基于倾向性评分的老年高胆固醇血症影响因素分析

郭颖; 裴冬梅

doi:10.7619/jcmp.20201914

基于倾向性评分的老年高胆固醇血症影响因素分析

郭颖,
裴冬梅^,

中国医科大学附属盛京医院全科医学科, 辽宁沈阳, 110000

基金项目:

辽宁省社会科学规划基金资助项目 L19BGL041

详细信息

通讯作者:
裴冬梅, E-mail: peidm@sj-hospital.org

中图分类号: R589.2;R592
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出版历程
- 收稿日期: 2020-12-29
- 网络出版日期: 2021-03-22
- 发布日期: 2021-03-14

Analysis in influencing factors of hypercholesterolemia in the elderly based on propensity score

GUO Ying,
PEI Dongmei^,

Department of General Medicine, Shengjing Hospital Affiliated to China Medical University, Shenyang, Liaoning, 110000

摘要

摘要:
目的基于倾向性评分对老年人发生高胆固醇血症的影响因素进行分析。
方法选取65岁以上的健康体检者763名作为研究对象，均接受体格检查和空腹血样检测，根据是否患高胆固醇血症将其分为高胆固醇血症组和非高胆固醇血症组，应用SPSS 23.0软件中的倾向性评分匹配模块分析老年人发生高胆固醇血症的相关因素。
结果本组老年人的高胆固醇血症的患病率为31.85%（243/763）。高胆固醇血症组的三酰甘油（TG）、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（Apo A1）、载脂蛋白B（Apo B）水平高于非高胆固醇血症组，总胆红素（TBIL）、直接胆红素（DBIL）水平低于非高胆固醇血症组，差异有统计学意义（P < 0.01）。Logistic多元回归分析提示，TG升高、HDL-C升高、Apo A1升高、TBIL降低、DBIL降低为高胆固醇血症的独立危险因素（P < 0.01）。倾向性评分匹配结果显示，TG升高、HDL-C升高、LDL-C升高、Apo A1升高、Apo B升高、TBIL降低、DBIL降低均是高胆固醇血症的危险因素（P < 0.05或P < 0.01）。
结论老年人高胆固醇血症的患病率较高，TG升高、HDL-C升高、LDL-C升高、Apo A1升高、Apo B升高、TBIL降低、DBIL降低均是引发高胆固醇血症的危险因素。
- 老年人 /
- 高胆固醇血症 /
- 影响因素 /
- 倾向性评分
Abstract:
objective To analyze influencing factors of hypercholesterolemia in the elderly based on propensity score.
Methods A total of 763 elderly people aged over 65 years who underwent physical examinations were selected as research objects. All the objects underwent physical examinations and their fasting blood samples were collected. According to the cholesterol levels, they were divided into hypercholesterolemia and non-hypercholesterolemia group, propensity score matching module of SPSS 23.0 software analysis was used to analyze the related factors of hypercholesterolemia.
Results The levels of triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), apolipoprotein A1 (Apo A1) and apolipoprotein B (Apo B) in the hypercholesterolemia group were significantly higher than those in non-hypercholesterolemia group(P < 0.01). Logistic multiple regression analysis suggested that the increase of TG, HDL-C, Apo A1 and the decrease of TBIL, DBIL were independently associated with hypercholesterolemia(P < 0.01). The results of propensity score matching showed that elevated levels of TG, HDL-C, LDL-C, Apo A1 as well as Apo B, and decreased levels of TBIL and DBIL were risk factors for hypercholesterolemia(P < 0.05 or P < 0.01).
Conclusion The prevalence of hypercholesterolemia in the elderly is higher, and elevated levels of TG, HDL-C, LDL-C, Apo A1 as well as Apo B, and decreased levels of TBIL and DBIL are risk factors for hypercholesterolemia.
- elderly /
- hypercholesterolemia /
- influencing factors /
- propensity score

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表 1 2组一般资料和实验室指标比较(x ±s)[n(%)]

指标		高胆固醇血症组(n=243)	非高胆固醇血症(n=520)	t/χ²	P
年龄/岁		70.40±5.88	71.09±5.82	-1.532	0.126
性别	男	99(40.74)	383(73.65)	8.887	< 0.001
	女	144(59.26)	137(26.35)
BMI/(kg/m²)		26.39±2.77	26.15±2.68	1.147	0.252
收缩压/mmHg		144.72±19.94	145.04±20.12	-0.204	0.838
舒张压/mmHg		78.81±11.95	79.66±11.56	-0.935	0.350
空腹血糖/(mmol/L)		5.97±1.49	6.05±1.64	-0.586	0.558
糖化血红蛋白/(mmol/L)		6.00±0.96	5.99±1.10	0.135	0.892
TG/(mmol/L)		1.79±1.36	1.44±0.85	3.766	< 0.001
HDL-C/(mmol/L)		1.42±0.40	1.20±0.32	7.519	< 0.001
LDL-C/(mmol/L)		4.12±0.61	2.72±0.62	29.227	< 0.001
Apo A1/(g/L)		1.60±0.26	1.42±0.22	9.60	< 0.001
Apo B/(g/L)		1.24±0.21	0.84±0.19	24.94	< 0.001
TBIL/(μmol/L)		13.86±4.87	15.21±5.21	-3.408	0.001
DBIL/(μmol/L)		2.74±1.05	3.72±1.47	-10.508	< 0.001
IBIL/(μmol/L)		11.11±3.96	11.49±3.97	-1.207	0.228
BMI: 体质量指数; TG: 三酰甘油; LDL-C: 低密度脂蛋白胆固醇; HDL-C: 高密度脂蛋白胆固醇; Apo A1: 载脂蛋白A1; Apo B: 载脂蛋白B; TBIL: 总胆红素; DBIL: 直接胆红素; IBIL: 间接胆红素。

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表 2 高胆固醇血症相关因素的Logistic多元回归分析

因素	B	S. E.	Exp(B)	Wald	P	95%CI
TG/(mmol/L)	0.318	0.078	1.375	16.599	< 0.001	1.180~1.602
HDL-C/(mmol/L)	1.736	0.237	5.673	53.725	< 0.001	3.567~9.024
Apo A1/(g/L)	3.244	0.371	25.631	76.562	< 0.001	12.394~53.005
TBIL/(μmol/L)	-0.056	0.017	0.945	11.210	0.001	0.915~0.977
DBIL/(μmol/L)	-0.730	0.085	0.482	73.355	< 0.001	0.408~0.570
TG: 三酰甘油; HDL-C: 高密度脂蛋白胆固醇; Apo A1: 载脂蛋白A1; TBIL: 总胆红素; DBIL: 直接胆红素。

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表 3 按不同因素分别匹配数据后各亚组胆固醇水平比较(x ±s)

因素	亚组	胆固醇/(mmol/L)	t	P
BMI	< 25 kg/m²	4.95±1.05	-0.504	0.615
	≥25 kg/m²	5.02±1.00
性别	男	5.07±1.04	0.262	0.793
	女	5.04±1.07
年龄	< 75岁	4.87±1.23	-0.953	0.343
	≥75岁	5.02±0.95
收缩压	< 150 mmHg	4.93±1.06	-0.702	0.484
	≥150 mmHg	5.02±1.02
舒张压	< 80 mmHg	5.00±0.99	0.363	0.717
	≥80 mmHg	4.96±1.08
糖化血红蛋白	< 6%	4.93±1.11	-0.655	0.513
	≥6%	5.01±0.98
空腹血糖	< 6 mmol/L	5.05±0.99
	≥6 mmol/L	4.94±1.06	0.836	0.404
TG	< 1.7 mmol/L	4.87±1.02	-2.439	0.015
	≥1.7 mmol/L	5.19±1.02
HDL-C	< 1.04 mmol/L	4.74±1.03	-2.882	0.004
	≥1.04 mmol/L	5.12±1.01
LDL-C	< 3.37 mmol/L	4.86±1.00	-2.369	0.019
	≥3.37 mmol/L	5.16±1.06
Apo A1	< 1.5 g/L	4.83±0.95	-2.532	0.012
	≥1.5 g/L	5.14±1.09
Apo B	< 1 g/L	4.86±0.94	-2.213	0.028
	≥1 g/L	5.14±1.12
TBIL	< 20 μmol/L	5.35±1.01	2.659	0.008
	≥20 μmol/L	4.91±1.02
DBIL	< 40 μmol/L	5.24±0.10	2.524	0.012
	≥40 μmol/L	4.89±1.03
IBIL	< 12 μmol/L	5.15±1.00	1.957	0.051
	≥12 μmol/L	4.90±1.04
BMI: 体质量指数; TG: 三酰甘油; LDL-C: 低密度脂蛋白胆固醇; HDL-C: 高密度脂蛋白胆固醇; Apo A1: 载脂蛋白A1; Apo B: 载脂蛋白B; TBIL: 总胆红素; DBIL: 直接胆红素; IBIL: 间接胆红素。

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参考文献(14)

[1]	SUN D, ZHOU B Y, ZHAO X, et al. Lipoprotein(a) level associates with coronary artery disease rather than carotid lesions in patients with familial hypercholesterolemia[J]. J Clin Lab Anal, 2018, 32(7): e22442. doi: 10.1002/jcla.22442
[2]	ZHANG D, KIM J. Use of propensity score and disease risk score for multiple treatments with time-to-event outcome: a simulation study[J]. J Biopharm Stat, 2019, 29(6): 1103-1115. doi: 10.1080/10543406.2019.1584205
[3]	王晓君. 中国40岁及以上人群颈动脉粥样硬化流行病学特征及其与心血管疾病关系研究[D]. 武汉: 华中科技大学, 2018.
[4]	赵冬. 中国人群血脂异常流行趋势和治疗控制现状[J]. 中华心血管病杂志, 2019, 47(5): 341-343. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_zhxxgb201905002
[5]	汪军, 李修德, 陶芳标, 等. 基于"老年人健康与环境可控性研究队列"的皖西地区社区老年人血脂异常研究[J]. 公共卫生与预防医学, 2018, 29(4): 127-130. https://www.cnki.com.cn/Article/CJFDTOTAL-FBYF201804035.htm
[6]	沈竹夏, 孙育民, 沈志文, 等. 上海社区老年人群高低密度脂蛋白胆固醇血症的危险因素分析[J]. 老年医学与保健, 2019, 25(4): 456-459. https://www.cnki.com.cn/Article/CJFDTOTAL-LYBJ201904009.htm
[7]	NAM K W, KWON H M, JEONG H Y, et al. High triglyceride/HDL cholesterol ratio is associated with silent brain infarcts in a healthy population[J]. BMC Neurol, 2019, 19(1): 147. doi: 10.1186/s12883-019-1373-8
[8]	李志昭, 陈盼盼, 王启辉, 等. 从胆固醇代谢标志物视角分析高脂血症患者血脂异常的影响因素[J]. 中国动脉硬化杂志, 2016, 24(5): 490-494. https://www.cnki.com.cn/Article/CJFDTOTAL-KDYZ201605012.htm
[9]	陈莹, 张博. apoA1/apoB Lp(a)在高胆固醇血症患者中的变化及意义[J]. 河北医学, 2019, 25(10): 1744-1747. https://www.cnki.com.cn/Article/CJFDTOTAL-HCYX201910041.htm
[10]	HAMUR H, DUMAN H, BAKIRCI E M, et al. Bilirubin levels and Thrombus burden in patients with ST-segment elevation myocardial infarction[J]. Angiology, 2016, 67(6): 565-570. doi: 10.1177/0003319715603899
[11]	郭鑫, 王静, 路月英, 等. 脑卒中后抑郁与血清胆红素及非高密度脂蛋白胆固醇的关系[J]. 中国老年学杂志, 2019, 39(1): 101-104. https://www.cnki.com.cn/Article/CJFDTOTAL-ZLXZ201901038.htm
[12]	吴雄健. 黄芩苷通过上调miR: 3595靶向ACSL4表达抑制大鼠肝纤维化的机制研究[D]. 广州: 南方医科大学, 2018.
[13]	王苏, 张艳艳, 林运. 胆红素与冠心病相关性的研究进展[J]. 中国循证心血管医学杂志, 2019, 11(8): 1019-1021. https://www.cnki.com.cn/Article/CJFDTOTAL-PZXX201908036.htm
[14]	HUANG F Y, PENG Y, HUANG B T, et al. The correlation between serum total bilirubin and outcomes in patients with different subtypes of coronary artery disease[J]. Clin Chim Acta, 2017, 465: 101-105. http://www.ncbi.nlm.nih.gov/pubmed/28017575