肱动脉内皮功能影响因素的结构方程模型构建及分析  

Construction and analysis of the structural equation model for the influencing factors of endothelial function of the brachial artery

作　　者：彭珽 缪汝佳[1] 赵琳琳 秦春香[1] 陈妮妮[1] 彭洁 赵群[1] 姚雯钊 袁挺 王建刚[1] Peng Ting;Miao Rujia;Zhao Linlin;Qin Chunxiang;Chen Nini;Peng Jie;Zhao Qun;Yao Wenzhao;Yuan Ting;Wang Jiangang(Health Management Center of the Third Xiangya Hospital,Central South University,Changsha 410013,China)

机构地区：[1]中南大学湘雅三医院健康管理科,长沙410013

出　　处：《中华健康管理学杂志》2022年第7期464-470,共7页Chinese Journal of Health Management

基　　金：国家自然科学基金青年项目(81600357);湖南省自然科学基金青年项目(2021JJ40941);湖南省重点研发计划(2020SK2089);湖南省科技创新计划项目(2020SK2055)

摘　　要：目的通过构建结构方程模型(SEM),分析肱动脉内皮功能影响因素。方法研究2015年5月至2020年8月在中南大学湘雅三医院健康管理中心体检的6861例无心血管疾病症状的受检者,对他们进行问卷调查和体检数据采集。对各类代谢因子和肱动脉内皮依赖性血管舒张功能(FMD)进行Spearman等级相关系数分析相关性。对饮食条目进行探索性因子分析(3430/6861)和验证性因子分析(3431/6861),并将饮食模式、心血管危险因素与FMD构建SEM,以多路径回归分析各指标间相关性。结果因子分析将饮食条目分为健康类食品、肉类食品、补充类食品。SEM中,年龄(β=0.27)和血压(β=0.12)对低FMD有较明显影响,三酰甘油(β=0.03)、空腹血糖(β=0.04)、体质指数(β=0.08)对低FMD均有正相关(均P<0.05)。健康类食品与血压(β=-0.04)、体质指数(β=-0.04)有负相关,肉类食品与三酰甘油(β=0.33)、血压(β=0.06)、空腹血糖(β=0.20)、体质指数(β=0.16)均有正相关,补充类食品与FBG(β=-0.30)有负相关,也是SEM中唯一对FMD有直接效应的饮食模式(β=0.05)。结论构建结构方程模型是一种能分析各风险因素对总体的影响和单项指标间相互关系的有效方法。年龄、饮食模式、代谢性心血管危险因素对肱动脉内皮功能损伤具有直接或间接影响,通过饮食模式和代谢指标的综合控制能潜在预防和改善心血管早期损伤。Objective To examine the influencing factors of endothelial injury using the structural equation model(SEM).Methods A total of 6861 asymptomatic individuals free of cardiovascular disease underwent health examinations at the health management center of the third Xiangya hospital,Central South University from May 2015 to August 2020.And collected their questionnaire and checkup data.Spearman′s rank correlation coefficient was used to analyze metabolic factors and brachial artery flow-mediated dilatation(FMD).Exploratory factor analysis(3430/6861)and confirmatory factor analysis(3431/6861)were conducted on the diet items.An SEM was constructed using the diet pattern data,cardiovascular risk factors and FMD,and using multi-path regression analysis to determine the correlation between the indicators.Results Based on the factor analysis,diet items were divided into three patterns:healthy food,meat,and supplementary food.The SEM indicated that age(β=0.27)and blood pressure(β=0.12)had obvious effects on low FMD.Triglyceride(β=0.03),fasting blood glucose(β=0.04),and body mass index(β=0.08)were positively correlated with low FMD.On the upstream,healthy food was negatively correlated with blood pressure(β=-0.04)and body mass index(β=-0.04),meat was positively correlated with triglyceride(β=0.33),blood pressure(β=0.06),fasting blood glucose(β=0.20),and body mass index(β=0.16),and supplementary food was negatively correlated with fasting blood glucose(β=-0.30).This was the only pattern that was directly correlated with FMD(β=0.05).Conclusions SEM is an effective method to analyze the influence of various risk factors on the population and the relationship between individual indicators.This study revealed direct and indirect correlations between age,diet pattern,cardiovascular-metabolic risk,and FMD impairment.Comprehensive control of dietary patterns and metabolic indicators could prevent and improve early cardiovascular injury.

关 键 词：内皮依赖性血管舒张功能 代谢综合征 体格检查 问卷 

分 类 号：R543.5[医药卫生—心血管疾病]