原发性高血压患者血浆致动脉粥样硬化指数与动脉硬化进展的相关性研究  

Correlation between plasma atherogenic index and progression of atherosclerosis in patients with primary hypertension

作　　者：阮玉瑛[1] 周涛[2] 李冰 RUAN Yuying;LIU Tao;LI Bing(Department of Emergency,Liuzhou Municipal Liutie Central Hospital,Liuzhou 545007,China)

机构地区：[1]广西柳州市柳铁中心医院急诊科,545007 [2]广西柳州市柳铁中心医院急诊医学科,545007 [3]广西柳州市柳铁中心医院心血管内科,545007

出　　处：《心肺血管病杂志》2023年第5期406-410,415,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：广西壮族自治区卫生健康委员会自筹科研课题(Z20200797);广西壮族自治区卫生健康委员会自筹科研课题(Z-B20221534)。

摘　　要：目的:探索原发性高血压患者血浆致动脉粥样硬化指数(plasma atherogenic index AIP)的影响因素,并研究此类患者中AIP与动脉硬化进展的相关性。方法:本研究为回顾性研究,连续选取2018年3月至2021年3月,柳州市柳铁中心医院收治的原发性高血压患者104例,男性78例,女性26例。根据患者基线AIP指数(中位数=2.8)分为高AIP组和低AIP组,比较两组基线资料及臂踝脉搏波流速(brachial ankle pulse wave velocity,ba-PWV)差异,并利用多因素Logistic回归模型分析动脉硬化(ba-PWV>1800cm/s)的影响因素。同时进行了随访,比较两组患者动脉硬化的进展差异,探索AIP与动脉硬化进展的关系。结果:两组基线资料比较发现:高AIP组[4.2(2.8,7.8)]较低AIP组[1.7(-0.3,2.8)]男性比例更大(84.6%vs.65.4%,P=0.024),BMI更大[(30.2±4.1)vs.(28.4±3.5)kg/m^(2),P=0.016],TG[2.1(1.3,3.9)vs.1.6(1.2,3.2)]mmol/L,P<0.001和ba-PWV[(1765.1±240.9)vs.(1457.2±218.4)cm/s,P<0.001]水平和ba-PWV变化率[25.0(-13.5,55.2)vs.9.3(-24.9,25.2)cm·s^(-1)·year^(-1),P<0.001]更高,动脉硬化比例更大(36.5%vs.17.3%,P=0.027)。余变量组间均差异无统计学意义(P均>0.05)。多因素Logistic回归分析显示:在调整了混杂因素后,高AIP组动脉硬化风险更大(OR=1.34,95%CI:1.07~2.03,P=0.013)。广义相加模型显示AIP与ba-PWV变化率存有剂量效应关系,在AIP指<3时,AIP每增加1个单位,ba-PWV变化率增加18.92 cm·s^(-1)·year^(-1);在AIP指数≥3时,AIP每增加1个单位,ba-PWV变化率增加1.72cm·s^(-1)·year^(-1)。结论:高AIP的原发性高血压患者年龄及ba-PWV更大,AIP增大与动脉硬化风险增加相关。高AIP患者其动脉硬化进展更快,ba-PWV变化率更大,且存在剂量效应关系:当AIP≥3时,其ba-PWV变化率的增长显著低于AIP<3时。综上,在原发性高血压患者中,AIP对于评估动脉硬化水平及其进展存在一定临床价值。Objective:To explore the influencing factors of plasma atherogenic index(AIP)in patients with primary hypertension and the correlation between AIP and the progression of atherosclerosis in these patients.Methods:This study is a retrospective study.A total of 104 patients with primary hypertension Liuzhou Municipal Liutie Central Hospital from March 2018 to March 2021 were selected,including 78 males and 26 females.They were divided into higher AIP group and lower AIP group by median of AIP(2.8).The clinical characteristics and ba-PWV differences between different groups were compared,and the factors influencing the arterial stiffness were analyzed by multivariate Logistic regression model.Also,the difference in the progression of arterial sclerosis between the two groups was compared,and the relationship between AIP and the progression of arterial sclerosis was explored.Results:Patients with higher AIP[4.2(2.8,7.8)]vs.lower AIP[1.7(-0.3,2.8)]were more likely to be male(84.6%vs.65.4%,P=0.024)and had higher BMI[(30.2±4.1)vs.(28.4±3.5)kg/m^(2),P=0.016],TG[2.1(1.3,3.9)vs.1.6(1.2,3.2)mmol/L],ba-PWV[(1765.1±240.9)vs.(1457.2±218.4)cm/s,P<0.001]and change rate of ba-PWV[25.0(-13.5,55.2)vs.9.34(-24.9,25.2)cm·s^(-1)·year^(-1),P<0.001]and a higher proportion of arterial stiffness(36.2%vs.18.6%,P<0.001).There was no significant difference in other variables between these two groups(P>0.05).Ba-PWV in patients with primary hypertension was positively correlated with age,male sex,history of diabetes mellitus,total cholesterol,LDL-C and AIP(P<0.05),and negatively correlated with serum uric acid(P<0.05).Multivariate logistic regression analysis showed that after adjusting for confounders,the risk of arterial stiffness in the high AIP group was higher(OR=1.34,95%CI:1.07-2.03,P=0.013).The generalized additive model showed that there was a dose-response relationship between AIP and change rate of ba-PWV.When AIP index was<3,the change rate of ba-PWV increased by 18.9 cm·s^(-1)·year^(-1)for each unit increase of AIP.When AIP

关 键 词：血浆致动脉粥样硬化指数 动脉硬化 臂踝脉搏波速度 原发性高血压 

分 类 号：R54[医药卫生—心血管疾病]