血脂与左心室肥厚的联系—1项来自于回顾性研究的新证据

doi:10.24920/004066

Chinese Medical Sciences Journal ›› 2022, Vol. 37 ›› Issue (2): 103-117.doi: 10.24920/004066

血脂与左心室肥厚的联系—1项来自于回顾性研究的新证据

黄学伟^1,⁵,邓克穷^2,^3,⁴,秦娟娟^1,⁵,雷昉^5,⁶,张兴元^5,⁶,汪文鑫^1,⁵,林立金^1,⁵,郑宇明⁷,幺冬爱⁸,卢惠明⁹,刘烽¹⁰,陈立东¹¹,张桂兰¹²,刘跃平^13,¹⁴,杨琼玉¹⁵,蔡菁菁¹⁶,折志刚^1,^5,^*(),李红良^1,^3,^5,^*()

¹武汉大学人民医院心血管内科,武汉 430060
²黄冈市中心医院心血管内科,黄冈 438000
³黄冈市医学转化研究院,黄冈 438000
⁴武汉大学中南医院心血管内科,武汉 430071
⁵武汉大学模式动物研究所,武汉 430071
⁶武汉大学基础医学院,武汉 430071
⁷湖北省中西医结合医院信息中心,武汉 430015
⁸武汉大学中南医院体检中心,武汉 430071
⁹华润武钢总医院综合医疗科,武汉 430000
¹⁰湖北省中西医结合医院信息中心,武汉 430015
¹¹湖北医药学院太和医院体检中心,十堰 442000
¹²武汉科技大学附属孝感医院健康管理中心,孝感 432000
¹³中部战区总医院基础医学实验室,武汉 430070
¹⁴中枢神经系统肿瘤发生与干预湖北省重点实验室,武汉 430070
¹⁵十堰市人民医院中医科,十堰 442000
¹⁶中南大学湘雅三医院心血管内科,长沙 410000

收稿日期:2022-01-22 接受日期:2022-03-01 出版日期:2022-06-30 发布日期:2022-03-02
通讯作者: 折志刚,李红良 E-mail:zgshe@whu.edu.cn;lihl@whu.edu.cn

Association Between Lipid Profiles and Left Ventricular Hypertrophy: New Evidence from a Retrospective Study

Xuewei Huang^1,⁵,Keqiong Deng^2,^3,⁴,Juanjuan Qin^1,⁵,Fang Lei^5,⁶,Xingyuan Zhang^5,⁶,Wenxin Wang^1,⁵,Lijin Lin^1,⁵,Yuming Zheng⁷,Dongai Yao⁸,Huiming Lu⁹,Feng Liu¹⁰,Lidong Chen¹¹,Guilan Zhang¹²,Yueping Liu^13,¹⁴,Qiongyu Yang¹⁵,Jingjing Cai¹⁶,Zhigang She^1,^5,^*(),Hongliang Li^1,^3,^5,^*()

¹Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
²Department of Cardiology, Center Hospital of Huanggang, Huanggang, Hubei 438000, China
³Huanggang Institute of Translation Medicine, Huanggang, Hubei 438000, China
⁴Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
⁵Institute of Model Animal, Wuhan 430071, China
⁶School of Basic Medical Science, Wuhan University, Wuhan 430071, China
⁷Physical Examination Center, The Central Hospital of Wuhan, Wuhan 430014, China
⁸Physical Examination Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
⁹General Medical Department, CR & WISCO General Hospital, Wuhan 430000, China
¹⁰Information Center, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan 430015, China
¹¹Department of Medical Examination Center, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
¹²Department of Health Management, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Xiaogan, Hubei 432000, China
¹³Basic Medical Laboratory, General Hospital of Central Theater Command, Wuhan 430070, China
¹⁴Hubei Key Laboratory of Central Nervous System Tumor and Intervention, Wuhan 430070, China
¹⁵Chinese Medicine Center, Shiyan Renmin Hospital, Shiyan, Hubei 442000, China
¹⁶Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410000, China

Received:2022-01-22 Accepted:2022-03-01 Published:2022-06-30 Online:2022-03-02
Contact: Zhigang She,Hongliang Li E-mail:zgshe@whu.edu.cn;lihl@whu.edu.cn

1. Supplementary Table S1-4 and Fig S1.pdf(1532KB)

摘要/Abstract

摘要：

目的在中国一般人群中探究血脂与左心室肥厚之间的联系。
方法为了探讨血脂与左心室肥厚之间的关系,我们开展了一项回顾性观察研究,纳入了以下血脂指标：甘油三酯、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、非高密度脂蛋白胆固醇、载脂蛋白A-I、载脂蛋白B、脂蛋白（a）和3种复合血脂指标。首先,我们构建了一项横断面研究,其中包含两个人群,分别来自于北京市和全国其他10个省份。受试者为2009年至2018年期间在中国不同健康管理中心进行体检的成年人,共计309,400人。然后,我们将7475名进行过多次体检且最初没有左心室肥厚的受试者组建了一个纵向队列,以分析各血脂指标与新发左心室肥厚之间的关联。超声心动图被用于诊断左心室肥厚（左心室肥厚为室间隔或左心室后壁的舒张末期厚度>11mm）。在横断面研究中采用Logistic回归模型。在队列研究中采用Cox比例风险回归模型和限制性立方样条Cox比例风险回归模型。
结果横断面研究显示：与对应血脂指标水平处于人群最低三分之一的受试者相比,甘油三酯（OR：1.250, 95%CI：1.060~1.474）、高密度脂蛋白胆固醇（OR：0.780,95%CI：0.662~0.918）和脂蛋白(a)（OR：1.311,95%CI：1.115~1.541）水平处于最高三分之一的受试者的左心室肥厚风险增加。队列研究显示：相比于基线时对应血脂指标处于最低三分之一的受试者,甘油三酯（HR：3.277,95%CI：1.720~6.244）、高密度脂蛋白胆固醇（HR：0.516,95%CI：0.283~0.940）,非高密度脂蛋白胆固醇（HR：2.309,95%CI：1.296~4.112）及载脂蛋白B（HR：2.244,95%CI：1.251~4.032）水平处于最高三分之一的受试者发生左心室肥厚的风险增加。在向前逐步回归的Cox模型中,甘油三酯是进入最终模型的唯一脂质标志物。
结论脂质水平,尤其是甘油三酯,与左心室肥厚有关。管控甘油三酯水平有可能成为阻止心室重塑的一种新途径,值得进一步深入研究。

关键词: 左心室肥厚, 脂质, 甘油三酯, 载脂蛋白

Abstract:

Objective To explore the association between lipid profiles and left ventricular hypertrophy in a Chinese general population.
Methods We conducted a retrospective observational study to investigate the relationship between lipid markers [including triglycerides, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein (HDL) cholesterol, non-HDL-cholesterol, apolipoprotein A-I, apolipoprotein B, lipoprotein[a], and composite lipid profiles] and left ventricular hypertrophy. A total of 309,400 participants of two populations (one from Beijing and another from nationwide) who underwent physical examinations at different health management centers between 2009 and 2018 in China were included in the cross-sectional study. 7,475 participants who had multiple physical examinations and initially did not have left ventricular hypertrophy constituted a longitudinal cohort to analyze the association between lipid markers and the new-onset of left ventricular hypertrophy. Left ventricular hypertrophy was measured by echocardiography and defined as an end-diastolic thickness of the interventricular septum or left ventricle posterior wall > 11 mm. The Logistic regression model was used in the cross-sectional study. Coxmodel and Coxmodel with restricted cubic splines were used in the longitudinal cohort.
Results In the cross-sectional study, for participants in the highest tertile of each lipid marker compared to the respective lowest, triglycerides [odds ratio (OR): 1.250, 95%CI: 1.060 to 1.474], HDL-cholesterol (OR: 0.780, 95%CI: 0.662 to 0.918), and lipoprotein(a) (OR: 1.311, 95%CI: 1.115 to 1.541) had an association with left ventricular hypertrophy. In the longitudinal cohort, for participants in the highest tertile of each lipid marker at the baseline compared to the respective lowest, triglycerides [hazard ratio (HR): 3.277, 95%CI: 1.720 to 6.244], HDL-cholesterol (HR: 0.516, 95%CI: 0.283 to 0.940), non-HDL-cholesterol (HR: 2.309, 95%CI: 1.296 to 4.112), apolipoprotein B (HR: 2.244, 95%CI: 1.251 to 4.032) showed an association with new-onset left ventricular hypertrophy. In the Coxmodel with forward stepwise selection, triglycerides were the only lipid markers entered into the final model.
Conclusion Lipids levels, especially triglycerides, are associated with left ventricular hypertrophy. Controlling triglycerides level potentiate to be a strategy in harnessing cardiac remodeling but deserve to be further investigated.

Key words: left ventricular hypertrophy, lipid, triglycerides, apolipoprotein

Xuewei Huang, Keqiong Deng, Juanjuan Qin, Fang Lei, Xingyuan Zhang, Wenxin Wang, Lijin Lin, Yuming Zheng, Dongai Yao, Huiming Lu, Feng Liu, Lidong Chen, Guilan Zhang, Yueping Liu, Qiongyu Yang, Jingjing Cai, Zhigang She, Hongliang Li. Association Between Lipid Profiles and Left Ventricular Hypertrophy: New Evidence from a Retrospective Study[J].Chinese Medical Sciences Journal, 2022, 37(2): 103-117.

图/表 6

Items	Overall	Normal LV wall thickness	LV wall thickening	Z or χ²	P
n	66,033	61,682 (93.40%)	4,351 (6.60%)
Age (yrs)	49 (43, 54)	48 (43, 54)	52 (47, 59)	27.46	<0.001
Women [n (%)]	23,118 (35.01)	22,573 (36.60)	545 (12.53)	1,034.90	<0.001
BMI (kg/m²)	25.18 (22.97, 27.38)	25.00 (22.83, 27.18)	27.52 (25.61, 29.64)	46.51	<0.001
Obesity [n (%)]	11,512 (19.74)	9,811 (18.02)	1,701 (44.19)	1,554.67	<0.001
Systolic blood pressure (mmHg)	121 (109, 134)	120 (108, 133)	136 (125, 150)	49.79	<0.001
Hypertension [n (%)]	13,839 (23.51)	11,808 (21.48)	2,031 (52.25)	1,911.29	<0.001
Total cholesterol (mmol/L)	4.75 (4.17, 5.39)	4.75 (4.17, 5.39)	4.79 (4.16, 5.46)	2.12	0.034
LDL-cholesterol (mmol/L)	3.06 (2.53, 3.61)	3.06 (2.53, 3.61)	3.07 (2.50, 3.63)	-0.81	0.417
HDL-cholesterol (mmol/L)	1.17 (0.97, 1.41)	1.17 (0.98, 1.42)	1.06 (0.89, 1.26)	-24.86	<0.001
Non-HDL-cholesterol (mmol/L)	3.54 (2.95, 4.17)	3.53 (2.94, 4.16)	3.70 (3.10, 4.33)	11.08	<0.001
Triglycerides (mmol/L)	1.46 (1.01, 2.19)	1.44 (0.99, 2.16)	1.79 (1.27, 2.73)	24.92	<0.001
Total cholesterol/HDL-c ratio	4.05 (3.27, 4.97)	4.02 (3.24, 4.93)	4.50 (3.72, 5.40)	23.44	<0.001
Triglycerides/HDL-c ratio	1.26 (0.76, 2.13)	1.23 (0.74, 2.08)	1.71 (1.06, 2.82)	27.97	<0.001
Apolipoprotein B (g/L)	0.91 (0.77, 1.07)	0.91 (0.76, 1.06)	0.94 (0.80, 1.10)	9.64	<0.001
Apolipoprotein A-I (g/L)	1.31 (1.16, 1.48)	1.32 (1.16, 1.49)	1.27 (1.13, 1.43)	-11.01	<0.001
ApoB/ApoA-I ratio	0.70 (0.56, 0.85)	0.69 (0.56, 0.84)	0.74 (0.61, 0.88)	14.30	<0.001
Lipoprotein(a) (mg/L)	119.00 (45.60, 261.00)	119.00 (45.30, 262.00)	119.00 (50.00, 254.00)	-0.51	0.610
Uric acid (μmol/L)	337.00 (274.00, 399.00)	333.00 (271.00, 396.10)	376.00 (321.00, 436.00)	30.42	<0.001
Hemoglobin A1c (%)	5.60 (5.30, 5.90)	5.50 (5.30, 5.90)	5.80 (5.50, 6.40)	29.43	<0.001
Fasting blood-glucose (mmol/L)	5.30 (4.92, 5.86)	5.28 (4.90, 5.81)	5.77 (5.24, 6.75)	36.27	<0.001
Diabetes mellitus [n (%)]	10,284 (15.60)	8,906 (14.46)	1,378 (31.69)	915.73	<0.001
C-reactive protein (mg/L)	1.20 (0.70, 2.10)	1.20 (0.70, 2.00)	1.60 (0.90, 2.80)	19.08	<0.001
Hemoglobin (g/L)	147.00 (134.00, 157.00)	146.00 (134.00, 157.00)	152.00 (143.00, 160.00)	22.72	<0.001
Red blood cell (×10¹²/L)	4.77 (4.43, 5.09)	4.76 (4.42, 5.09)	4.92 (4.61, 5.19)	19.80	<0.001
White blood cell (×10⁹/L)	5.87 (4.98, 6.92)	5.85 (4.96, 6.90)	6.15 (5.25, 7.20)	12.15	<0.001
Alanine transaminase (IU/L)	19.95 (14.10, 29.50)	19.70 (13.90, 29.10)	23.95 (17.10, 34.80)	21.77	<0.001
Aspartate transaminase (IU/L)	18.40 (15.40, 22.70)	18.40 (15.40, 22.60)	19.40 (16.10, 24.90)	13.07	<0.001
GGT (IU/L)	28.00 (17.00, 49.00)	27.00 (16.30, 48.00)	39.00 (25.00, 69.00)	31.22	<0.001
Serum creatinine (μmol/L)	67.00 (57.00, 77.00)	67.00 (57.00, 77.00)	71.00 (63.00, 80.00)	20.65	<0.001
eGFR [ml/(min·1.73m²)]	105.72 (95.24, 112.34)	105.90 (95.81, 112.48)	102.89 (81.83, 110.31)	-16.40	<0.001
Albumin (g/L)	45.00 (42.60, 47.30)	45.00 (42.60, 47.30)	45.20 (42.70, 47.20)	1.30	0.194
Blood urea nitrogen (mmol/L)	5.00 (4.30, 5.90)	5.00 (4.30, 5.90)	5.30 (4.50, 6.20)	16.41	<0.001
Platelet count (×10⁹/L)	220.00 (187.00, 256.00)	220.00 (187.00, 257.00)	209.00 (177.00, 244.00)	-13.53	<0.001
C-peptide (ng/ml)	2.42 (1.88, 3.09)	2.38 (1.85, 3.04)	3.00 (2.39, 3.73)	38.11	<0.001
Fasting insulin (mU/L)	9.22 (6.38, 13.36)	9.07 (6.28, 13.08)	11.87 (8.29, 17.14)	29.86	<0.001
HOMA-IR	2.28 (1.48, 3.54)	2.27 (1.47, 3.50)	2.50 (1.63, 3.98)	10.17	<0.001

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Variables	HR (95%CI)^a	P value
Age (yrs)	1.032 (1.017,1.046)	<0.001
Sex (female/male)	0.352 (0.239,0.519)	<0.001
BMI (kg/m²)	1.124 (1.086,1.164)	<0.001
Systolic blood pressure (mm Hg)	1.026 (1.020,1.033)	<0.001
Blood urea nitrogen (mmol/L)	1.099 (1.007,1.200)	0.034
Triglycerides
First tertile (≤1.18 mmol/L)	Reference
Second tertile (1.18-1.92 mmol/L)	1.827 (1.277,2.614)	0.001
Third tertile (≥1.92 mmol/L)	1.904 (1.336,2.714)	<0.001

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