rate≥80 beats/m group,new hypertension cases were more likely to have higher body mass index and blood pressures in the high RHR subgroup at baseline.Subjects with higher YKL-40 levels had higher blood pressures during follow-up period.The odd ratio(OR)of the high YKL-40 category compared with the low category was 4.39[95%confidential intervals(CI):1.24-15.48],and its trend test was significant(P=0.04).Adding YKL-40 to a conditional conventional risk factors significantly improved the accuracy of risk prediction for hypertension(NRI=16.13%,P=0.04;IDI=4.29%,P<0.01).No similar association was detected in heart rate<80 beats/m group.A significant interaction on hypertension risk was observed between YKL-40 and heart rate(P=0.01).Conclusion:In high heart rate group,high YKL-40 was associated with hypertension risk and it may become a novel biomarker for predicting the incidence of hypertension.This finding needs to be further verified by prospective cohort studies.

关 键 词：高血压病 人类软骨糖蛋白-39 心率 巢式病例对照研究 

分 类 号：R544.1[医药卫生—心血管疾病]