脂质蓄积指数与中青年人群新发高血压发病风险的关系：一项队列研究

The association between lipid accumulation product and the risk of new-onset hypertension in young and middle-aged population: a cohort study

    摘要
  • 摘要:
    目的 探索脂质蓄积指数（LAP）与中青年人群新发高血压病发病风险的关联，为该人群高血压防治寻求极具临床实用性的新型指标。
    方法 利用前瞻性队列开滦研究数据库，以2006年度参加开滦集团职工健康查体的中青年人群（年龄＜65岁）作为研究对象，纳入49 738人进行回顾性队列研究。计算LAP：男性LAP=腰围（cm）−64.72×甘油三酯（mmol/L），女性 LAP=腰围（cm）−52.99×甘油三酯（mmol/L）。根据2006年体检LAP水平（LAP2006，单位为cm·mmol/L）四分位数将研究对象分为4组：第1四分位组（LAP2006＜14.75，n=12 433）；第2四分位组（LAP2006 14.75～＜25.95，n=12 429）；第3四分位组（25.95～＜45.67，n=12 441）；第4四分位组（≥45.67；n=12 435）。根据累积LAP（cLAP，单位为cm·mmol/L·年）暴露水平四分位数分为4组：第1四分位组（cLAP＜68.97；n=10 004）；第2四分位组（cLAP 68.97～＜111.14；n=10 005)；第3四分位组（cLAP 111.14～＜182.48；n=10 005）；第4四分位组（cLAP ≥182.48；n=10 005）。用Kaplan-Meier法绘制高血压累积发病率曲线，并采用log-rank检验比较组间差异。采用Cox比例风险回归模型分析不同LAP及cLAP水平对中青年人群新发高血压发病的影响。
    结果 中位随访9.6（4.0, 14.8）年期间，共16 529例（33.23%）受试者新发高血压。LAP2006第1～4四分位组累积新发高血压发病率分别为24.19%、33.43%、40.25%、47.39%。校正混杂因素后，Cox回归分析显示，与LAP2006第1四分位组比较，第2、3、4四分位组新发高血压的HR（95%CI）分别为1.28(1.22～1.35)、1.52(1.45～1.60)、1.66(1.57～1.76)。与cLAP第1四分位组比较，第2、3、4四分位组新发高血压的HR（95%CI）分别为1.30(1.21～1.39)、1.57(1.46～1.68)、1.86(1.73～1.98)。
    结论 LAP水平增高与中青年人群新发高血压发病风险增加相关，是中青年人群新发高血压的独立预测因子。

     

    Abstract:
    Objective To explore the association between lipid storage index (LAP) and the risk of new-onset hypertension in young and middle-aged people, and to seek new indicators for the prevention and treatment of hypertension in this population.
    Methods Using the prospective cohort database of the Kailuan Study, the middle-aged and young population (age ＜ 65 years) who participated in the health check-up of Kailuan Group in 2006 was selected as the research subjects, and a total of 49 738 people were included in the retrospective cohort study. LAP was calculated according to the following formula: for men LAP = waist circumference (cm)−64.72 × triglycerides (mmol/L), for women LAP = waist circumference (cm) − 52.99 × triglycerides (mmol/L). According to the LAP level in 2006 (LAP2006, cm·mmol/L ), the subjects were divided into 4 groups by quartiles: group Q1 (n = 12 443, LAP2006 ＜14.75 ); group Q2 (n =12 429, LAP2006 14.75 to ＜25.95); group Q3 (n =12 441, LAP2006 25.95 to ＜45.67); and group Q4 (n=12 435, LAP2006 ≥45.67). According to the quartiles of cumulative LAP (cLAP, unit: cm·mmol/L·year) exposure level, the subjects were divided into 4 groups: group Q1 (n =10 004, cLAP＜68.97); group Q2 (n =10 005, cLAP 68.97 to ＜111.14); group Q3 (n =10 005, cLAP 111.14 to ＜182.48); Q4 group (n =10 005, cLAP≥182.48). The cumulative incidence curves of hypertension were plotted using the Kaplan-Meier method, and the differences between groups were compared using the log-rank test. The Cox proportional hazards regression model was used to analyze the effects of different LAP and cLAP levels on the incidence of new-onset hypertension in the middle-aged and young population.
    Results During a median follow-up of 9.6 (4.0, 14.8) years, a total of 16 529 subjects (33.23%) developed new-onset hypertension. The cumulative incidence rates of new-onset hypertension in the first to fourth quartiles of LAP2006 were 24.19%, 33.43%, 40.25%, and 47.39%, respectively. After adjusting for confounding factors, Cox regression analysis showed that compared with the first quartile of LAP2006, the HRs (95%CI) for new-onset hypertension in the second, third, and fourth quartiles were 1.28 (1.22–1.35), 1.52 (1.45–1.60), and 1.66 (1.57–1.76), respectively. Compared with the first quartile of cLAP, the HRs (95%CI) for new-onset hypertension in the second, third, and fourth quartiles were 1.30 (1.21–1.39), 1.57 (1.46–1.68), and 1.86 (1.73–1.98), respectively.
    Conclusion The increase in LAP level is associated with an increased risk of new-onset hypertension in young and middle-aged people and is an independent predictor of new-onset hypertension in young and middle-aged people.

     

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