上海某体检机构成年体检人群颈动脉粥样硬化的发生现状及危险因素分析

Current situation and risk factors of carotid atherosclerosis in adults from a medical check-up institution in Shanghai

目的从上海某体检机构成年体检人群入手,探讨颈动脉粥样硬化(CAS)发生现状,并进一步探索CAS发生的危险因素。方法采用便利抽样方法选取2019年1—12月在华东疗养院体检中心进行体检的10336例成年人群为研究对象,采集受试者的基本资料和体检资料,包括年龄、性别、吸烟、饮酒、BMI、腰臀比、血压、血糖、血脂、颈动脉超声检查结果、幽门螺杆菌(H.pylori)检测结果等。根据颈动脉超声是否发现CAS,将研究对象分为CAS组和非CAS组,比较两组人群的基本资料和各类实验室指标,采用logistic回归模型分析CAS发生的可能危险因素。结果10366例研究对象中,3747例检出CAS,CAS总检出率为36.1%,其中男性检出率为41.9%(2853/6801),女性检出率为25.1%(894/3565),男性的CAS检出率显著高于女性(P<0.001);偏瘦或正常、超重、肥胖组的CAS检出率分别为28.8%、41.4%、44.2%,随着BMI的升高,CAS检出率呈显著上升趋势(P<0.001)。<60岁者CAS检出率为27.4%,显著低于≥60岁者的85.8%(P<0.001)。logistic回归模型分析显示,男性≥60岁(OR=14.756,95%CI为12.099~17.995,P<0.001)和女性≥60岁(OR=15.530,95%CI为12.067~19.987,P<0.001)皆为相应性别CAS发生的独立危险因素。男性CAS发生的其他独立危险因素分别为吸烟(OR=1.461,95%CI为1.305~1.637,P<0.001)、高血压(OR=1.320,95%CI为1.144~1.523,P<0.001)、血脂异常(OR=1.141,95%CI为1.019~1.278,P=0.022)、FBG升高(OR=2.088,95%CI为1.819~2.396,P<0.001)、H.pylori感染(OR=1.164,95%CI为1.032~1.313,P=0.014)。女性CAS发生的独立危险因素分别为超重(OR=1.443,95%CI为1.175~1.772,P<0.001)、肥胖(OR=1.692,95%CI为1.154~2.481,P=0.007)、高血压(OR=1.928,95%CI为1.409~2.637,P=0.001)、血脂异常(OR=2.218,95%CI为1.771~2.557,P<0.001)、FBG升高(OR=1.685,95%CI为1.220~2.326,P=0.002),但H.pylori感染不是女性CAS发生的危险因素(P>0.05)。结论上海某体检机构成年体检人群CAS的总检出率约为36.1%,H.pylori感染可能是男性CAS发生的独立危险因素。

Objective To explore the current status of carotid atherosclerosis(CAS)occurrence in adults from a medical check-up facility in Shanghai,and to further explore the risk factors for CAS.Methods A convenience sample of 10336 adults who underwent physical examination at Huadong Sanatorium between January and December 2019 was selected as study subjects.Basic information and physical examination data were collected from the subjects,including age,gender,smoking,alcohol consumption,body mass index(BMI),waist-hip ratio,blood pressure,blood glucose,blood lipids,carotid ultrasound,H.pylori test and other indicators.The subjects were divided into CAS and non-CAS groups according to carotid ultrasound results.The basic data and laboratory indexes were compared between the two groups.Results The overall detection rate of CAS was 36.1%(3747/10366).CAS detection rate in males was 41.9%(2853/6801),which was significantly higher than that in females(25.1%,894/3565,P<0.001).The detection rates of CAS were 28.8%,41.4%and 44.2%in the lean or normal,overweight,and obese groups,respectively,and they tended to increase significantly with the increase of BMI(P<0.001).The CAS detection rate in subjects aged<60 years was lower than those aged≥60 years(27.4%vs.85.8%,P<0.001).Logistic regression model showed that the risk of CAS was significantly higher in people aged≥60 years(men:OR=14.756,95%CI:12.099-17.995;women:OR=15.530,95%CI:12.067-19.987,both P<0.001).Independent risk factors for the occurrence of CAS in men were smoking(OR=1.461,95%CI:1.305-1.637,P<0.001),high blood pressure(OR=1.320,95%CI:1.144-1.523,P<0.001),dyslipidemia(OR=1.141,95%CI:1.019-1.278,P=0.022),high fasting glucose(OR=2.088,95%CI:1.819-2.396,P<0.001),and H.pylori infection(OR=1.164,95%CI:1.032-1.313,P=0.014).Independent risk factors for the occurrence of CAS in women were overweight(OR=1.443,95%CI:1.175-1.772,P<0.001),obesity(OR=1.692,95%CI:1.154-2.481,P=0.007),high blood pressure(OR=1.928,95%CI:1.409-2.637,P=0.001),dyslipidemia(OR=2.218,95%CI:1.771-2.557,P<0.001),and high fasting glucose(OR=1.685,95%CI:1.220-2.326,P=0.002),but H.pylori infection was not a risk factor for the occurrence of CAS in women(P>0.05).Conclusion The overall detection rate of CAS in the adults of a medical check-up institution in Shanghai is 36.1%.H.pylori infection may be an important independent risk factor for the development of CAS in men.