地中海饮食模式和急性非ST段抬高型心肌梗死发生风险的关系研究

A study on the relationship between Mediterranean dietary pattern and the risk of acute non-ST-segment elevation myocardial infarction

目的探讨地中海饮食模式与急性非ST段抬高型心肌梗死(NSTEMI)发生风险的相关性。方法本研究是一项单中心大型病例对照研究。收集2017年1月至2020年12月在首都医科大学附属北京安贞医院首次确诊为急性NSTEMI的患者600例作为急性NSTEMI组。根据年龄、性别进行1∶1匹配选取同期本院体检中心健康体检者600人作为对照组。比较2组一般资料。根据饮食频率调查问卷计算出改良地中海饮食评分(AMEDS)。将所有受试者按AMEDS分为AMEDS<4分组、AMEDS 4~5分组和AMEDS≥6分组。分析总体及不同AMEDS组的急性NSTEMI发生风险,分析AMEDS中不同种类食物与急性NSTEMI发生风险的相关性。结果急性NSTEMI组有高血压病、糖尿病病史的患者比例、收缩压、体重指数、目前吸烟者比例均高于对照组,家庭收入≥120000元/年的比例、AMEDS均低于对照组,差异均有统计学意义(均P<0.05)。相对于AMEDS<4分组的受试者而言,AMEDS 4~5分组以及AMEDS≥6分组受试者急性NSTEMI发生风险明显降低(调整年龄、性别、受教育年限、家庭年收入、病史、体重指数、血压、血红蛋白、生活方式等多个协变量后的多因素分析比值比=0.72,95%置信区间:0.53~0.94,P=0.031;比值比=0.62,95%置信区间:0.47~0.84,P=0.008)。将患者按年龄和性别进行分层,多因素回归分析后发现,随AMEDS增加,急性NSTEMI发生风险降低的趋势在男性和年龄<60岁的人群依然存在(均P<0.05),在女性和≥60岁的人群中,趋势差异无统计学意义(均P>0.05),同时分层之间交互性分析后差异均无统计学意义(均P>0.05)。AMEDS食物种类分析结果显示,蔬菜、鱼类降低急性NSTEMI发生风险,红肉或加工肉类增加其发生风险(比值比=0.51,95%置信区间:0.42~0.66,P<0.001;比值比=0.75,95%置信区间:0.59~0.94,P=0.010;比值比=1.51,95%置信区间:1.21~1.90,P<0.001)。结论地中海饮食模式和急性NSTEMI的发生相关,改良地中海饮食的高依从性可能降低急性NSTEMI的发生风险。

Objective To explore the correlation between Mediterranean dietary pattern and the risk of acute non-ST-segment elevation myocardial infarction(NSTEMI).Methods This study was a large case-control study at a single center.A total of 600 patients who were first diagnosed with acute NSTEMI in Beijing Anzhen Hospital,Capital Medical University from January 2017 to December 2020 were collected as the acute NSTEMI group.1∶1 match was conducted based on age and gender,and 600 healthy examinees from the physical examination center of our hospital during the same period were selected as the control group;the general datas were compared between the two groups.The alternate Mediterranean diet score(AMEDS)was computed from Food Frequency Questionnaires.All subjects were divided into AMEDS<4 group,AMEDS 4-5 group,and AMEDS≥6 group based on AMEDS.The risks of acute NSTEMI were analyzed overall and in different AMEDS groups,and the correlation between different types of food in AMEDS and the risk of acute NSTEMI was analyzed.Results The proportion of patients with hypertension and diabetes history,systolic blood pressure,body mass index,and the proportion of current smokers in the acute NSTEMI group were higher than those in the control group,the proportion of family income≥120000 yuan/year,and AMEDS were lower than those in the control group(all P<0.05).Compared to subjects in the AMEDS<4 group,the risk of acute NSTEMI was significantly reduced among participants in the AMEDS 4-5 and AMEDS≥6 groups(adjusted for multiple covariates such as age,gender,years of education,annual family income,medical history,body mass index,blood pressure,hemoglobin,lifestyle,etc.,odds ratio=0.72,95%confidence interval:0.53-0.94,P=0.031;odds ratio=0.62,95%confidence interval:0.47-0.84,P=0.008).Patients were stratified by age and gender,and multivariate regression analysis showed that with the increase of AMEDS,the risk of acute NSTEMI decreased in men and people<60 years old(all P<0.05).There were no statistically significant differences in trend between women and people≥60 years old(all P>0.05),and there were no statistically significant differences in interaction analysis between layers after interaction analysis(all P>0.05).The results of AMEDS food category analysis showed that vegetables and fish reduced the risk of acute NSTEMI,and red meat or processed meat increased its risk(odds ratio=0.51,95%confidence interval:0.42-0.66,P<0.001;odds ratio=0.75,95%confidence interval:0.59-0.94,P=0.010;odds ratio=1.51,95%confidence interval:1.21-1.90,P<0.001).Conclusions The Mediterranean dietary pattern is associated with the occurrence of acute NSTEMI.High adherence to the modified Mediterranean diet may reduce the risk of acute NSTEMI.