颈动脉斑块危险因素的巢式病例对照研究  

Nested case-control study on risk factors of carotid artery plaques

作　　者：孙小平 高宁 陈睿迪 闫雯[1] 王敏珍[2] SUN Xiao-ping;GAO Ning;CHEN Rui-di;YAN Wen;WANG Min-zhen(Health Management Center,The Second Hospital of Lanzhou University,Lanzhou,Gansu 730000,China;不详)

机构地区：[1]兰州大学第二医院健康管理中心,甘肃兰州730000 [2]兰州大学公共卫生学院流行病与卫生统计学研究所,甘肃兰州730000

出　　处：《现代预防医学》2025年第5期942-948,共7页Modern Preventive Medicine

基　　金：甘肃省自然科学基金(23JRRA0997,24JRRA351);甘肃省卫生行业科研计划项目(GSWSKY-2019-19);兰州市科技计划项目(2023-02-27)。

摘　　要：目的 基于前瞻性动态队列分析颈动脉斑块发生的影响因素。方法 采用巢式病例对照研究,以2018年3月-2023年11月新发1 150例颈动脉斑块患者为病例组,按照同性别、年龄±3岁、初检时间同年同月原则,1∶1个体匹配1 150例未发生颈动脉斑块者为对照组,最终纳入2 300名研究对象。采用条件logistic回归模型分析颈动脉斑块发生的影响因素,同时运用三分位数分层和限制性立方样条(restricted cubic spline,RCS)分析不同暴露因素对颈动脉斑块发病风险的剂量-反应关系。结果 多因素条件logistic回归分析结果显示,血清高密度脂蛋白胆固醇(high density lipoprotein-cholesterol,HDL-C)异常(OR=1.370,95%CI:1.073~1.748)、尿素氮/肌酐(OR=1.024,95%CI:1.004~1.044)以及红细胞分布宽度-SD(OR=1.037,95%CI:1.003~1.072)是颈动脉斑块的危险因素,总蛋白(OR=0.966,95%CI:0.944~0.988)是颈动脉斑块的保护因素。RCS结果显示,HDL-C、总蛋白与颈动脉斑块发病风险呈负向线性剂量-反应关系,尿素氮/肌酐与颈动脉斑块发病风险呈正向线性剂量-反应关系(P for overall<0.05,P for non-linear>0.05),未发现红细胞分布宽度-SD与颈动脉斑块发病风险间存在剂量-反应关系。结论 HDL-C、总蛋白、尿素氮/肌酐和红细胞分布宽度-SD与颈动脉斑块的发病有关,且HDL-C、尿素氮/肌酐、总蛋白与颈动脉斑块的发病风险存在线性剂量-反应关系。Objective To analyze the influencing factors of carotid artery plaque occurrence based on a prospective dynamic cohort.Methods A nested case-control study was adopted.A total of 1150 newly-diagnosed patients with carotid artery plaques from March 2018 to November 2023 were selected as the case group.According to the principles of the same gender,age±3 years,and the same year and month of the initial examination,1150 individuals without carotid artery plaques were individually matched at a ratio of 1:1 as the control group.Finally,2300 subjects were included in the study.A conditional Logistic regression model was used to analyze the influencing factors of carotid artery plaque occurrence.Meanwhile,the dose-response relationship between different exposure factors and the risk of carotid artery plaque was analyzed by using tertile stratification and restricted cubic spline(RCS).Results The results of multivariate conditional Logistic regression analysis showed that abnormal serum high-density lipoprotein-cholesterol(HDL-C)(OR=1.370,95%CI:1.073-1.748),blood urea nitrogen/creatinine(OR=1.024,95%CI:1.004-1.044),and red blood cell distribution width-SD(OR=1.037,95%CI:1.003-1.072)were risk factors for carotid artery plaques,while total protein(OR=0.966,95%CI:0.944-0.988)was a protective factor.The RCS results showed that there was a negative linear dose-response relationship between HDL-C,total protein and the risk of carotid artery plaque,and a positive linear dose-response relationship between blood urea nitrogen/creatinine and the risk of carotid artery plaque(P overall<0.05,P non-linear>0.05).No dose-response relationship was found between red blood cell distribution width-SD and the risk of carotid artery plaque.Conclusion HDL-C,total protein,blood urea nitrogen/creatinine,and red blood cell distribution width-SD are associated with the occurrence of carotid artery plaques,and there is a linear dose-response relationship between HDL-C,blood urea nitrogen/creatinine,total protein and the risk of carotid artery plaq

关 键 词：颈动脉斑块 危险因素 巢式病例对照研究 

分 类 号：R543.4[医药卫生—心血管疾病]