甘油三酯腰围表型与老年男性阻塞性睡眠呼吸暂停患者不良心血管事件的相关性  

Correlation between triglyceride-waist-circumference phenotype and adverse cardiovascular events in elderly male patients with obstructive sleep apnea

作　　者：李天骄 韩继明[1] 赵力博 高莹卉 李开亮 薛鑫 聂庭玉 刘霖 Li Tianjiao;Han Jiming;Zhao Libo;Gao Yinghui;Li Kailiang;Xue Xin;Nie Tingyu;Liu Lin(Medical College,Yan'an University,Yan'an 716000,Shaanxi Province,China;Department of Respiratory and Critical Care Medicine,Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Graduate School,Chinese PLA General Hospital,Beijing 100853,China;Sleep Center,Peking University International Hospital,Beijing 102206,China;Department of Cardiology,Second Medical Center,Chinese PLA General Hospital,Beijing 100853,China;National Clinical Research Center for Geriatric Diseases,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]延安大学医学院,陕西延安716000 [2]中国人民解放军总医院第二医学中心呼吸与危重症医学科,北京100853 [3]中国人民解放军总医院研究生院,北京100853 [4]北京大学国际医院睡眠中心,北京102206 [5]中国人民解放军总医院第二医学中心心血管内科,北京100853 [6]中国人民解放军总医院国家老年疾病临床医学研究中心,北京100853

出　　处：《中华老年多器官疾病杂志》2025年第3期182-186,共5页Chinese Journal of Multiple Organ Diseases in the Elderly

基　　金：军队保健专项科研课题(22BJZ52,23BJZ27);军队装备建设应用研究项目(LB20211A010013);军队实验动物专项研究项目(SYDW_KY[2021]04)。

摘　　要：目的探讨老年男性阻塞性睡眠呼吸暂停(OSA)患者合并高甘油三酯(TG)和(或)高腰围表型对主要不良心血管事件(MACE)风险的影响。方法选择2015年1月至2017年10月中国人民解放军总医院、北京大学国际医院等多中心连续纳入的704例符合研究条件的老年男性OSA患者为研究对象。按TG腰围表型将患者分为4组,即TG腰围正常组(NTNW,173例)、单纯高TG症组(HTNW,95例)、单纯腹型肥胖组(NTGW,299例)和高TG腰围组(HTGW,137例)。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用Kruskal-Wallis检验或χ^(2)检验比较4组患者人口学和临床病理学特征、合并症、睡眠参数与实验室检查结果的差异。采用Kaplan-Miere生存分析检验4组老年男性OSA患者组间累积生存率。采用Cox回归分析HTGW表型老年男性OSA患者MACE的发生情况。结果4组患者年龄、体质量指数(BMI)、腰围(WC)、收缩压(SBP)、舒张压(DBP)、TG、低密度脂蛋白胆固醇(LDL-C)、呼吸暂停低通气指数(AHI)、氧减指数(ODI)、高脂血症史及高血压史比较,差异均有统计学意义(P<0.05)。704例患者中,68例(9.7%)老年男性OSA患者发生MACE,其中HTGW组MACE发生率更高(16.1%)。HTGW组累积生存率低于其他3组(P Logrank=0.007)。Cox回归分析显示,HTGW与老年男性OSA患者MACE发生有关,风险比(HR)为2.290(95%CI 1.153~4.548;P=0.018)。调整混杂因素后,结论一致,调整后的风险比(aHR)为4.433(95%CI 1.496~13.132;P=0.007)。此外,年龄(HR=1.051,95%CI 1.017~1.086;P<0.01)及高收缩压水平(HR=1.025,95%CI 1.012~1.038;P<0.001)是老年OSA患者MACE发生的危险因素。结论HTGW表型的老年男性OSA患者MACE的发生风险相对更高。Objective To investigate the effect of high triglyceride(TG)and/or high waist circumference phenotypes on the risk of major adverse cardiovascular events(MACE)in elderly males with obstructive sleep apnea(OSA).Methods A total of 704 consecutive elderly male OSA patients were enrolled from multiple centers including the Chinses PLA General Hospital and Peking University International Hospital,etc,from January 2015 to October 2017.The patients were categorized into four groups according to triglyceride-waist-circumference phenotype,normal TG with normal WC(NTNW)group(n=173),high TG with normal WC(HTNW)group(n=95),normal TG with enlarged WC(NTGW)group(n=299),and high triglyceride-waist-circumference(HTGW)group(n=137).SPSS 26.0 was used for data analysis.According to the data type,Kruskal-Wallis test or χ^(2) test was used to compare the differences in demographic characteristics,clinical pathological characteristics,comorbidities,sleep parameters,and laboratory findings among the four groups.Kaplan-Miere survival analysis was used to test the cumulative survival rate among the four groups of elderly male OSA patients,and Cox regression analysis was used to analyze the occurrence of MACE of elderly male OSA patients with HTGW phenotype.Results The differences were all statistically significant among the four groups in age,body mass index(BMI),waist circumference(WC),systolic blood pressure(SBP),diastolic blood pressure(DBP),TG,low-density lipoprotein cholesterol(LDL-C),apnea hypopnea index(AHI),oxygen desaturation index(ODI),history of hyperlipidemia,and history of hypertension(P<0.05).Of the 704 patients,MACE occurred in 68(9.7%),with the highest incidence of MACE in the HTGW group(16.1%).The cumulative survival rate was lower in the HTGW group than those in the other three groups(P Logrank=0.007).COX regression analysis showed that HTGW was associated with the occurrence of MACE in elderly male OSA patients,with a hazard ratio(HR)of 2.290(95%CI 1.153-4.548;P=0.018).After adjusting for confounders,the findings were

关 键 词：老年人 阻塞性睡眠呼吸暂停 高甘油三酯腰围 肥胖 男性 

分 类 号：R56[医药卫生—呼吸系统] R54[医药卫生—内科学]