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摘要:
目的 探讨超重/肥胖与高同型半胱氨酸血症(hyperhomosycteinemia, HHcy)之间的交互作用对高血压发病的影响。 方法 采用分层整群抽样方法，于2013年5月―2014年6月在湖南省抽取长沙、株洲、岳阳、衡阳、永州、湘西6个样本地区，再将每个样本地区随机抽取城市和农村各2个社区，共24个社区中所有30岁及以上且常住5年及以上共5 258名居民作为调查对象进行体格检查、问卷调查和实验室检测。应用Logistic回归分析模型分析超重/肥胖和HHcy与高血压发病风险的关联强度，并分析相加模型和相乘模型交互作用。 结果 具有完整数据的4 012名对象中，患高血压者1 538例，高血压患病率为38.3%；有39.3%的居民超重/肥胖，有35.1%的居民患HHcy。在调整了性别、年龄、婚姻状况、教育程度、吸烟、饮酒、饮食和体力活动等混杂因素后，多因素非条件Logistic回归分析模型分析结果显示，超重/肥胖者患高血压的风险为非超重/肥胖者的2.801倍(OR=2.801, 95% CI: 2.407~3.261)，HHcy患者高血压的患病风险为Hcy正常者的3.488倍(OR=3.488, 95% CI: 3.000~4.055)，超重/肥胖且HHcy患者高血压患病风险为非超重/肥胖且Hcy正常者的10.205倍(OR=10.205, 95% CI: 8.120~12.826)。交互作用分析结果显示，超重/肥胖及HHcy的交互作用超额相对危险度、交互作用归因比和交互作用指数分别为5.218(95% CI: 3.213~7.222)、0.527(95% CI: 0.420~0.634)和2.415(95% CI: 1.848~3.156)，即超重/肥胖和HHcy对高血压患病具有相加交互作用。本研究未发现超重/肥胖和HHcy之间对高血压患病的相乘交互作用有统计学意义(OR=1.246, 95% CI: 0.920~1.688)。 结论 超重/肥胖和HHcy均可增加高血压的患病风险，且两者的相加交互作用增加了患高血压的风险。 Abstract:Objective To investigate the interaction between overweight/obesity and hyperhomocysteinemia (HHcy) on the risk of hypertension. Methods Six districts in Hunan Province (Changsha, Zhuzhou, Yongzhou, Hengyang, Yueyang, and Xiangxi) were selected from June 2013 to May 2014 by the stratified cluster sampling method. Two urban and two rural communities were randomly selected in each district. A total of 5 258 residents aged 30 or above and living in the district for at least 5 years were invited to participate in the present study. Physical examination, questionnaire survey and laboratory measurements were conducted for participants. Logistic regression model was used to analyze the association between overweight/obesity or HHcy and the risk of hypertension, and the additive and multiplicative interaction were further analyzed. Results Among 4 012 subjects with complete data, 1 538 were categorized with hypertension (38.3%); 39.3% participants were considered to be overweight/obese and 35.1% participants with HHcy. After adjustment with covariates such as gender, age, marital status, educational level, smoking, alcohol drinking, diet behavior and physical activity, multivariate unconditional Logistic regression analysis showed that the risk of hypertension in overweight/obese participants was 2.801 times (95% CI: 2.407-3.261) of that in participants without overweight/obesity, and the risk of hypertension in HHcy participant was 3.488 times (95% CI: 3.000-4.055) of that in normal Hcy participants. The risk of hypertension in participants with both overweight and HHcy was 10.205 times (95% CI: 8.120-12.826) of that in non-overweight/obese participants with normal Hcy. With further interaction analysis, we found that the Relative Excess Risk of Interaction, Attributable Proportion of Interaction and Interaction Index S of coexisting of overweight/obesity and HHcy were 5.218 (95% CI: 3.213-7.222), 0.527 (95% CI: 0.420-0.634) and 2.415 (95% CI: 1.848-3.156), respectively, which means that overweight/obesity and HHcy have an additive interaction effect on hypertension. There was no significant multiplicative interaction between overweight/obesity and HHcy (OR=1.246, 95% CI: 0.920-1.688). Conclusions Overweight/obesity and HHcy are both associated higher risk of hypertension. In addition, there is an interaction between overweight/obesity and HHcy associated with significantly elavated risk of hypertension. -
Key words:
- Hypertension /
- Overweight /
- Obesity /
- Hyperhomocysteinemia /
- Interaction
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表 1 研究对象基本情况[n (%)]
Table 1. The general characteristics of the 4 012 participants [n (%)]
变量 总人数(例) 高血压患病人数 χ2值 P值 变量 总人数(例) 高血压患病人数 χ2值 P值 性别 80.365 < 0.001 吃水果 54.959 < 0.001 男 1 644 766(46.6) 不经常吃 614 282(45.9) 女 2 368 772(32.6) 有时 1 985 819(41.3) 婚姻状况 16.717 0.001 经常吃 1 413 437(30.9) 未婚 65 31(47.7) 吃蔬菜 0.566 0.753 已婚 3 808 1 471(38.6) 不经常吃 58 25(43.1) 分居 53 20(37.7) 有时 277 106(38.3) 离异或丧偶 86 16(18.6) 经常吃 3 677 1 407(38.3) 教育程度 34.076 < 0.001 吃快餐 12.561 0.002 小学毕业以下 1 093 485(44.4) 不经常吃 3 068 1 211(39.5) 小学毕业后至初中毕业 940 323(34.4) 有时 827 275(33.3) 初中毕业后至高中毕业 1 154 458(39.7) 经常吃 117 52(44.4) 大学以上毕业 825 272(33.0) 吃甜食 45.341 < 0.001 吸烟 39.125 < 0.001 不经常吃 1 260 578(45.9) 是 842 388(46.1) 有时 1 994 708(35.5) 过去吸烟现在不吸 237 111(46.8) 经常吃 758 252(33.2) 否 2 933 1 039(35.4) 超重/肥胖 164.72 < 0.001 饮酒 5.282 0.022 否 2 434 740(30.4) 是 962 399(41.5) 是 1 578 798(50.6) 否 3 050 1 139(37.3) HHcy 388.42 < 0.001 中度体力活动 1.606 0.205 正常 2 605 709(27.2) 否 1 497 593(39.6) 高 1 407 829(58.9) 是 2 479 932(37.6) 重体力活动 21.105 < 0.001 否 2 610 1 068(40.9) 是 1 402 470(33.5) 
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表 2 超重/肥胖或HHcy对高血压发生风险的独立作用
Table 2. The independent associations between overweight/obesity or HHcy with risk of hypertension
变量 变量分类 模型1 模型2 模型3 OR(95% CI)值 P值 OR(95% CI)值 P值 OR(95% CI)值 P值 超重/肥胖 否 1.000 1.000 1.000 是 2.285(1.991~2.623) < 0.001 2.613(2.257~3.025) < 0.001 2.801(2.407~3.261) < 0.001 HHcy 否 1.000 1.000 1.000 是 3.774(3.282~4.339) < 0.001 3.506(3.029~4.058) < 0.001 3.488(3.000~4.055) < 0.001 注：模型1：调整混杂因素；模型2：调整性别和年龄；模型3：调整性别、年龄、婚姻状况、教育程度、吸烟、饮酒、吃水果、快餐、甜食和蔬菜。频率、中度体力活动、重体力活动。
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表 3 超重/肥胖与HHcy对高血压患病风险的交互作用
Table 3. The interaction between overweight/obesity and HHcy on risk of hypertension
超重/肥胖 HHcy 总人数(例) 高血压人数(%) 模型1 模型2 模型3 OR(95% CI)值 P值 OR(95% CI)值 P值 OR(95% CI)值 P值 非超重/肥胖 正常 1 655 353(21.3) 1.000 1.000 1.000 超重/肥胖 正常 950 356(37.5) 2.211(1.853~2.637) < 0.001 2.436(2.026~2.929) < 0.001 2.578(2.132~3.117) < 0.001 非超重/肥胖 高 779 387(49.7) 3.641(3.032~4.373) < 0.001 3.243(2.676~3.930) < 0.001 3.176(2.606~3.871) < 0.001 超重/肥胖 高 628 442(70.4) 8.765(7.120~10.789) < 0.001 9.490(7.613~11.830) < 0.001 10.205(8.120~12.826) < 0.001 交互作用 相加: RERI(95% CI值) 3.917(2.327~5.507) 4.811(2.890~6.733) 5.218(3.213~7.222) API(95% CI值) 0.447(0.334~0.560) 0.507(0.395~0.619) 0.527(0.420~0.634) SI(95% CI值) 2.017(1.583~2.571) 2.309(1.764~3.021) 2.415(1.848~3.156) 相乘: OR(95% CI值) 1.089(0.820~1.445) 0.556 1.201(0.895~1.612) 0.222 1.246(0.920~1.688) 0.155 注：模型1：调整混杂因素；模型2：调整性别和年龄；模型3：调整性别、年龄、婚姻状况、教育程度、吸烟、饮酒、吃水果、快餐、甜食和蔬菜频率、中度体力活动、重体力活动。
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