心脏代谢指数与代谢相关脂肪性肝病患者新发心肌梗死的关联

Association between cardiometabolic index and risk of new-onset myocardial infarction in patients with metabolic-associated fatty liver disease

    摘要
  • 摘要:
    目的 探讨心脏代谢指数（CMI）与代谢相关脂肪性肝病（MAFLD）人群新发心肌梗死的关联。
    方法 利用开滦研究数据库，以2006年度在开滦集团接受健康检查，基于腹部超声及体检资料诊断为MAFLD的30464名参与者作为观察对象。由甘油三酯/高密度脂蛋白胆固醇和腰高比计算CMI，根据基线CMI四分位数分为4组：第1四分位组（Q1组，CMI＜0.43），第2四分位组（Q2组，CMI 0.43～＜0.65），第3四分位组（Q3组，CMI 0.65～＜1.05），第4四分位组（Q4组，CMI≥1.05）。采用Kaplan-Meier法计算各组中心肌梗死累积发病率，并使用类log-rank检验比较组间差异。采用Cox比例风险模型分析MAFLD人群中CMI对新发心肌梗死的影响，并根据性别、年龄、是否患有糖尿病进行分层分析。在敏感性分析中，分别排除随访2年内发生终点事件以及基线服用降压药、降血糖药和调血脂药人群后，重复进行Cox比例风险分析。
    结果 平均随访（14.70±3.25）年，共新发心肌梗死943例。随着CMI四分位数的升高，心肌梗死累积发病率呈现上升趋势，Q1～Q4组累积发病率分别为2.30%、3.14%、3.31%、3.66%（log-rank 检验，χ2 = 25.613，P = 0.002）。多因素Cox回归分析显示，校正其他混杂因素后，Q4组发生心肌梗死的风险是Q1组的1.41倍，HR（95%CI）为1.41（1.12～1.79）。分层分析结果显示，在男性、年龄＜60岁及非糖尿病人群中可观察到CMI水平升高与心肌梗死风险增加相关，Q4组心肌梗死风险分别是Q1组的1.47、1.54、1.73倍，HR（95%CI）分别为1.47（1.14～1.89）、1.54（1.14～2.09）、1.73（1.31～2.28），但是CMI与性别和年龄之间的交互作用未达到统计学意义（P＞0.05）。敏感性分析结果稳健。
    结论 在MAFLD人群中CMI升高会增加心肌梗死的发病风险。

     

    Abstract:
    Objective To investigate the association between cardiometabolic index (CMI) and new-onset myocardial infarction (MI) in the adults with metabolic-associated fatty liver disease (MAFLD).
    Methods The Kailuan database was used. A total of 30464 participants who underwent health examinations at the Kailuan Group in 2006 and were diagnosed with MAFLD based on abdominal ultrasonography and health check-up data were included. CMI was derived from the triglyceride/high density lipoprotein cholesterol ratio and the waist-to-height ratio, and the participants were categorized into four groups based on baseline CMI quartiles: Q1 (CMI＜0.43), Q2 (CMI 0.43 to ＜0.65), Q3 (CMI 0.65 to ＜1.05), and Q4 (cumCMI≥1.05). The cumulative incidence of MI was calculated using the Kaplan-Meier method, and differences between groups were compared using the log-rank test. Cox proportional hazards model was used to assess the impact of CMI on new-onset MI in the MAFLD population and its subtypes, with stratification by age, gender and diabetes mellitus. In the sensitivity analysis, the Cox model was repeated after excluding individuals who experienced endpoint events within 2 years of follow-up, and individuals taking antihypertensive drugs, antihyperglycemics, and blood-lipid modulators at baseline.
    Results During a mean follow-up of (14.70±3.25) years, 943 MI cases occurred. The cumulative incidence of MI increased with ascending CMI quartiles. The cumulative incidence rates of MI in Q1 to Q4 groups were 2.30%, 3.14%, 3.31%, and 3.66%, respectively (log-rank test, χ2 = 25.613, P = 0.002). Multivariate Cox regression analysis showed that after adjusting for confounding factors, the risk of MI in Q4 group was 1.41 times that in Q1 group, HR (95%CI) was 1.41 (1.12 to 1.79). Stratified analysis revealed that elevated CMI was associated with an increased risk of MI in males, individuals aged＜60 years, and non-diabetic participants. The risk of MI in Q4 group were 1.47 times, 1.54 times, and 1.73 times that in Q1 group, HRs (95%CI) were 1.47 (1.14 to 1.89), 1.54 (1.14 to 2.09), 1.73 (1.31 to 2.28), respectively. However, the interaction between CMI level and sex or age had not significance (P ＞ 0.05). Sensitivity analysis yielded consistent results.
    Conclusion Elevated CMI levels in the MAFLD population are associated with an increased risk of MI.

     

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