吸烟与低密度脂蛋白胆固醇交互作用对瓣膜性心脏病的影响

Effect on interaction between smoking and high low density lipoprotein on valvular heart disease

目的 探讨吸烟与低密度脂蛋白胆固醇(LDL-C)交互作用对瓣膜性心脏病(VHD)的影响。方法 选择在山东省医学科学院心脑血管病防治研究中心进行体检的健康体检者3 438例,以是否患有VHD为依据分为病例组464例、对照组2 974例。对比两组基线特征(包括性别、年龄、吸烟史、饮酒史、体育锻炼情况等)、BMI、心脏杂音及LDL-C。采用单因素与多因素logistic回归法分析吸烟与LDL-C对VHD发生的影响。结果 病例组年龄、吸烟比例、心脏杂音比例、LDL-C高于对照组(P<0.05),两组性别、饮酒、体育锻炼比例及BMI比较差异无统计学意义(P>0.05)。多因素logistic回归分析结果显示,吸烟、LDL-C均是VHD的危险因素(P<0.05)。对吸烟、LDL-C进行哑变量设置,分为四组,以不吸烟且LDL-C正常为对照组进行比较,调整混杂因素,多因素logistic回归分析结果显示,与对照组相比,不吸烟且LDL-C升高组患病风险增加了1.881倍,吸烟且LDL-C正常组患病风险增加了1.970倍,吸烟且LDL-C升高组的患病风险增加了6.867倍。吸烟、LDL-C升高的交互作用指数为3.17,交互作用归因比为58.48%,纯交互作用归因比为68.45%。结论 吸烟与LDL-C升高均为VHD发生的危险因素,两者对VHD发生存在交互作用。

Objective To study the effect and interaction of smoking and low density lipoprotein cholesterol(LDL-C) on valvular heart disease(VHD). Methods A total of 3 438 healthy subjects who underwent physical examination at the Research Center for Prevention and Treatment of Cardio-Cerebrovascular Diseases, Shandong Academy of Medical Sciences were selected and divided into a case group(464 cases) and a control group(2 974 cases) based on whether or not they had VHD.Baseline characteristics(including gender, age, smoking history, alcohol history, and physical activity),BMI,cardiac murmur, and LDL-C were compared between the 2 groups.Single-factor and multi-factor logistic regression was used to analyze the effect of smoking and LDL-C on the occurrence of VHD. Results Age, proportion of smoking, proportion of heart murmur and LDL-C were higher in the case group than in the control group(P<0.05),and there was no statistically significant difference between the 2 groups in terms of gender, alcohol consumption, proportion of physical exercise and BMI(P>0.05).Multi-factor logistic regression analysis showed that smoking and LDL-C were all risk factors for VHD(P<0.05).Dummy variables were set for smoking and LDL-C and divided into 4 groups, and the non-smoking and normal LDL-C group was used as the control group for comparison.Adjusting for confounders, the results of multifactorial logistic regression analysis showed that compared with the control group, the risk of non-smoking and increased LDL-C increased by 1.881 times, that of smoking and normal LDL-C increased by 1.970 times, and that of smoking and increased LDL-C increased by 6.867 times.The risk increased by 6.867 times in the group with increased LDL-C.The interaction index for smoking and increased LDL-C was 3.17,with an interaction attributable ratio of 58.48% and a pure interaction attributable ratio of 68.45%. Conclusion Smoking and increased LDL-C are both risk factors for VHD,and they interact with each other.