中国中老年人群甘油三酯和高密度脂蛋白胆固醇比值与认知障碍发病关系

Relationship between the ratio of triglyceride to high-density lipoprotein cholesterol and cognitive impairment incidence in middle-aged and elderly residents in China:an analysis on CHARLS data

目的 探讨中国中老年人群甘油三酯(TG)和高密度脂蛋白胆固醇(HDL-C)比值与认知障碍发病的关系,为制定认知障碍的干预措施提供参考依据。方法 收集2011、2013、2015和2018年中国健康与养老追踪调查(CHARLS)中2011年基线调查时无认知障碍的6 883名≥45岁中老年人群的相关数据,将2011年基线调查中TG/HDL-C比值按四分位数分组,采用多因素非条件logistic回归模型分析中国中老年人群TG/HDL-C比值与认知障碍发病的关系,并采用限制立方样条(RCS)曲线拟合TG/HDL-C比值与中老年人群认知障碍发生风险的剂量反应关系。结果 随访至2018年,基线调查时6 883名无认知障碍的≥45岁中国中老年人群中发生认知障碍者2 532例,累积发病率为36.79%;认知障碍组和非认知障碍组中老年人群TG/HDL-C比值分别为(3.08±4.69)和(3.64±6.28),认知障碍组中老年人群TG/HDL-C比值低于认知障碍正常组,差异有统计学意义(t=-3.875,P <0.001)。在调整了性别、年龄、文化程度、婚姻状况、居住地、吸烟情况、饮酒情况、是否高血压、是否糖尿病、是否血脂异常、是否心脏病、体质指数、空腹血糖、尿酸、肌酐、总胆固醇(TC)和低密度脂蛋白胆固醇(LDL-C)后,多因素非条件logistic回归分析结果显示,TG/HDL-C比值最高四分位数组中老年人群发生认知障碍的风险为TG/HDL-C比值最低四分位数组中老年人群的1.257倍(OR=1.257,95%CI=1.045~1.513);趋势性检验结果显示,中国中老年人群TG/HDL-C比值与认知障碍发病风险存在剂量反应关系(χ^(2)=2.636,P=0.008),RCS曲线近似“J”形(χ^(2)=11.810,P=0.019)。结论 TG/HDL-C比值升高是中国中老年人群认知障碍发病的危险因素。

Objective To investigate the association between the triglyceride(TG)to high-density lipoprotein cholesterol(HDL-C)ratio and cognitive impairment incidence among middle-aged and elderly Chinese residents,aiming to develop intervention strategies for cognitive impairment.Methods The study data were obtained from four waves of the China Health and Retirement Longitudinal Study(CHARLS)conducted in 2011,2013,2015,and 2018.The analysis included 6883 residents who were aged≥45 years at the enrollment,with complete baseline information including TG and HDL-C,and free from cognitive impairment as determined by the Mini-Mental State Examination(MMSE)and Telephone Interview for Cognitive Status(TICS)assessments at the baseline survey in 2011 and were successfully followed up till 2018.The residents'baseline TG/HDL-C ratios were computed and categorized into quartile groups.The association between the baseline TG/HDL-C ratio and the cumulative incidence of cognitive impairment in residents was examined using a non-conditional multivariate logistic regression model.The relationship between the baseline TG/HDL-C ratio and the risk of cognitive impairment was then modeled using a restricted cubic spline(RCS)curve.Results At the end of the follow-up period,a total of 2532 out of 6883residents were diagnosed with cognitive impairment,resulting in a cumulative incidence rate of 36.79%over seven years.The TG/HDL-C ratio was 3.08±4.69 in the individuals with cognitive impairment,which was significantly lower than the ratio of 3.64±6.28 observed in those without the disorder(t=-3.875,P<0.001).After adjusting for covariates including sex,age,education,marital status,place of residence,smoking status,alcohol consumption,hypertension,diabetes,dyslipidemia,heart disease,body mass index,fasting blood glucose,uric acid,creatinine,total cholesterol,and low-density lipoprotein cholesterol,the multivariate unconditional logistic regression analysis revealed that the individuals in the highest quartile of TG/HDL-C ratio was at a significantly increased risk of cognitive impairment compared to those in the lowest quartile of TG/HDL-C ratio(odds ratio=1.257,95 confidence interval:1.045-1.513).The results of the trend test indicated a significant dose-response relationship between the TG/HDL-C ratio and the risk of cognitive impairment in the residents(x^(2)=2.636,P=0.008).Furthermore,the RCS curve exhibited an approximate"J"shape(x^(2)=11.810,P=0.019).Conclusion The elevated TG/HDL-C ratio constitutes a significant risk factor for cognitive impairment in the middle-aged and elderly population of China.