超重、肥胖与高血压对B期心力衰竭患病的交互作用分析

Interaction of overweight,obesity and hypertension on B stage heart failure

目的了解超重、肥胖与高血压的交互作用对B期心力衰竭患病风险的影响,为科学合理预防或延缓心力衰竭病情提供科学依据。方法数据来源于2021年深圳市心力衰竭流行病学调查,采用分层随机抽样的方法,对6080名≥18岁深圳市常住居民进行一般信息问卷调查、身体测量和超声心动图检查。采用R 4.2.1进行χ^(2)检验,用logistic模型分析超重、肥胖与高血压对B期心力衰竭患病的影响,用相乘与相加模型分析超重、肥胖与高血压的交互作用。计算相对超额危险度(RERI)、交互作用归因比(API)、交互作用指数(SI)。结果B期心衰患者940例(15.46%),高血压患者1650例(27.14%),超重患者1985例(32.65%),肥胖患者734例(12.07%)。多因素logistic回归分析模型调整混杂因素后结果显示,超重、肥胖与高血压不存在相乘交互作用(超重OR=1.36,95%CI:0.95~1.94,肥胖OR=1.37,95%CI:0.90~2.09)。超重、肥胖与高血压对B期心力衰竭的患病风险存在正向相加交互作用,超重与高血压的交互作用RERI、API和SI分别为0.98(95%CI:0.31~1.65)、0.33(95%CI:0.14~0.51)和1.97(95%CI:1.17~3.30),肥胖与高血压交互作用的RERI、API和SI分别为2.41(95%CI:0.66~4.16)、0.37(95%CI:0.17~0.58)和1.81(95%CI:1.19~2.74)。结论超重、肥胖与高血压可能存在相加交互作用,同时控制高血压与体质指数在正常水平可能会协同预防或延缓B期心力衰竭的发生。

Objective To understand the influence of interaction of overweight,obesity and hypertension on risk of B stage heart failure,and provide the scientific basis for scientific and rational prevention or delay of heart failure condition.Methods Data were from the epidemiological investigation of heart failure in Shenzhen city,and the stratified random sampling method was used to select 6080 residents(≥18 years old)as the subjects.The investigation was performed with information questionnaire,physical measurement and echocardiogram examination.Logistic regression model was used to analyze the influence of overweight,obesity and hypertension on B stage heart failure.Multiplication and additive model was used to analyze the interaction between overweight,obesity and hypertension.Relative excess risk due to interaction(RERI),attributable proportion due to interaction(API)and synergy index(SI)were calculated.Theχ^(2)test was used to analyze the data,the used software was R 4.2.1.Results Among 6080 subjects,there were 940 cases with B stage heart failure(15.46%),1650 cases with hypertension(27.14%),1985 cases with overweight(32.65%),and 734 cases with obesity(12.07%).The multivariate logistic regression analysis showed that after adjusting the confounding factors,there was no multiplicative interaction between overweight,obesity and hypertension(overweight:OR=1.36,95%CI:0.95-1.94,obesity:OR=1.37,95%CI:0.90-2.09).There was the positive additive interaction between overweight,obesity and hypertension on the risk of B stage heart failure;RERI,API and SI of interaction between overweight and hypertension were 0.98(95%CI:0.31-1.65),0.33(95%CI:0.14-0.51)and 1.97(95%CI:1.17-3.30),respectively;RERI,API and SI of interaction between obesity and hypertension were 2.41(95%CI:0.66-4.16),0.37(95%CI:0.17-0.58)and 1.81(95%CI:1.19-2.74),respectively.Conclusion There may be an additive interaction between overweight,obesity and hypertension,and simultaneous control of hypertension and body mass index(BMI)at normal levels may synergistically prevent or delay the development of B stage heart failure.