体检人群颈动脉、眼底动脉硬化的影响因素分析

Analysis of influencing factors of carotid artery and fundus arteriosclerosis in the physical examination people

目的观察体检人群颈动脉、眼底动脉硬化的检出率,分析其危险因素。方法选取2018年5—12月来北京大学第三医院北方院区参加健康体检的647例北方公司在职及离退休人员,记录性别、年龄、高血压史、冠心病史、糖尿病史,检查收缩压(SBP)、舒张压(DBP)、空腹血糖(FBG)、总胆固醇(TC)、三酰甘油(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、尿酸(UA)、骨密度、腹部彩超、颈动脉超声及眼底血管。根据颈动脉超声结果,分为非颈动脉硬化组(n=437)和颈动脉硬化组(n=210);根据眼底检查结果,分为非眼底动脉硬化组(n=534)和眼底动脉硬化组(n=113)。比较非颈动脉硬化组和颈动脉硬化组、非眼底动脉硬化组和眼底动脉硬化组的各项临床资料。采用Logistic回归分析颈动脉硬化和眼底动脉硬化的危险因素。结果647例体检者中,颈动脉硬化检出率为32.5%,眼底动脉硬化检出率为17.5%。单因素分析结果显示,颈动脉硬化组的男性占比、年龄、高血压史占比、冠心病史占比、糖尿病史占比、骨密度减低占比、SBP、DBP、FBG、UA及TC水平高于非颈动脉硬化组,HDL-C水平低于非颈动脉硬化组,差异有统计学意义(P<0.05)。单因素分析结果显示,眼底动脉硬化组的男性占比、年龄、冠心病史占比、糖尿病史占比、骨密度减低占比、SBP、DBP、FBG及UA水平高于非眼底动脉硬化组,HDL-C水平低于非眼底动脉硬化组,差异有统计学意义(P<0.05)。Logistic多因素分析结果显示,男性(β=0.673,OR=0.510,95%CI=0.263~0.991)、年龄(β=0.128,OR=1.136,95%CI=1.110~1.163)、骨密度减低(β=0.735,OR=2.085,95%CI=1.212~3.587)及SBP(β=0.031,OR=1.031,95%CI=1.008~1.056)是颈动脉硬化的危险因素(P<0.05),HDL-C(β=-1.326,OR=0.265,95%CI=0.107~0.661)是颈动脉硬化的保护因素(P<0.05)。Logistic多因素分析结果显示,年龄(β=0.091,OR=1.095,95%CI=1.071~1.120)、糖尿病(β=0.900,OR=2.460,95%CI=0.981~6.167)及SBP(β=0.034,OR=1.035,95%CI=1.014~1.056)是眼底动脉硬化的危险因素(P<0.05)。按年龄分组分析动脉硬化的发生情况,结果显示,随着年龄增长,各动脉硬化的发生率均增加,颈动脉硬化发生早于眼底动脉。结论颈动脉和眼底动脉硬化发生与性别(男性)、年龄、糖尿病史、收缩压、骨密度减低相关,应该定期体检,积极控制危险因素。

Objective To observe the detection rate of patients with carotid artery and fundus arteriosclerosis in the physical examination population,and analyze the risk factors.Methods A total of 647 employees and retired employees from Northern Company who came to the Beifang Section of Peking University Third Hospital from May to December 2018 to participate in physical examination were selected.Sex,age,history of hypertension,coronary heart disease,and diabetes were recorded.Systolic blood pressure(SBP),diastolic blood pressure(DBP),fasting blood glucose(FBG),total cholesterol(TC),triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),uric acid(UA),bone mineral density(BMD),abdominal color ultrasound,carotid artery ultrasound and fundus vessels were examined.According to the results of carotid ultrasound,they were divided into non carotid atherosclerosis group(n=437)and carotid atherosclerosis group(n=210).According to the results of fundus examination,they were divided into non fundus arteriosclerosis group(n=534)and fundus arteriosclerosis group(n=113).The clinical datas of non carotid atherosclerosis group and carotid atherosclerosis group,non fundus arteriosclerosis group and fundus arteriosclerosis group were compared.Logistic regression was used to analyze the risk factors of carotid arteriosclerosis and fundus arteriosclerosis.Results The detection rate of carotid arteriosclerosis was 32.5%and fundus arteriosclerosis was 17.5%in 647 patients.Univariate analysis showed that the proportion of men,age,history of hypertension,history of coronary heart disease,history of diabetes,decreased bone mineral density,SBP,DBP,FBG,UA and TC levels in the carotid atherosclerosis group were higher than those in the non carotid atherosclerosis group,and the level of HDL-C was lower than that in the non carotid atherosclerosis group,with statistical significances(P<0.05).Univariate analysis showed that the proportion of men,age,history of coronary heart disease,history of diabetes,decreased bone mineral density,SBP,DBP,FBG and UA levels in the fundus arteriosclerosis group were higher than those in the non fundus arteriosclerosis group,and the level of HDL-C was lower than that in the non fundus arteriosclerosis group,with statistical significances(P<0.05).Logistic multivariate analysis showed that male(β=0.673,OR=0.510,95%CI=0.263-0.991),age(β=0.128,OR=1.136,95%CI=1.110-1.163),decreased bone mineral density(β=0.735,OR=2.085,95%CI=1.212-3.587)and SBP(β=0.031,OR=1.031,95%CI=1.008-1.056)were risk factors for carotid atherosclerosis(P<0.05).HDL-C(β=-1.326,OR=0.265,95%CI=0.107-0.661)was a protective factor for carotid atherosclerosis(P<0.05).Logistic multivariate analysis showed that age(β=0.091,OR=1.095,95%CI=1.071-1.120),diabetes mellitus(β=0.900,OR=2.460,95%CI=0.981-6.167)and SBP(β=0.034,OR=1.035,95%CI=1.014-1.056)were risk factors for fundus arteriosclerosis(P<0.05).According to the age group analysis of the occurrence of atherosclerosis,the results showed that,with the growth of age,the incidence of all atherosclerosis increased,carotid atherosclerosis occurred earlier than fundus artery.Conclusion The occurrence of carotid and fundus arteriosclerosis is related to gender(male),age,diabetes,high systolic blood pressure and decreased bone density.People should have regular physical examination and actively control the risk factors.