心源性猝死影响因素的巢式病例对照研究

A nested case-control study on the influencing factors of sudden cardiac death

目的基于队列人群研究心源性猝死(sudden cardiac death,SCD)的影响因素,为SCD的预防和病因学研究提供科学依据。方法采用巢式病例对照研究的方法,以金昌队列2011―2019年三次随访新发52例SCD者为病例组,按照年龄(±2岁)及同性别1∶4个体匹配的方法,以同期随访未发生SCD者的208例为对照组。用条件logistic回归分析模型分析金昌队列人群发生SCD的影响因素,并通过限制性立方样条(restricted cubic spline,RCS)模型拟合SCD发病风险的剂量-反应关系曲线。结果多因素条件logistic回归分析模型分析结果显示:三酰甘油(triglycerides,TG)(OR=2.94,95%CI:1.15~7.51)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol,LDL-C)(OR=2.70,95%CI:1.18~6.22)、糖尿病(OR=5.59,95%CI:1.79~17.46)和心电图异常(OR=5.54,95%CI:2.11~14.56)是SCD的危险因素;文化程度在高中及以上(OR=0.33,95%CI:0.12~0.88)是SCD的保护因素。RCS结果显示:空腹血糖(fasting plasma glucose,FPG)、TG与SCD发病风险间呈正向线性剂量-反应关系(P总趋势<0.05,P非线性>0.05)。结论TG、LDL-C、糖尿病、心电图异常和文化程度与SCD的发生有关且FPG、TG与SCD的发生风险间存在线性剂量-反应关系。

Objective To study the influencing factors of sudden cardiac death(SCD)based on the cohort population,and to provide basic data for the prevention and etiological research of SCD.Methods A nested case-control study was conducted,involving 52 newly diagnosed cases of SCD during three follow-up visits from 2011 to 2019 in Jinchang cohort.And 208 participants without SCD during the same period of follow-up were selected as the control group according to the matching method of age(±2 years)and 1∶4 individuals of the same sex.Conditional logistic regression model was used to analyze the influencing factors of SCD in Jinchang cohort,and the dose-response relationship of SCD risk was fitted by restricted cubic spline(RCS)models.Results Multivariate conditional logistic regression analysis showed that triglycerides(TG)(OR=2.94,95%CI:1.15-7.51),low density lipoprotein cholesterol(LDL-C)(OR=2.70,95%CI:1.18-6.22),diabetes(OR=5.59,95%CI:1.79-17.46)and abnormal electrocardiogram(OR=5.54,95%CI:2.11-14.56)were risk factors for SCD.Education level in high school and above(OR=0.33,95%CI:0.12-0.88)was a protective factor for SCD.RCS analysis showed that there was a positive linear dose-response relationship between fasting plasma glucose(FPG),TG and the risk of SCD(general trend P<0.05,non-linear P>0.05).Conclusions TG,LDL-C,diabetes,abnormal electrocardiogram and education level were related to the occurrence of SCD,and there was a dose-response relationship between FPG,TG and the risk of SCD.