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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
- Affiliations：
1. 1Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, China
2. 2Department of Cardiology, Center Hospital of Huanggang, Huanggang, Hubei 438000, China
3. 3Huanggang Institute of Translation Medicine, Huanggang, Hubei 438000, China
4. 4Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
5. 5Institute of Model Animal, Wuhan 430071, China
6. 6School of Basic Medical Science, Wuhan University, Wuhan 430071, China
7. 7Physical Examination Center, The Central Hospital of Wuhan, Wuhan 430014, China
8. 8Physical Examination Center, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
9. 9General Medical Department, CR & WISCO General Hospital, Wuhan 430000, China
10. 10Information Center, Hubei Provincial Hospital of Integrated Chinese and Western Medicine, Wuhan 430015, China
11. 11Department of Medical Examination Center, Taihe Hospital, Hubei University of Medicine, Shiyan, Hubei 442000, China
12. 12Department of Health Management, Xiaogan Hospital Affiliated to Wuhan University of Science and Technology, Xiaogan, Hubei 432000, China
13. 13Basic Medical Laboratory, General Hospital of Central Theater Command, Wuhan 430070, China
14. 14Hubei Key Laboratory of Central Nervous System Tumor and Intervention, Wuhan 430070, China
15. 15Chinese Medicine Center, Shiyan Renmin Hospital, Shiyan, Hubei 442000, China
16. 16Department of Cardiology, The Third Xiangya Hospital, Central South University, Changsha 410000, China
- Author bio：
Zhigang She, E-mail: zgshe@whu.edu.cn, Tel: 86-27-68759885.
* E-mail: lihl@whu.edu.cn, Tel: 86-27-68759302;
- Funds：
DOI：10.24920/004066
中图分类号：收稿日期：2022-01-22，
录用日期：2022-3-1，
网络出版日期：2022-02-02，
纸质出版日期：2022-06-30
- Accepted：
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黄学伟, 邓克穷, 秦娟娟, 等. 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[J]. 中国医学科学杂志（英文版）, 2022,37(2):103-117.
Xuewei Huang, Keqiong Deng, Juanjuan Qin, et al. Association Between Lipid Profiles and Left Ventricular Hypertrophy: New Evidence from a Retrospective Study[J]. Chinese medical sciences journal, 2022, 37(2): 103-117.
黄学伟, 邓克穷, 秦娟娟, 等. 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[J]. 中国医学科学杂志（英文版）, 2022,37(2):103-117. DOI： 10.24920/004066.
Xuewei Huang, Keqiong Deng, Juanjuan Qin, et al. Association Between Lipid Profiles and Left Ventricular Hypertrophy: New Evidence from a Retrospective Study[J]. Chinese medical sciences journal, 2022, 37(2): 103-117. DOI： 10.24920/004066.
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。
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.
Cox
model and
Cox
model 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
Cox
model 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.
关键词
Keywords
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