中老年人群理想心血管健康评分变化与颈动脉内中膜厚度的关系

The relationship between changes in ideal cardiovascular health score and the carotid intima-media thickness among the middle age and elderly population

目的 探讨中老年人群理想心血管健康评分变化（△ICHS）与颈动脉内中膜厚度（CIMT）的关系.方法 在参加2006至2007年健康体检的1 01 510名开滦集团职工中,随机分层抽取5 852名作为研究对象,其中符合入选标准（包括年龄≥40岁,既往无卒中、短暂性脑缺血发作和心肌梗死病史）者5 440名.2010至2011年再次健康体检时,增加超声CIMT测量,统计分析其中资料完整的研究对象4 367名.参照美国心脏协会（AHA）提出的7项理想心血管健康指标,对人群进行理想心血管健康评分.将研究对象分为3组：△ICHS＜0为降低组（n=1 355）,△ICHS=0为不变组（n=1 451）,△ICHS＞0为升高组（n=1 561）.△ICHS为2010至2011年与2006至2007年健康体检时理想心血管健康评分的差值.采用线性回归和多因素logistic回归分析△ICHS与CIMT的关系.结果 2006至2007年健康体检时,研究人群的理想心血管健康评分为（3.03±1.27）分,2010至2011年健康体检时理想心血管健康评分为（3.09±1.40）分,差异有统计学意义（P＜0.01）.线性回归分析显示：在校正多种昆杂因素之后,△ICHS每增加1分,CIMT下降0.009 mm（B=-0.009,P＜0.01）.多因素logistic回归分析显示：在校正多种混杂因素之后,与降低组比较,不变组（OR =0.73,95％CI：0.59 ～0.91）和升高组（OR=0.66,95％ CI：0.52 ～0.82）的CIMT增厚风险均下降.结论 △ICHS增加是中老年人群CIMT增厚的独立保护因素.

Objective To explore the relationship between changes in ideal cardiovascular health score（△ICHS） and the carotid intima-media thickness （CIMT） among the middle age and elderly population.Methods A total of 5 852 cases were enrolled from 101 510 Kailuan Group employees who participated in the health examination in 2006-2007 and 2010-2011 through stratified random sampling.A total of 5 440 individuals met the inclusion criteria （≥ 40 years old;no history of stroke,transient ischemic attack,or myocardial infarction）.CIMT was measured by ultrasound during 2010-2011 examination.Excluding individuals with incomplete data,4 367 cases were included for the final analysis.According to the AHA definition of ideal cardiovascular health metric,individual △ICHS was evaluated and the subjects were divided into 3 groups：group reduced （△ICHS 〈 0,n =1 355）,invariant group （△ICHS =0,n =1 451） and elevated group （△ICHS 〉0,n =1 561）.△ICHS was derived from the difference between 2010-2011 and 2006-2007.Multivariate linear regression and logistic regression analysis were used to analysis the relationship between △ICHS and CIMT.Results The ICHS was 3.03-± 1.27 in 2006-2007 study population and 3.09 ± 1.40（P 〈0.01） in 2010-2011 study population.Multivariate linear regression analysis showed that △ICHS was inversely related to CIMT.For every 1 score increase in △ICHS,CIMT decreased by 0.009 mm（B =-0.009,P 〈 0.01）.Multivariate logistic regression analysis showed that after adjusting for multiple confounding factors,the risk of CIMT wall thickening was lower in the △ICHS invariant group （OR =0.73,95% CI：0.59-0.91）and in △ICHS elevated group （OR =0.66,95 % CI：0.52-0.82） compared to the △ICHS reduce group.Conclusion Elevated △ICHS is an independent protective factors of CIMT increase in the middle age and elderly population.