颈动脉最大斑块面积纵向变化轨迹与新发心血管疾病的队列研究  

A cohort study of longitudinal change trajectories of carotid artery maximum plaque area on the new-onsetcardiovascular diseases

作　　者：吴都 陆梅佳 张康峰 WU Du;LU Meijia;ZHANG Kangfeng(Health Management Center of Hangzhou Wuyunshan Hospital,Hangzhou,Zhejiang Province 310009,China)

机构地区：[1]杭州市五云山医院(杭州市健康促进研究院)健康管理中心,浙江省杭州310009

出　　处：《中国慢性病预防与控制》2024年第2期106-110,共5页Chinese Journal of Prevention and Control of Chronic Diseases

基　　金：杭州市农业与社会发展科研一般项目(20201203B196)。

摘　　要：目的 探讨颈动脉最大斑块面积纵向轨迹对新发心血管疾病(CVD)的预测价值,为CVD的防治提供科学依据。方法选择在杭州市五云山医院连续参加2014、2015、2016、2017和2018年5次健康体检的65岁及以上体检人群作为研究对象,回顾性分析2014—2018年度5次健康体检时的颈动脉最大斑块面积数值。以2018年度健康体检时点为随访起点,以发生CVD为随访终点,排除不能遵守随访方案、自愿退出研究者共30例,最终纳入研究对象411例,依据颈动脉最大斑块面积纵向轨迹分为低水平渐增组(198例)、中水平渐增组(174例)、高水平升高组(20例)和先升后降组(19例)。基线调查和随访调查均包括病史采集、体格检查、实验室检查和颈动脉超声检查。采用R 4.2.1统计软件中的潜变量混合增长模型(LCMM)建立颈动脉最大斑块面积轨迹模型,采用SPSS 26.0软件进行单因素方差分析、Kruskal-Wallis秩和检验、χ^(2)检验、χ^(2)_(趋势)检验、Cox比例风险回归模型分析。结果随访(3.57±1.03)年,新发CVD 70例,发病密度为4.78/100人年。随着颈动脉最大斑块面积纵向轨迹的升高,CVD的发病密度呈上升趋势(χ^(2)_(趋势)=22.221,P<0.01),高水平升高组发病密度最高,为20.37/100人年。Cox比例风险回归模型分析结果显示,校正混杂因素后,高水平升高组CVD的发病风险是低水平渐增组的8.787倍(95%CI:3.684~20.955),差异有统计学意义(P<0.05)。结论65岁及以上老年人群颈动脉最大斑块面积存在不同纵向变化轨迹,且不同纵向轨迹对新发CVD的预测价值不同,颈动脉最大斑块面积纵向轨迹高水平升高老年人群CVD发生风险高。Objective To explore the value of the longitudinal change trajectories of the carotid artery maximum plaque area in predicting new-onset cardiovascular diseases(CVD),and provide the scientific basis for the prevention and treatment of CVD.Methods People(≥65 years old)who participated in continuing 5 physical examinations in 2014,2015,2016,2017 and 2018 in Hangzhou Wuyunshan Hospital,were selected as the subjects.The retrospective analysis was performed for the carotid artery maximum plaque area values in continuing 5 physical examinations from 2014 to 2018.The physical examination in 2018 served as the starting point of follow-up,and developing CVD served as the end point of follow-up,excluding 30 cases who could not comply with the follow-up plan and voluntarily withdrew from the study,and 411 cases were finally included in the study.According to the longitudinal change trajectories of carotid artery maximum plaque area,198 cases served as the low levelincreasing group,174 cases served as the medium level-increasing group,20 cases served as the high level-increasing group and 19 cases served as decreasing after increasing group.The baseline and follow-up investigations included the history collection,physical examination,laboratory test,and carotid ultrasound.The trajectory model of the maximum carotid plaque area was established using the Latent class mixed model(LCMM),the used software was R 4.2.1.The single variance analysis,Kruskal-Wallis rank sum test,χ2 test,χ2 trend test and Cox proportional risk regression model were used to analyze the data,the used software was SPSS 26.0.Results The duration of followed up was(3.57±1.03)years,new CVD patients were 70 cases,the incidence density was 4.78/100 person-years.The trend of CVD incidence density elevated with the increase of the longitudinal trajectory of the carotid artery maximum plaque area(χ2 trend=22.221,P<0.01),the CVD incidence density in the high level-increasing group was the highest(20.37/100 person-years).Cox proportional risk regression analy

关 键 词：颈动脉最大斑块面积 纵向轨迹 心血管疾病 队列研究 

分 类 号：R543.5[医药卫生—心血管疾病]