血脂正常人群血浆致动脉粥样硬化指数与动脉粥样硬化性心血管疾病及全因死亡风险的关联性研究  

Association of plasma atherosclerotic index with risks of atherosclerotic cardiovascular diseases and all-cause mortality in normolipidemic individuals

作　　者：王美肖 刘露晴 刘士贺 刘智慧 陈奕秀 温薪冉 吴寿岭[2] 吴云涛[2] Wang Meixiao;Liu Luqing;Liu Shihe;Liu Zhihui;Chen Yixiu;Wen Xinran;Wu Shouling;Wu Yuntao(Graduate School,North China University of Science and Technology,Tangshan 063210,China;Department of Cardiology,Kailuan General Hospital,Tangshan 063000,China;Department of Respiratory Medicine,Kailuan General Hospital,Tangshan 063000,China;Department of Rheumatic Immunity,Kailuan General Hospital,Tangshan 063000,China)

机构地区：[1]华北理工大学研究生学院,唐山063210 [2]开滦总医院心内科,唐山063000 [3]开滦总医院呼吸科,唐山063000 [4]开滦总医院风湿免疫科,唐山063000

出　　处：《中国心血管杂志》2025年第2期158-167,共10页Chinese Journal of Cardiovascular Medicine

摘　　要：目的探讨血脂正常人群血浆致动脉粥样硬化指数(AIP)与动脉粥样硬化性心血管疾病(ASCVD)及全因死亡风险的关联性。方法前瞻性队列研究。纳入开滦研究2006—2007年接受健康体检且血脂水平正常、既往无ASCVD、肿瘤病史及使用降脂药的开滦集团职工共39215名作为研究对象,平均年龄(50.3±13.5)岁,男性30405名(77.5%)。以发生ASCVD或全因死亡为随访终点事件,未发生终点事件者随访至2021年12月31日。根据基线AIP三分位数将研究对象分为3组:T_(1)组(AIP<-0.273,13074名)、T_(2)组(-0.273≤AIP<-0.110,13063名)和T_(3)组(AIP≥-0.110,13078名)。采用Kaplan-Meier法计算不同AIP组ASCVD及全因死亡累积发病率,并采用log-rank检验进行组间比较。采用多因素Cox比例风险回归模型分析AIP与ASCVD及全因死亡风险的关联性,并对不同ASCVD风险人群如高血压、糖尿病、服用降压药、吸烟、饮酒及不同性别和年龄等进行分层分析。采用限制性立方样条回归模型分析AIP与ASCVD及全因死亡的剂量-反应关系。采用部分分布竞争风险模型进行AIP与ASCVD特定终点的分析。排除ASCVD中高危人群后,进行AIP与ASCVD发生风险的敏感性分析。结果随着AIP水平升高,T_(1)~T_(3)组中男性、体质指数、心率、糖尿病、高血压、服用降糖药和降压药的比例及收缩压、舒张压、空腹血糖、低密度脂蛋白胆固醇、三酰甘油、高敏C反应蛋白水平均呈升高趋势,高密度脂蛋白胆固醇呈下降趋势(均为P<0.001)。平均随访(14.9±3.2)年,4097名(10.4%)发生ASCVD,5251名(13.4%)发生死亡。经log-rank检验分析,3组ASCVD累积发病率差异有统计学意义(χ^(2)=65.24,P<0.001),而全因死亡累积发病率差异无统计学意义(χ^(2)=4.29,P=0.088)。多因素Cox比例风险回归模型分析结果显示,在血脂正常人群中,与T_(1)组相比,T_(3)组ASCVD发病风险增加17%(HR=1.17,95%CI:1.08~1.27),AIP每增加1个标准差,ASCVD的�Objective To investigate the association between atherogenic index of plasma(AIP)and risks of atherosclerotic cardiovascular diseases(ASCVD)and all-cause mortality in individuals with normal lipid levels.Methods A prospective cohort study was conducted.A total of 39215 employees in Kailuan Group who underwent physical examination between 2006 and 2007 and had normal blood lipid levels,no history of ASCVD,cancer,or use of lipid-lowering drugs were included from the Kailuan study.The average age was 50.3±13.5 years,and there were 30405 males(77.5%).The incidence of ASCVD or all-cause death were defined as endpoints,and individuals without endpoint events were followed up until December 31,2021.The subjects were divided into 3 groups according to the tertiles of baseline AIP:T_(1)group(AIP<-0.273,13074 cases),T_(2)group(-0.273≤AIP<-0.110,13063 cases)and T_(3)group(AIP≥-0.110,13078 cases).The Kaplan-Meier method was used to calculate the cumulative incidence of ASCVD and all-cause mortality in different AIP groups,and the log-rank test was used for comparison between groups.Multivariate Cox proportional hazards regression model was used to analyze the association between AIP and the risk of ASCVD or all-cause mortality.Stratified analyses were performed for different ASCVD risk groups such as hypertension,diabetes,antihypertensive medication use,smoking,drinking,sex and age.Restricted cubic spline regression model was used to analyze the dose-response relationship between AIP and ASCVD or all-cause mortality.Partial distribution competing risk model was used to analyze AIP and ASCVD specific endpoints.The sensitivity analysis of AIP and ASCVD after excluding the high-risk population of ASCVD was performed.Results With increasing AIP levels from T_(1)to T_(3),the proportion of males,body mass index,heart rate,prevalence of diabetes and hypertension,use of antidiabetic and antihypertensive medications,and levels of systolic and diastolic blood pressure,fasting blood glucose,low-density lipoprotein cholesterol,trig

关 键 词：动脉粥样硬化 心血管疾病 血浆致动脉粥样硬化指数 全因死亡 危险因素 关联性 

分 类 号：R54[医药卫生—心血管疾病]