高血压患者部分血脂指标与颈动脉斑块的相关性

Correlation between lipid parameters and carotid plaque among patients with hypertension

目的分析高血压患者颈动脉斑块的流行病学特征以及与血脂指标的相关关系,确定与颈动脉斑块相关性最好的血脂指标。方法前瞻性收集2016年6月—2017年6月于北京安贞医院高血压门诊及全科门诊就诊并且进行颈动脉超声检查的高血压患者。结果共纳入研究对象2626例,颈动脉斑块的检出率为46.3%(1215/2626),男性高于女性,并随着年龄的增加而显著增加(均P<0.001)。具有颈动脉斑块的高血压患者低密度脂蛋白胆固醇(LDLC)、非高密度脂蛋白胆固醇(non-HDLC)、总胆固醇(TC)水平以及LDLC/HDLC、TC/HDLC均显著高于无颈动脉斑块的高血压患者(均P<0.01);而HDLC和甘油三酯(TG)水平两组间差异无统计学意义(P>0.05)。调整性别、年龄、高血压病程、血压控制、吸烟、饮酒、体力活动不足、腰围、空腹血糖、同型半胱氨酸水平的影响后,LDLC、non-HDLC、TC、LDLC/HDLC、TC/HDLC与颈动脉斑块均具有显著的相关关系,相对危险度分别为1.373(95%CI:1.233~1.529)、1.310(95%CI:1.187~1.447)、1.257(95%CI:1.147~1.376)、1.202(95%CI:1.096~1.319)和1.116(95%CI:1.039~1.199)。上述指标判断颈动脉斑块存在的ROC曲线下面积分别为:0.557(95%CI:0.535~0.579,P<0.001)、0.553(95%CI:0.531~0.575,P<0.001)、0.540(95%CI:0.518~0.562,P<0.001)、0.551(95%CI:0.529~0.573,P<0.001)、0.539(95%CI:0.517~0.561,P=0.001)。结论接近半数高血压患者检出颈动脉斑块,血脂指标中LDLC、non-HDLC、TC判断颈动脉斑块存在的价值相近,和单一的指标相比LDLC/HDLC、TC/HDLC并没有增加判断颈动脉斑块存在的价值。

Aim To describe the status of carotid plaque and the relationship between lipid parameters and carotid plaque in patients with hypertension.Methods This cross-sectional survey was conducted between June 2016 and June 2017,2626 subjects with hypertension who were assessed carotid plaque by Color Doppler ultrasonography at Anzhen Hospital were enrolled in the study.Results In total of subjects,1215 of 2626 subjects were examined carotid plaque.The prevalence of carotid plaque was higher in men than that in women,and increased with age(all P<0.001).Low density lipoprotein cholesterol(LDLC),non-high density lipoprotein cholesterol(non-HDLC)levels,total cholesterol(TC)level,LDLC/HDLC and TC/HDLC were significantly higher in subjects with carotid plaque than those without carotid plaque(all P<0.01).There was no significant difference between the two groups regarding the other two lipid parameters(triglyceride(TG)and HDLC)(all P>0.05).Carotid plaque was correlated with LDLC,non-HDLC,TC levels and ratios of LDLC/HDLC,TC/HDLC,the odds ratio was 1.373(95%CI:1.233~1.529),1.310(95%CI:1.187~1.447),1.257(95%CI:1.147~1.376),1.202(95%CI:1.096~1.319)and 1.116(95%CI:1.039~1.199),respectively after adjustment for sex,age,duration of hypertension,blood pressure control,current smoking,current drinking,lack of leisure time activities,waist circumference,plasma glucose level and homocysteine blood level.The AUC-values for LDLC/HDLC 0.551(95%CI:0.529~0.573,P<0.001)and TC/HDLC 0.539(95%CI:0.517~0.561,P=0.001)didn t show the larger area under the curve than each lipid parameter separately used,for LDLC 0.557(95%CI:0.535-0.579,P<0.001),non-HDLC 0.553(95%CI:0.531~0.575,P<0.001),and TC 0.540(95%CI:0.518~0.562,P<0.001).Conclusions Almost half of patients with hypertension were detected carotid plaque;LDLC and non-HDLC levels were the most specific lipoprotein associated with the presence of carotid plaque,TC/HDLC and LDLC/HDLC ratios didn t show more significant correlation than each lipid parameter separately used.