空腹血糖和高血压对心脑血管疾病的交互作用研究

Relationship and interactions between elevated fasting glucose and hypertension for cardiocerebral vascular disease

目的 探讨空腹血糖和高血压与心脑血管疾病的关系及二者对心脑血管疾病的交互作用强度.方法于2007年5-8月,采用横断面研究的方法,调查北京社区常住居民10 054名,运用非条件logistic回归模型分析空腹血糖升高和高血压与心血管疾病以及脑卒中的关系,通过模型中纳入空腹血糖和高血压的乘积项分析其相乘交瓦作用,通过Bootstrap法计算相对超额危险度比（RERI）,归因比（AP）和交互作用指数（S）及其可信区间来评价空腹血糖受损和高血压以及糖尿病和高血压之间的相加交瓦作用.结果调整年龄、性别、吸烟、饮酒、体质指数（BMI）和地区后,空腹血糖和高血压的乘积项无统计学意义,二者对心血管疾病和脑卒中均无相乘交互作用；糖尿病和高血压对心血管疾病的相加交互作用指标RERI、AP和S及其95％可信区间分别为0.64（0.03～1.25）、0.27（0.01～0.47）和1.83（1.02～5.13）,说明二者之间存在相加交瓦作用,但对脑卒中无相加交互作用；空腹血糖受损和高血压对心血管疾病和脑卒中均无相加交互作用.结论高血压是心血管疾病和脑卒中的危险因素,糖尿病是脑卒中的危险因素.糖尿病和高血压对心血管疾病存在相加交互作用,同时患有糖尿病和高血压会使心血管疾病的患病风险增加.

Objective To explore the relationship and interaction of elevated fasting glucose and hypertension on cardiocerebral vascular disease.Methods 10 054 males and females were recruited for our cross-sectional study during May 2007 to August 2007.Unconditional logistic regression was used to analysis the relationship between fasting glucose and hypertension on cardiocerebral vascular disease.A product of fasting glucose and hypertension was added to the logistic regression model to evaluate the multiplicative interaction and relative excess risk of interaction（RERI）,attributable proportion（AP）of interaction and synergy index（S）was applied to evaluate the additive interaction of the two factors.Bootstrap was used to calculate 95% confidence intervals（CI）of RERI,AP and S.Results After adjusting age,gender,smoking,drinking,body mass index（BMI）and region,the product of fasting glucose and hypertension was not statistically significant,which means there was no multiplicative interaction between the two.But the additive indexes RERI,AP and S with 95% CI of diabetes and hypertension were 0.64（0.03,1.25）,0.27（0.01,O.47）and 1.83（1.02,5.13）respectively,which means significant additive interaction was shown between the two on cardiovascular disease but not no stroke.And there were no additive interaction bmtween impaired fasting glucose on cardiovascular disease or stroke.Conclusions Hypertension was independently related to cardiovascular disease and stroke in Beijing citizens,and diabetes were independently related to stroke.There was additive interaction between diabetes and hypertension on cardiovascular disease.