北京地区中老年人心脏代谢指数与左心房增大的关系

Correlation of cardiac metabolic index with left atrial enlargement in middle-aged and elderly people in Beijing

背景左心房容积对多种心脏疾病具有重要的预后预测价值。有研究发现肥胖与左心房增大(left atrial enlargement,LAE)的发生风险显著相关。心脏代谢指数(cardiac metabolic index,CMI)是一项新型肥胖指数,能够综合反映腹型肥胖和血脂水平。目的探索CMI与LAE的关系。方法采用横断面调查方法,样本来源于中国2型糖尿病患者肿瘤发生风险的流行病学研究(risk evaluation of cancers in Chinese diabetic individuals:a longitudinal study,REACTION)于2015年4月-2015年9月调查的北京市古城、金顶街等社区居民。选择左心房内径(left atrial diameter,LAD)作为反映左心房容积的参数。CMI与LAD的关系采用Pearson相关性分析,CMI与LAE发生风险的关系采用二元logistic回归分析。结果共7955名受试者纳入本研究,其中男性2909例,女性5046例,平均年龄(64.24±7.83)岁。LAD与CMI呈正相关(r=0.227,P<0.001)。根据CMI水平四分位数由低到高分为Q1~Q4组(Q1:n=1989,CMI≤0.3078;Q2:n=1989,CMI 0.3078~0.4892;Q3:n=1989,CMI 0.4892~0.7976;Q4:n=1988,CMI>0.7976),以Q1组为对照,Q3、Q4组发生LAE风险的OR值分别为1.441(95%CI:1.024~2.027)、2.005(95%CI:1.432~2.807)(P<0.05)。分层分析提示血压130~140 mmHg组(n=2254;1 mmHg=0.133 kPa)CMI增大时LAE发生风险明显增高,以Q1组为对照,Q2、Q3、Q4组OR值分别为2.370(95%CI:1.118~5.024,P=0.024)、2.653(95%CI:1.271~5.540,P=0.009)、3.434(95%CI:1.654~7.131,P=0.001)。糖尿病前期组(n=2502)CMI增大时LAE发生风险明显增加,以Q1组为对照,Q3、Q4组OR值分别为2.792(95%CI:1.345~5.793,P=0.006)、3.331(95%CI:1.614~6.878,P=0.001)。谷氨酰氨基转肽酶(gamma-glutamyl transpeptidase,GGT)>40 U/L组(n=1009)CMI增大时LAE患病风险明显增加,以Q1组为对照,Q3、Q4组OR值分别为3.845(95%CI:1.093~13.520,P=0.036)、3.496(95%CI:1.010~12.100,P=0.048)。结论CMI越大LAE发病风险越高,特别是在血压处于正常高值、糖尿病前期及GGT升高的人群中。

Background Left atrial volume has an important prognostic value for a variety of cardiovascular diseases,and studies have shown that obesity is significantly associated with the risk of left atrial enlargement(LAE).Cardiac metabolic index(CMI)is a novel adiposity index and can comprehensively reflect abdominal obesity and blood lipid levels.Objective To investigate the correlation between CMI and LAE.Methods A cross-sectional study was performed for the residents from Gucheng and Jindingjie communities of Beijing who were investigated by REACTION study(risk evaluation of cancers in Chinese diabetic individuals:a longitudinal study)from April to September in 2015.Left atrial diameter(LAD)was used as the parameter for left atrial volume.Pearson correlation analysis was used to investigate the correlation between CMI and LAD,and binary logistic regression analysis was used to analyze the correlation between CMI and the risk of LAE.Results A total of 7955 subjects were included in this study,with 2909 males and 5046 females,and a mean age of 64.24±7.83 years.LAD was positively correlated with CMI(r=0.227,P<0.001).Based on the quartiles of CMI,the subjects were divided into Q1 group with 1989 subjects(CMI≤0.3078),Q2 group with 1989 subjects(CMI:0.3078-0.4892),Q3 group with 1989 subjects(CMI:0.4892-0.7976),and Q4 group with 1988 subjects(CMI>0.7976).Compared with Q1 group,odds ratio(OR)for the risk of LAE in Q3 and Q4 groups was 1.441(95%CI:1.024-2.027,P<0.05)and 2.005(95%CI:1.432-2.807,P<0.05),respectively.Stratified analysis showed that in the 130-140 mmHg blood pressure group(n=2254),the risk of LAE increased significantly with the increase in CMI,and compared with Q1 group,OR of Q2,Q3,and Q4 groups was 2.370(95%CI:1.118-5.024,P=0.024),2.653(95%CI:1.271-5.540,P=0.009),and 3.434(95%CI:1.654-7.131,P=0.001),respectively.In the prediabetes group(n=2502),the risk of LAE increased significantly with the increase in CMI,and compared with Q1 group,OR of Q3 and Q4 groups was 2.792(95%CI:1.345-5.793,P=0.006)and 3.331(95%CI:1.614-6.878,P=0.001),respectively.In the gamma-glutamyl transpeptidase(GGT)>40 U/L group(n=1009),the risk of LAE increased significantly with the increase in CMI,and compared with Q1 group,OR of Q3 and Q4 groups was 3.845(95%CI:1.093-13.520,P=0.036)and 3.496(95%CI:1.010-12.100,P=0.048),respectively.Conclusion The risk of LAE increases with the increase in CMI,especially in the population with elevated blood pressure,prediabetes,and elevated GGT.