中国非动脉硬化性心血管疾病人群脂蛋白(a)水平分布特征及影响因素  

Distribution and influencing factors of lipoprotein(a)levels in non-arteriosclerotic cardiovascular disease population in China

作　　者：柯雅蕾 潘烺 吕筠[1,2,3] 孙点剑一 裴培 陈怡平[4] 杨玲[4] 杜怀东[4] Clarke Robert 陈君石 陈铮鸣[4] 章晓 陈婷 李润琴 齐丽彤[7] 李立明[1,2,3] 余灿清[1,2,3] 中国慢性病前瞻性研究项目协作组 Ke Yalei;Pan Lang;Lyu Jun;Sun Dianjianyi;Pei Pei;Chen Yiping;Yang Ling;Du Huaidong;Clarke Robert;Chen Junshi;Chen Zhengming;Zhang Xiao;Chen Ting;Li Runqin;Qi Litong;Li Liming;Yu Canqing;for the China Kadoorie Biobank Collaborative Group(Department of Epidemiology and Biostatistics,School of Public Health,Peking University,Beijing 100191,China;Peking University Center for Public Health and Epidemic Preparedness&Response,Beijing 100191,China;Key Laboratory of Epidemiology of Major Diseases(Peking University),Ministry of Education,Beijing 100191,China;Clinical Trial Service Unit and Epidemiological Studies Unit,Nuffield Department of Population Health,University of Oxford,Oxford OX37LF,United Kingdom;China National Center for Food Safety Risk Assessment,Beijing 100022,China;Beijing Novartis Pharma Company Limited,Beijing 102200,China;Department of Cardiovascular Diseases,Peking University First Hospital,Beijing 100034,China;不详)

机构地区：[1]北京大学公共卫生学院流行病与卫生统计学系,北京100191 [2]北京大学公众健康与重大疫情防控战略研究中心,北京100191 [3]重大疾病流行病学教育部重点实验室(北京大学),北京100191 [4]牛津大学临床与流行病学研究中心纳菲尔德人群健康系,牛津OX37LF [5]国家食品安全风险评估中心,北京100022 [6]北京诺华制药有限公司,北京102200 [7]北京大学第一医院心内科,北京100034 [8]不详

出　　处：《中华流行病学杂志》2024年第6期779-786,共8页Chinese Journal of Epidemiology

基　　金：国家自然科学基金(82192904,82192901,82192900);国家重点研发计划“精准医学研究”重点专项(2016YFC0900500);中国香港Kadoorie Charitable基金。

摘　　要：目的描述中国非动脉硬化性心血管疾病(ASCVD)人群脂蛋白(a)[Lp(a)]的分布并分析其影响因素。方法基于中国慢性病前瞻性研究项目的一项巢式病例对照研究,选取其中进行了血液生化指标检测的对照人群进行分析,使用参比实验室检定的多克隆抗体比浊法测定Lp(a)水平,≥75.0 nmol/L定义为高Lp(a)。采用多因素logistic回归模型分析Lp(a)水平的影响因素。结果在纳入研究的5870名非ASCVD人群中,Lp(a)水平呈正偏态分布,M(Q_(1),Q_(3))为17.5(8.8,43.5)nmol/L。多因素logistic回归分析结果显示,女性与高Lp(a)相关(OR=1.23,95%CI:1.05~1.43),中心性肥胖者的高Lp(a)风险降低(OR=0.68,95%CI:0.52~0.89)。随TC、LDL-C、载脂蛋白A1(Apo A1)和载脂蛋白B(Apo B)水平升高,高Lp(a)风险增加,各升高组的OR值(95%CI)分别为2.40(1.76~3.24)、2.68(1.36~4.93)、1.29(1.03~1.61)和1.65(1.27~2.13);HDL-C降低组高Lp(a)风险降低,OR值(95%CI)为0.76(0.61~0.94);而TG、Apo A1与Apo B的比值(Apo A1/B)与高Lp(a)风险呈负相关,TG升高组的OR值(95%CI)为0.73(0.60~0.89),Apo A1/B升高组的OR值(95%CI)为0.60(0.50~0.72);Lp(a)水平与血脂指标(除Apo A1外)的相关性均存在线性趋势(线性趋势检验P≤0.001)。未发现行为生活方式因素如饮食、吸烟、体力活动水平与Lp(a)水平存在统计学关联。结论Lp(a)水平与性别及中心性肥胖有关,但受行为生活方式因素影响较小。Objective To describe the distribution of lipoprotein(a)[Lp(a)]levels in non-arteriosclerotic cardiovascular disease(ASCVD)population in China and explore its influencing factors.Methods This study was based on a nested case-control study in the CKB study measured plasma biomarkers.Lp(a)levels was measured using a polyclonal antibody-based turbidimetric assay certified by the reference laboratory and≥75.0 nmol/L defined as high Lp(a).Multiple logistic regression model was used to examine the factors related to Lp(a)levels.Results Among the 5870 non-ASCVD population included in the analysis,Lp(a)levels showed a right-skewed distribution,with a M(Q_(1),Q_(3))of 17.5(8.8,43.5)nmol/L.The multiple logistic regression analysis found that female was associated with high Lp(a)(OR=1.23,95%CI:1.05-1.43).The risk of increased Lp(a)levels in subjects with abdominal obesity was significantly reduced(OR=0.68,95%CI:0.52-0.89).As TC,LDL-C,apolipoprotein A1(Apo A1),and apolipoprotein B(Apo B)levels increased,the risk of high Lp(a)increased,with OR(95%CI)for each elevated group was 2.40(1.76-3.24),2.68(1.36-4.93),1.29(1.03-1.61),and 1.65(1.27-2.13),respectively.The risk of high Lp(a)was reduced in the HDL-C lowering group with an OR(95%CI)of 0.76(0.61-0.94).In contrast,an increase in TG levels and the ratio of Apo A1/Apo B(Apo A1/B)was negatively correlated with the risk of high Lp(a),with OR(95%CI)of 0.73(0.60-0.89)for elevated triglyceride group,and OR(95%CI)of 0.60(0.50-0.72)for the Apo A1/B ratio increase group(linear trend test P≤0.001 except for Apo A1).However,no correlation was found between Lp(a)levels and lifestyle factors such as diet,smoking,and physical activity.Conclusions Lp(a)levels were associated with sex and abdominal obesity,but less with lifestyle behaviors.

关 键 词：脂蛋白(a) 非动脉硬化性心血管疾病人群 分布 影响因素 

分 类 号：R54[医药卫生—心血管疾病]