脂质蓄积指数在大连地区女性人群颈动脉硬化筛查中的价值

The value of lipid accumulation product index on screening carotid atherosclerosis in females in Dalian area

目的:探讨不同性别人群脂质蓄积指数(LAP)与颈动脉硬化患病风险的关系。方法:回顾性分析2018年1—6月在大连医科大学附属大连市中心医院健康医学部体检的大连市机关事业单位职工2740例,其中男1583例,女1157例,收集该人群的一般资料、实验室指标及颈动脉超声等数据,计算体质量指数和LAP值。根据颈动脉内膜中层厚度(IMT)将研究对象分为颈动脉硬化组(IMT≥1.0 mm)和颈动脉正常组(IMT<1.0 mm),比较两组临床指标的差异。二分类Logistic回归分析颈动脉硬化的独立危险因素,应用受试者工作特征(ROC)曲线计算LAP预测颈动脉硬化的界值。结果:男、女颈动脉硬化组在年龄、腰围、LAP、体质量指数、总胆固醇、低密度脂蛋白胆固醇、空腹血糖、收缩压、舒张压、高血压和糖尿病患病率均高于颈动脉正常组,差异均有统计学意义(P<0.05);二分类Logistic回归分析结果显示,校正年龄、体质量指数、臀围、腰围、是否吸烟、是否饮酒、是否患高血压、是否患糖尿病、总胆固醇、低密度脂蛋白胆固醇后,女性LAP每增加一个四分位间距会增加颈动脉硬化的患病风险1.316倍(OR=1.316,95%CI 1.063~1.629,P=0.012);而对于男性,在校正上述因素以后,LAP对颈动脉硬化患病风险的独立影响消失;在女性,LAP预测颈动脉硬化的曲线下面积(AUC)达到0.713,显著高于体质量指数(AUC为0.614)和腰围(AUC为0.654),且差异均有统计学意义(P<0.05),而在男性人群中三个指标对颈动脉硬化的预测效能差异均无统计学意义(P>0.05)。根据ROC曲线计算的预测颈动脉粥样硬化的最佳LAP截断值:男性为32.13 cm·mmol/L,女性为33.70 cm·mmol/L。结论:LAP是女性人群发生颈动脉硬化的独立危险因素,其对于颈动脉硬化的预测能力高于体质量指数和腰围,LAP≥33.70 cm·mmol/L可作为筛查女性人群颈动脉硬化的最佳界值。

Objective To explore the relationship between the lipid accumulation product index(LAP)and the risk of carotid atherosclerosis in different gender groups.Methods The data of 2740 employees of Dalian municipal government and institutions,including 1583 males and 1157 females,who had underwent physical examination in Dalian Municipal Central Hospital Affiliated of Dalian Medical University from January to June 2018 were analyzed retrospectively.The general data,laboratory indexes and carotid ultrasound data of the population were collected,and the body mass index(BMI)and LAP value were calculated.According to carotid intima-media thickness(IMT),the subjects were divided into carotid atherosclerosis group(IMT≥1.0 mm)and carotid normal group(IMT<1.0 mm).The clinical indicators between the two groups were compared.Independent risk factors for carotid atherosclerosis were analyzed by binary Logistic regression,and the cutoff point for predicting carotid atherosclerosis by LAP was calculated by receiver operating characteristic(ROC)curve.Results The age,waist circumference(WC),hip circumference(HC),LAP,BMI,total cholesterol(TC),low density lipoprotein cholesterol(LDL-C),fasting plasma glucose(FPG),systemic blood pressure(SBP),diastolic blood pressure(DBP)and the prevalence of hypertension and diabetes in the male and female population carotid atherosclerosis groups were significantly higher than those in the normal group(P<0.05).The results of binary Logistic regression analysis showed that after adjusting age,BMI,HC,WC,smoking,drinking,hypertension,diabetes,TC and LDL-C,the risk of carotid arteriosclerosis still increased 1.316 times with each quartile interval of LAP in women(OR=1.316,95%CI 1.063 to 1.629,P=0.012).In men,after adjusting for these factors,the independent effect of LAP on the risk of carotid atherosclerosis disappeared.In women,the area under curve(AUC)of LAP in predicting carotid atherosclerosis was 0.713,significantly higher than that of BMI(AUC 0.614)and WC(AUC 0.654),and the differences were statistically significant(P<0.05).But there was no significant difference among the three indexes in the male population in predicting carotid atherosclerosis.According to ROC curve,the best cut-off value of LAP for predicting carotid atherosclerosis was 32.13 cm·mmol/L in men and 33.70 cm·mmol/L in women.Conclusions LAP is an independent risk factor for carotid atherosclerosis in female population,and its predictive ability for carotid atherosclerosis is higher than that of body mass index and waist circumference.LAP≥33.70 cm·mmol/L can be used as the best cut-off value for screening carotid atherosclerosis in female population.