收缩压和LDL-C对颈动脉斑块的影响

Effects of systolic blood pressure and low density lipoprotein on carotid plaques

目的探讨收缩压（SBP）、LDL—C对颈动脉斑块的影响。方法在参加2006--2009年健康体检的101510名某公司在职及离退休职工中，按年龄、性别比例分层随机抽取5852名作为观察队列，于2010—2011年对观察队列进行健康体检，同时进行了颈动脉超声检查，最后符合入选标准和资料完整的为5361名，将其分为SBP及LDL—C正常（3524名）、SBP正常但LDL—C升高（356名）、SBP升高但LDL-C正常（1308名）、SBP及LDL-C升高（173名）共4组。计算各组颈动脉斑块的检出率及加权率，并采用logistic回归分析SBP及LDL—C水平对颈动脉斑块检出率的影响。结果SBP及LDL—C正常、SBP正常但LDL—C升高、SBP升高但LDL—C正常、SBP及LDL—C升高组颈动脉斑块检出率分别为33．7％（1186／3524）、41．3％（147／356）、64．8％（847／1308）、68．8％（119／173）（X^2=425．75，P〈0．05），加权检出率分别为36．0％、42．0％、64．5％、68．3％；男性颈动脉斑块的检出率分别为44．2％（877／1985）、51．1％（97／190）、70．6％（657／930）、71．3％（82／115）（X^2=194．02，P〈0．05），加权率分别为31．2％、36．1％、49．8％、50．3％；女性分别为20．1％（309／1539）、30．1％（50／166）、50．3％（190／378）、63．8％（37／58）（X^2=180．17，P〈0．05），加权检出率分别为30．9％、46．3％、70．3％、88．1％，校正其他因素后，与SBP及LDL-C正常组相比，SBP正常LDL-C升高、SBP升高LDL—C正常、SBP及LDL—C升高组的OR（95％CI）值分别为1．37（1.05～1．78），2．05（1．74～2．43），2．12（1．45～3．12）。结论高SBP与高LDL—C是颈动脉斑块形成的危险因素，与高LDL—C相比，高SBP引起颈动脉斑块的风险更大。

Objective To explore the different effects of systolic blood pressure （SBP） and low density lipoprotein on carotid plaques（LDL-C）. Methods A total of 101 510 serving and retired workers of a company who participated in the health examination in 2006 - 2009, 5852 participants were selected as study subjects by stratified random sampling according to the age and sex ratio. These subjects took their health examination in 2010 -2011 including the carotid ultrasound. Finally, 5361 eligible participants with complete data were included in the analysis. The detection and weighted rates of carotid plaques were calculated for four groups ： normal SBP and LDL-C group （ 3524 subjects）, normal SBP and high LDL-C group （356 subjects）,elevated SBP and normal LDL-C group （1308 subjects） and elevated SBP and high LDL-C group （173 subjects）. The effects of different baseline SBP and LDL-C on detection rates of the carotid artery plaques were analyzed by logistic regression. Results The detection rate of carotid plaques in normal SBP and LDL-C group, normal SBP and high LDL-C group, elevated SBP and normal LDL-C group , elevated SBP and high LDL-C group was 33.7% （1186/3524） ,41.3% （147/356） ,64. 8% （847/1308）, 68.8% （119/173） （X^2 = 425.75 ,P 〈 0. 05） and the weighted detection rate was 36. 0% ,42. 0% ,64. 5% and 68. 3% respectively. For men, the detection rate was 44. 2% （877/1985） ,51.1% （97/190）, 70. 6% （657/930） ,71.3% （ 82/115 ） （ X^2 = 194. 02, P 〈 0.05 ） and the weighted detection rate was 31.2%, 36. 1% ,49. 8% and 50. 3% respectively. For women, the detection rate was 20. 1% （309/1539） ,30. 1% （50/166） ,50. 3% （ 190/378 ）, 63.8% （ 37/58 ） （ X^2 = 180. 17, P 〈 O. 05 ） and the weighted detection rate was 30.9% ,46. 3% ,70.3%, and 88.1% respectively. After adjusted for other risk factors, the OR （95%（？/） value was 1.37 （1.05 -1.78）,2.05（1.74-2.43） and 2. 12 （1.45 -3.12） for normalSBP and high LDL-C group, elevated SBP and normal LDL-C group and elevated SBP and high LDL-C group respectively compared with normal SBP and LDL-C group. Conclusion Elevated SBP and high LDL-C were risk factors of the carotid artery plaques. Compared with high LDL-C, elevated SBP may add a higher risk for carotid plaques.