22886名健康体检者踝臂指数与年龄的关系:限制性立方样条分析

Relationship between ankle-brachial index and age among 22 886 people undergoinghealth examination: a restricted cubic spline regression analysis

目的调查重庆地区健康体检人群的踝臂指数(ABI)水平,分析与ABI水平相关的危险因素,为有效评估动脉粥样硬化病变及病变严重程度,早期发现、早期干预、早期治疗临床心血管事件及心血管疾病提供依据。方法回顾性分析2016年1~12月重庆医科大学附属第一医院体检中心年龄在20~85岁的22 886名健康体检者资料,收集ABI及相关生理生化指标数据,应用Logistic逐步回归模型结合限制性立方样条分析踝臂指数与年龄关系。结果 22 886名健康体检者ABI的异常检出率为3.31%;男性异常检出率为2.90%,女性异常检出率为3.92%。<40岁年龄段ABI异常检出率最高(6.17%),其中男性<40岁的ABI异常检出率为4.72%,女性<40岁的ABI异常检出率为8.66%。将人群分为ABI≤0.9组和ABI>0.9组进行比较,发现两组在年龄、BMI、WC、SBP、DBP、TC、LDL-C水平方面差异均有统计学意义(P<0.05)。多因素Logistic逐步回归结合限制性立方样条分析结果显示,年龄、性别、BMI为ABI指数的独立影响因素,其中<40岁[OR=2.885,95%CI(2.445,3.404),P<0.000 1]为主要危险因素,校正性别和BMI影响后绘制年龄和ABI异常概率曲线图,在按性别和BMI分层的不同亚组中,ABI异常概率均呈现出随着年龄的增长先下降再升高的U形趋势。结论基于重庆市的健康体检人群的ABI异常检出率为3.31%。校正性别和BMI影响后,ABI异常概率均呈现随年龄增长先下降再升高的U形趋势。对于没有心血管疾病危险因素的青年人群(20~40岁),ABI≤0.9的临床意义需要进一步深入探究。

Objectives To investigate the level ofankle-brachial index (ABI)of health examination population in Chongqing municipality and analyze the risk factors related to the level of ABI,so as to provide basis for effective evaluation of atherosclerotic lesions and their severity,as well as early detection,intervention and treatment of clinical cardiovascular diseases.Methods A total of 22886 subjects aged from 20 to 85undergoing health examination in the medical examination center of First Affiliated Hospital of Chongqing Medical University in Chongqing municipality from January to December in 2016 were retrospectively analyzed.ABI and related physiological and biochemical data were collected.The relationship between ABI and age was analyzed using stepwise logistic regression model combined with restricted cubic splines.Results The detection rate of abnormal ABI was 3.31% in 22886 subjects undergoing health examination with 2.90%in males and 3.92%in females.The subjects aged below 40 presented the highest detection rate of abnormal ABI (6.17%)with 4.72% in males and 8.66% in females.The subjects were divided into two groups,one with ABI ≤0.9and one with ABI>0.9;the differences in age and levels of body mass index (BMI),waist circumference (WC), systolic blood pressure (SBP),diastolic blood pressure (DBP),total cholesterol (TC),and low-density lipoprotein cholesterol (LDL-C)between the two groups were statistically significant (all P<0.05).Multivariate stepwise logistic regression combined with restricted cubic splines showed that age,gender and BMI were presented as independent factors affecting ABI,among which the age below 40(OR=2.885,95% CI (2.445,3.404),P<0.0001)was the main risk factor.A curve relating age to probability of abnormal ABI was produced after correcting for the influences of sex and BMI, stratified by gender and BMI into different subgroups,showing a U-shaped curve of decreasing initially and then increasing between the probability of abnormal ABI and age.Conclusions The detection rate of abnormal ABI based on individuals undergoing health examination in Chongqing municipality was 3.31%.A U-shaped curve of downward trend followed by an upward one was shown between probability of abnormal ABI and age after correcting for the influences of gender and BMI.The clinical significance of ABI ≤0.9 for youth population (20to 40 years old)without cardiovascular risk factors requires further exploration.