于昊^1,,
贾晓东²,
张楠¹,
卢林娜¹,
潘晓芳^2,,
1. 大连医科大学附属大连市中心医院 健康管理中心, 辽宁 大连 116033
2. 大连医科大学附属大连市中心医院 超声影像科, 辽宁 大连 116033

基金项目: 大连市医学科学研究计划项目(1811022)


详细信息 作者简介: 于昊(1987-), 女, 主治医师。E-mail: mac1014@126.com





通讯作者: 潘晓芳, 主任医师。E-mail: xfpan801@163.com 中图分类号: R543.4


摘要:目的探讨青年女性人群危险因素与亚临床动脉粥样硬化之间的关系。方法选取2019年5至10月于大连医科大学附属大连市中心医院健康管理中心常规健康体检的青年女性为研究对象，进行体格检查、生化检查，并通过颈动脉超声完成颈动脉内中膜厚度（carotid intima-media thickness，CIMT）测量。共入选731名女性，年龄18~44岁，平均年龄（37.34±4.18）岁。根据CIMT结果分为两组，正常组（CIMT < 0.9 mm）682例，CIMT增厚组（CIMT ≥ 1.0 mm）49例。分析脂质参数、血糖、血尿酸等指标与颈动脉内膜增厚的关系，采用多因素Logistic回归分析CIMT增厚的影响因素，受试者工作特征曲线评估影响因素对CIMT增厚的预测价值。结果（1）研究对象的一般情况：CIMT增厚组与CIMT正常组在年龄、TC、non-HDL-C、LDL-C、TC/HDL-C、LDL-C/HDL-C、FBG和CIMT存在显着差异（P < 0.01）。（2）CIMT增厚影响因素的多因素Logistic回归结果：以CIMT增厚为因变量，在调整了年龄因素后，TC、LDL-C、non-HDL-C、TC/HDL-C、LDL-C/HDL-C和FBG与CIMT增厚显著相关（P均 < 0.01）。当上述变量分别进入多因素回归模型后，结果显示，仅年龄、TC、LDL-C/HDL-C和FBG是CIMT增厚的独立影响因素（OR=1.275，95% CI：1.166~1.393，P < 0.001；OR=1.419，95% CI：0.960~2.097，P=0.039；OR=1.605，95% CI：1.003~2.567，P=0.049；OR=1.280，95% CI：0.936~1.750，P=0.035）。（3）受试者工作特征曲线：四个变量的ROC曲线下面积（AUC）分别为：年龄（AUC=0.747；P < 0.001；95% CI：0.657~0.838）、TC（AUC=0.622；P=0.043；95% CI：0.527~0.717）、LDL-C/HDL-C（AUC=0.631；P=0.037；95% CI：0.539~0.724）、FBG（AUC=0.641；P=0.004；95% CI：0.535~0.748）。上述四个变量的线性组合模型后，AUC增加到0.785（P < 0.001；95% CI：0.693~0.857），优于任意单一指标。结论随着年龄、血脂及血糖水平增高，青年女性人群亚临床动脉粥样硬化风险增高，并且各指标的联合应用预测价值优于单一指标，可提高动脉硬化的早期识别率。
关键词: 危险因素/
亚临床动脉粥样硬化/
青年女性


Abstract:ObjectiveTo investigate the association between risk factors and subclinical atherosclerosis in young asymptomatic women.MethodsYoung asymptomatic women, who had routine check-up with carotid ultrasound in the health examination center of Dalian City Central Hospital from May to October 2019, were enrolled in the study.Physical exam and biochemical analysis were performed; and carotid intima-media thickness (CIMT) was measured by carotid ultrasound.A total of 731 women were selected, aged 18-44 years old with an average age (37.34±4.18). The patients were divided into two groups according to the CIMT measurements: normal group (CIMT < 0.9 mm, n=682) and CIMT thickening group (CIMT ≥ 1.0 mm, n=49).The relationship between lipid parameters, blood glucose, uric acid and CIMT was analyzed.Regression analysis was used to examine the influence of metabolic risk factors on CIMT.Predictive value of influencing factors on abnormal CIMT was evaluated by receiver operating characteristic (ROC).Results(1) General data analysis revealed significant differences in the age, TC, non-HDL-C, LDL-C, TC/HDL-C, LDL-C/HDL-C, and FBG between normal group and thickening group (P < 0.01). (2)Logistic regression analysis revealed that TC, LDL-C, non-HDL-C, TC/HDL-C, LDL-C/HDL-C and FBG were correlated with CIMT thickening, when adjusted by age(P < 0.01).Age, TC, LDL-C/HDL-C and FBG were the only independent risk factors for CMIT thickening by multivariate model (OR=1.275, 95%CI: 1.166-1.393, P < 0.001;OR=1.419, 95%CI: 0.960-2.097, P=0.039;OR=1.605, 95%CI: 1.003-2.567, P=0.049;OR=1.280, 95%CI: 0.936-1.750, P=0.035, respectively). (3)The area under ROC curve for a linear combination of age, TC, LDL-C/HDL-C and FBG was 0.785(P < 0.001; 95%CI: 0.693-0.857), superior to any of the variables taken alone including age (AUC=0.747, P < 0.001, 95%CI: 0.657-0.838), TC (AUC=0.622, P=0.043, 95%CI: 0.527-0.717), LDL-C/HDL-C (AUC=0.631;P=0.037; 95%CI: 0.539-0.724), and FBG (AUC=0.641, P=0.004, 95%CI: 0.535-0.748).ConclusionThe combined assessment of age, TC, LDL-C/HDL-C and FBG contributes to an early detection for subclinical atherosclerosis and provides guidance to clinicians for early interventions of latent cardiovascular disease in young women. None of the above four individual indicators is qualified alone.
Keywords:risk factors/
subclinical atherosclerosis/
young women

PDF全文下载地址:

https://journal.dmu.edu.cn/data/article/export-pdf?id=dlykdxxb_20210507