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甘油三酯与高密度脂蛋白胆固醇比值(TG/HDL-C)对原发性肝癌发病的影响

Influence of triglyceride/high-density lipoprotein cholesterol ratio on the onset of primary liver cancer
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摘要 目的探究甘油三酯与高密度脂蛋白胆固醇比值(TG/HDL-C)对原发性肝癌发病的影响。方法采用前瞻性队列研究的方式,收集2006年7月—2007年12月参加开滦集团健康体检的99750例在职及离退休职工的体检资料,并对其原发性肝癌的发病情况进行随访,随访截止时间为2021年12月31日。根据TG/HDL-C三分位水平将受试者分成3组,分别为Q1组(TC/HDL-C<0.66,n=33229)、Q2组(0.66≤TC/HDL-C<1.14,n=33302)、Q3组(TC/HDL-C≥1.14,n=33219)。计算各组原发性肝癌的发病密度。符合正态分布的计量资料多组间比较采用单因素方差分析;符合偏态分布的计量资料多组间比较采用Kruskal-Wallis H检验。计数资料组间比较采用χ2检验。采用Kaplan⁃Meier法计算各组原发性肝癌的累积发病率,以Logrank检验比较各组间累积发病率的差异。采用Cox比例风险模型分析不同TG/HDL-C水平分组对原发性肝癌发病的影响。结果3组受试者年龄、男性比例、腰围、BMI、空腹血糖、收缩压、舒张压、TG、TC、HDL-C、LDL-C、ALT、超敏C-反应蛋白、慢性肝病、高血压病、糖尿病、恶性肿瘤家族史、饮酒、吸烟、体育锻炼、受教育程度组间对比差异均有统计学意义(P值均<0.05)。在平均(14.06±2.71)年的随访过程中,新发肝癌共计484例,其中男446例,女38例。Q1组、Q2组、Q3组原发性肝癌的发病密度分别是0.39/千人年、0.35/千人年、0.30/千人年。3组受试者的原发性肝癌累积发病率分别是6.03‰、5.28‰和4.49‰,经Log-rank检验,差异有统计学意义(χ^(2)=6.06,P=0.048)。校正了考虑到的混杂因素后,Cox比例风险模型结果显示,以Q3组为对照,Q1、Q2组的风险比及95%可信区间分别为2.04(1.61~2.58)、1.53(1.21~1.92)(P for trend<0.05)。结论TG/HDL-C水平降低与原发性肝癌发病风险升高有关,特别是在慢性肝病的人群中这种关联更加明显。 Objective To investigate the influence of triglyceride(TG)/high-density lipoprotein cholesterol(HDL-C)ratio on the onset of primary liver cancer.Methods A prospective cohort study was conducted.Physical examination data were collected from 99750 cases of on-the-job and retired employees of Kailuan Group who participated health examination from July 2006 to December 2007,and they were followed up till December 31,2021 to observe the onset of primary liver cancer.A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the Kruskal-Wallis H test was used for comparison of continuous data with skewed distribution between multiple groups;the chi-square test was used for comparison of categorical data between groups.According to the tertiles of TG/HDL-C ratio,the subjects were divided into Q1,Q2,and Q3 groups,and the incidence density of primary liver cancer was calculated for each group.The Kaplan-Meier method was used to calculate the cumulative incidence rate of primary liver cancer in each group,and the log-rank test was used to compare the difference in cumulative incidence rate between groups.The Cox proportional hazards model was used to analyze the influence of TG/HDL-C ratio on the onset of primary liver cancer.Results There were significant differences between the three groups in age,proportion of male subjects,waist circumference,body mass index,fasting blood glucose,systolic pressure,diastolic pressure,triglyceride,total cholesterol,HDL-C,low-density lipoprotein cholesterol,alanine aminotransferase,high-sensitivity C-reactive protein,chronic liver diseases,hypertension,diabetes,the family history of malignant tumor,drinking,smoking,physical exercise,and educational level(P<0.05).During the mean follow-up time of 14.06±2.71 years,there were 484 cases of new-onset liver cancer,among whom there were 446 male subjects and 38 female subjects.The incidence density of primary liver cancer was 0.39/1000 person-years in the Q1 group,0.35/1000 person-years in the Q2 group,and 0.30/1000 person-years in the Q3 group,and the cumulative incidence rates of primary liver cancer in the three groups were 6.03‰,5.28‰,and 4.49‰,respectively,with a significant difference between the three groups based on the long-rank test(χ^(2)=6.06,P=0.048).After adjustment for the confounding factors considered,the Cox proportional hazards model showed that compared with the Q3 group,the Q1 group had a hazard ratio of 2.04(95%confidence interval[CI]:1.61—2.58,Pfor trend<0.05),and the Q2 group had a hazard ratio of 1.53(95%CI:1.21—1.92,Pfor trend<0.05).Conclusion The reduction in TG/HDL-C ratio is associated with an increase in the rask of primary liver cancer,especially in people with chronic liver diseases.
作者 贾建国 马向明 田菲 张亚丽 戴佳盈 罗赛芳 曹立瀛 JIA Jianguo;MA Xiangming;TIAN Fei;ZHANG Yali;DAI Jiaying;LUO Saifang;CAO Liying(Graduate School of North China University of Science and Technology,Tangshan,Hebei 063000,China;Department of Hepatobiliary Surgery,Kailuan General Hospital,North China University of Science and Technology,Tangshan,Hebei 063000,China;Department of Tumor Chemoradiotherapy,The Affiliated Hospital of North China University of Science and Technology,Tangshan,Hebei 063000,China)
出处 《临床肝胆病杂志》 CAS 北大核心 2024年第4期753-759,共7页 Journal of Clinical Hepatology
基金 河北省2023年度医学科学研究课题计划(20231865)。
关键词 肝肿瘤 甘油三酯类 胆固醇 HDL 队列研究 Liver Neoplasms Triglycerides Cholesterol,HDL Cohort Studies
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