大连地区血压、生化指标正常人群颈动脉内膜中膜厚度的影响因素

The Risk Factors of Carotid Intima-media Thickness in Adults of Normal Blood Pressure and Biochemical Indices of Dalian

目的探讨大连地区血压、生化指标正常人群颈动脉内膜中膜厚度的危险因素。方法选取大连地区血压、生化指标正常人群736例。所有研究人群均已测量身高、体重、血压、腰围、臀围,检测空腹血糖、糖化血红蛋白、75 g OGTT 2 h血糖、空腹胰岛素、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、总胆固醇、甘油三酯、血尿酸及血肌酐等指标,计算腰臀比、体质指数、尿白蛋白/肌酐、肌酐清除率、胰岛素抵抗指数及脉压差,应用血管彩色多普勒超声检测患者颈动脉内膜中膜厚度。将入选人群根据颈动脉内膜中膜厚度值分为C1组（颈动脉内膜中膜厚度〈0.9 mm）、C2组（0.9 mm≤颈动脉内膜中膜厚度〈1.2 mm）及C3组（颈动脉内膜中膜厚度≥1.2 mm）,研究上述各指标与颈动脉内膜中膜厚度的相关关系。结果 （1）三组间在年龄、体质指数、腰围、腰臀比、血尿酸、收缩压及脉压差存在组间差异,差异有统计学意义（P〈0.05）。随着年龄、腰围、血尿酸、收缩压及脉压差的升高,颈动脉内膜中膜厚度有增厚的趋势;而体质指数和腰臀比仅在C3组高于C2和C1组,差异有统计学意义（P〈0.05）。（2）男性和女性人群颈动脉内膜中膜厚度均随年龄增加有逐渐增加的趋势,差异有统计学意义（P〈0.05）;在40-50岁组,男性颈动脉内膜中膜厚度高于女性,差异有统计学意义（P〈0.05）,在50-60岁组,女性颈动脉内膜中膜厚度高于男性,差异有统计学意义（P〈0.05）。（3）偏相关分析显示,在控制年龄因素的影响后,无论男性、女性,脉压差、体质指数、腰围、收缩压及血尿酸均与颈动脉内膜中膜厚度呈正相关;单因素Logistic回归分析显示,无论男性、女性,年龄、脉压差均是颈动脉内膜中膜厚度的独立危险因素（P〈0.05）。结论 （1）在血压、生化指标正常人群中,无论男性、女性,颈动脉内膜中膜厚度均随年龄增加有逐渐增加的趋势,男性颈动脉内膜中膜厚度在40-50岁组明显高于女性,女性颈动脉内膜中膜厚度在50-60岁组明显高于女性。（2）增龄和脉压差是颈动脉内膜中膜厚度增厚的独立危险因素。

Aim To analyze the risk factors of carotid intima-media thickness（CIMT） in adults with normal blood pressure and biochemical indices. Methods We recruited 736 healthy people with normal blood pressure and biochemical indices from the population of Dalian,China. All participants were tested for their CIMT,and biochemical indices（fasting plasma glucose（FPG）,fasting insulin（FINS）,2 hours postprandial blood glucose of 75 g OGTT（2h PPG）,glycosylated hemoglobin（Hb A1c）,high density lipoprotein cholesterol（HDLC）,low density lipoprotein cholesterol（LDLC）,total cholesterol（TC）,triglyceride（TG）,serum uric acid（SUA） and serum creatinine（SCr）） and anthropometric indices（weight,height,waistline and systolic/diastolic pressure）. Furthermore,waist-to-hip ratio（WHR）,BMI,urinary alumin/creatinine ratio（UACR）,creatinine clearance（Ccr）,HOMA-IR and pulse pressure were calculated. Par-ticipants were then stratified into three groups according to their CIMT： C1（ CIMT 0. 9 mm）,C2（ 0. 9 mm≤CIMT 1. 2mm） and C3（ CIMT≥1. 2 mm）. The associations between biochemical and anthropometric indices and the risk factors of CIMT were analyzed. Results（ 1） There was statistically significant difference（ P〈0. 05） in age,BMI,waist circumference,WHR,SUA,systolic pressure and pulse pressure between the three groups stratified by CIMT. CIMT increased with age,waist circumference,SUA,systolic pressure and pulse pressure. WHR and BMI in C3 group were significantly higher than C1 and C2 group（ P〈0. 05）.（ 2） CIMT increased with age in males and females. The age-related increase in CIMT was different between male and female in 40-50 group and 50-60 group. The CIMT of male was significantly higher than female in age of 40-50. The CIMT of female was significantly higher than male in age of 50-60.（ 3） The partial correlation analysis showed that pulse pressure,BMI,waist circumference,SUA and systolic pressure all positively correlated with CIMT in males and females when excluded the influence of age. Logistic regression analysis showed that age and pulse pressure were independent risk factors of CIMT in males and females（ P〈0. 05）. Conclusions（ 1） CIMT increased with age within a cohort with normal blood pressure and biochemical indices. The CIMT of male was significantly higher than female in age of 40-50. The CIMT of female was significantly higher than male in age of 50-60.（ 2） The present study shows that increasing age and pulse pressure are independent risk factors of CIMT in males and femals.