陕西省延安市成年人群血清n-HDL-C水平参考区间的建立及影响因素分析

Establishment of Reference Interval for Serum n-HDL-C Level of Adult Population in Yan’an City of Shaanxi Province and Analysis of Influencing Factors

目的建立陕西省延安市成年人血清非高密度脂蛋白-胆固醇(non-high-density lipoprotein cholesterol,n-HDL-C)的参考区间并分析影响因素。方法采用随机整体抽样的方法,抽取2023年1~9月陕西省延安市10个乡镇16921例成人为研究对象。调查年龄、性别、吸烟、饮酒、锻炼、高血压、糖尿病、血脂异常、慢性病、居住、饮食习惯、婚姻状况、文化程度、月收入等。测量身高、体重、腰围和血压。检测血清三酰甘油(TG)、总胆固醇(TCHO)、高密度脂蛋白-胆固醇(HDL-C)、低密度脂蛋白-胆固醇(LDL-C)、载脂蛋白A1(ApoA1)、载脂蛋白B(ApoB)及脂蛋白a[Lp(a)]水平,计算n-HDL-C水平,n-HDL-C(mmol/L)=TCHO(mmol/L)-HDL-C(mmol/L)。按照WS/T402-2012《中华人民共和国卫生行业标准》建议的百分位数法计算95%参考区间(P_(2.5)~P_(97.5))。采用多因素Logistic回归分析影响血清n-HDL-C水平的影响因素。结果男性和女性血清n-HDL-C水平均呈非正态分布(S=2.119,2.091,均P<0.001)。男性>60岁血清n-HDL-C水平[2.98(2.50,3.37)mmol/L]与18~30岁[2.84(2.49,3.26)mmol/L],31~40岁[2.98(2.62,3.42)mmol/L],41~50岁[3.10(2.62,3.47)mmol/L]和51~60岁[3.05(2.64,3.46)mmol/L]比较,差异具有统计学意义(H=3.618~5.680,均P<0.05);女性51~60岁血清n-HDL-C水平[3.08(2.71,3.44)mmol/L]与18~30岁[2.64(2.29,3.07)mmol/L],31~40岁[2.67(2.31,3.08)mmol/L],41~50岁[2.94(2.58,3.29)mmol/L]比较(H=8.161~13.445,均P<0.001),>60岁血清n-HDL-C水平[2.98(2.57,3.34)mmol/L]与18~30岁、31~40岁、41~50岁比较,差异具有统计学意义(H=7.985~14.018,均P<0.001)。将无统计学意义的年龄组合并,得到成年人群血清n-HDL-C水平参考区间:男性18~60岁(1.97~3.97mmol/L),>60岁(1.86~3.91mmol/L);女性18~50岁(1.82~3.74mmol/L),>50岁(1.94~3.88mmol/L)。将纳入的16921例成人分为n-HDL-C水平正常组和异常组,两组血清TG(1.02±0.31 mmol/L vs 1.24±0.37mmol/L),TCHO(3.97±1.02 mmol/L vs 4.66±1.25 mmol/L),LDL-C(2.37±0.58mmol/L vs 2.59±0.67 mmol/L)水平及年龄(43.55±11.52岁vs 46.27±8.13岁)比较,差异具有统计学意义(t=2.041~3.151,均P<0.05),血清n-HDL-C水平异常率42.50%。经多因素Logistic回归分析,男性、锻炼缺乏、超重和肥胖、血脂异常、城市居民、高中及以上学历是该地区成年人血清n-HDL-C水平的影响因素(均P<0.05)。结论初步建立了该地区成年人血清n-HDL-C水平参考区间,男性、锻炼缺乏、超重和肥胖、血脂异常、城市居民、高中及以上学历是该地区成年人血清n-HDL-C水平异常的影响因素。

Objective To establish the reference interval of serum non-high-density lipoprotein cholesterol(n-HDL-C)in adults in Yan’an city of Shaanxi Province and analyze the influencing factors.Methods A total of 16921 adults from 10 towns in Yan’an City of Shaanxi Province from January to September 2023 were selected by random sampling.Age,sex,smoking,drinking,exercise,hypertension,diabetes,dyslipidemia,chronic disease,residence,eating habits,marital status,education and monthly income were investigated.Height,weight,waist circumference and blood pressure were measured.Serum triglyceride(TG),total cholesterol(TCHO),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),Apolipoprotein A1(ApoA1),Apolipoprotein B(ApoB)and lipoprotein a[Lp(a)]levels were detected,and n-HDL-C levels were calculated:n-HDL-C(mmol/L)=TCHO(mmol/L)-HDL-C(mmol/L).The 95%reference interval(P_(2.5)~P_(97.5))was calculated according to the percentile method recommended in WS/T402-2012 Health Industry Standard of the People’s Republic of China.Multivariate logistic regression was used to analyze the influencing factors of serum n-HDL-C level.Results The serum n-HDL-C levels in both males and females were not normally distributed(S=2.119,2.091,all P<0.001).There were significant differences in serum levels of n-HDL-C among males aged>60 years old[2.98(2.50,3.37)mmol/L],18~30 years old[2.84(2.49,3.26)mmol/L],31~40 years old[2.98(2.62,3.42)mmol/L],41~50 years old[3.10(2.62,3.47)mmol/L]and 51~60 years old[3.05(2.64,3.46)mmol/L]contrast,and the differences were significant(H=3.618~5.680,all P<0.05).There were significant differences in serum levels of n-HDL-C among women aged 51~60 years[3.08(2.71,3.44)mmol/L],18~30 years[2.64(2.29,3.07)mmol/L],31~40 years[2.67(2.31,3.08)mmol/L]and 41~50 years old[2.94(2.58,3.29)mmol/L]contrast(H=8.161~13.445,all P<0.001).There were significant differences in serum n-HDL-C levels among patients aged>60 years old[2.98(2.57,3.34)mmol/L],18~30 years old,31~40 years old and 41~50 years old contrast,and the differences were significant(H=7.985~14.018,all P<0.001).The reference interval of serum n-HDL-C level in adult population was obtained by combining the age groups with no statistical significance:males aged 18~60 years old(1.97~3.97mmol/L),>60 years old(1.86~3.91mmol/L);females aged 18~50 years(1.82~3.74 mmol/L),>50 years old(1.94~3.88 mmol/L).A total of 16921 adults were divided into normal n-HDL-C group and abnormal group,and the differences of serum TG(1.02±0.31 mmol/L vs 1.24±0.37mmol/L),TCHO(3.97±1.02 mmol/L vs 4.66±1.25 mmol/L),LDL-C(2.37±0.58mmol/L vs 2.59±0.67 mmol/L)levels and age(43.55±11.52 years vs 46.27±8.13 years)between the two groups were significant(t=2.041~3.151,all P<0.05),in which the abnormal rate of serum n-HDL-C level was 42.50%.Multivariate Logistic regression analysis showed that males,lack of exercise,overweight or obesity,dyslipidemia,urban residents,and high school education or above were the influential factors for serum n-HDL-C levels in adults in this region(all P<0.05).Conclusion The reference interval of serum n-HDL-C level in adults in this area was preliminarily established.Males,lack of exercise,overweight or obesity,dyslipidemia,urban residents,and high school education or above were the influential factors of abnormal serum n-HDL-C levels in adults in this area.