我国中年人群载脂蛋白B与载脂蛋白A-1比值对冠心病事件预测作用的研究  

Predictive Value of the Ratio of Apolipoprotein B/A-1 Alone or in Combination With Blood Pressure on Coronary Artery Disease in Middle-aged Chinese Adults

作　　者：董莹[1,2] 王馨 陈祚[1] 张林峰[1] 田野[1] 王增武[1] DONG Ying;WANG Xin;CHEN Zuo;ZHANG Linfeng;TIAN Ye;WANG Zengwu(Division of Prevention and Community Health,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(102308),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院国家心血管病中心社区防治部,北京市102308 [2]首都医科大学附属北京朝阳医院心脏中心高血压病研究北京市重点实验室

出　　处：《中国循环杂志》2021年第11期1077-1082,共6页Chinese Circulation Journal

基　　金：国家卫生行业科研专项(200902001);国家自然基金“与冠心病相关的循环miRNA在中年人群中的分布特点及其对冠心病发生风险的预测研究”(81373070)。

摘　　要：目的:探究载脂蛋白B与载脂蛋白A-1比值(apoB/apoA-1)对冠心病事件的独立预测作用以及血压和apoB/apoA-1两因素对冠心病事件的联合作用。方法:卫生行业科研专项“心血管疾病监测、预防预警和诊治技术应用研究”开始于2009~2010年,2016~2017年通过面对面、电话和死亡登记对研究对象进行随访。根据apoB/apoA-1的中位数将研究对象分为apoB/apoA-1<0.64组(n=4443)和apoB/apoA-1≥0.64组(n=4285)。结果:经过中位随访时间为6.35年的随访,在最终纳入分析的8728例研究对象中,有88例发生了冠心病事件。在调整年龄、性别、血压水平和其它危险因素后,随着apoB/apoA-1的增高,冠心病事件的发生风险也随之增加[HR(95%CI):5.18(2.18~12.33),P<0.001]。apoB/apoA-1<0.64组血压正常者冠心病事件的发生率为0.73/1000人年;而apoB/apoA-1≥0.64组合并高血压患者冠心病事件发生率为3.77/1000人年。在全部发生冠心病事件病例中由apoB/apoA-1增高与高血压的相加交互作用所引起的病例占52.2%[95%CI:0.23~0.82,P=0.024]。结论:apoB/apoA-1增高,特别是与高血压同存时,冠心病事件的发生风险明显增加。因而,在中国人群中预防冠心病事件需要apoB/apoA-1和血压同时关注。Objectives: To investigate the impact of ratio of apolipoprotein B(apoB)/apolipoprotein A-1(apoA-1) alone or in combination with blood pressure(BP) on the risk of coronary artery disease(CAD) in Chinese middle-aged adults.Methods: The cardiovascular disease risk factor study in China was conducted in 2009-2010. Follow-up were conducted via clinical visits, telephone, or death certification until 2016-2017. Participants were divided into low(<0.64) and high apoB/apoA-1 ratio(≥0.64) groups according to the median of apoB/apoA-1.Results: The median duration of follow-up was 6.35 years. 88 out of 8 728 participants developed CAD. After adjusting the age, sex, BP level and other cardiovascular risk factors, there was a significant linear trend between apoB/apoA-1 ratio and risk of CAD(HR=5.18 [95% CI:2.18-12.33], P<0.001). The incidence of CAD was 0.73 per 1 000 person-years in those with both low apoB/apoA-1 ratio(<0.64) and normotension;and 3.77 per 1 000 person-years in those with both high apoB/apoA-1 ratio(≥0.64) and hypertension. Among the participants with both high apoB/apoA-1 ratio and hypertension, about 52.2%(95%CI: 0.23-0.82, P=0.024) of the risk of CAD was attributed to the interaction between high apoB/apoA-1 and hypertension.Conclusions: High apoB/apoA-1 ratio, especially the combination with hypertension, is associated with the increased risk of CAD, thus, joint interventions on apoB/apoA-1 ratio and hypertension might play an important role in prevention of CAD in middle-aged Chinese adults.

关 键 词：载脂蛋白B与载脂蛋白A-1比值 高血压 冠心病 队列研究 

分 类 号：R54[医药卫生—心血管疾病]