HIV/AIDS患者静息心率和血脂异常与正常高值血压/高血压的关联

何春燕; 陈潇潇; 冯程; 王妙辰; 林海江; 何纳; 丁盈盈

doi:10.16462/j.cnki.zhjbkz.2021.12.005

HIV/AIDS患者静息心率和血脂异常与正常高值血压/高血压的关联

doi: 10.16462/j.cnki.zhjbkz.2021.12.005

1.
200032 上海，复旦大学公共卫生学院流行病学教研室，公共卫生安全教育部重点实验室，复旦大学义乌研究院
2.
318000 台州，台州市疾病预防控制中心艾滋病防制科

基金项目:

国家自然科学基金 81872671

上海市公共卫生三年行动计划流行病学重点学科建设 GWV-10.1-XK16

浙江省基础公益研究计划 LY19H260001

详细信息

通讯作者:
丁盈盈，E-mail: dingyy@fudan.edu.cn

中图分类号: R183.7
计量
- 文章访问数: 449
- HTML全文浏览量: 159
- PDF下载量: 64
- 被引次数: 0
出版历程
- 收稿日期: 2021-09-01
- 修回日期: 2021-11-05
- 网络出版日期: 2021-12-27
- 刊出日期: 2021-12-10

Associations of resting heart rate and dyslipidemia with prehypertension and hypertension among HIV/AIDS patients

1.
Department of Epidemiology, School of Public Health, Key Laboratory of Public Health Safety of Ministry of Education, Yi-Wu Research Institute, Fudan University, Shanghai 200032, China
2.
Taizhou City Center for Disease Control and Prevention, Taizhou 318000, China

Funds:

National Natural Science Foundation of China 81872671

Shanghai Municipal Health Commission GWV-10.1-XK16

Zhejiang Provincial Basic Public Welfare Research Project LY19H260001

More Information

Corresponding author: Ding Ying-ying, E-mail: dingyy@fudan.edu.cn

摘要

摘要: 目的探索HIV/AIDS患者中的静息心率(resting heart rate, RHR)过快和血脂异常与正常高值血压/高血压的关联及其交互作用。方法采用横断面研究的方法，基于浙江省台州市2017―2019年“HIV与衰老相关疾病前瞻性队列研究”基线数据，纳入分析30岁以上的HIV/AIDS患者。采用Logistic回归分析模型分析HIV/AIDS患者患正常高值血压/高血压的影响因素，用相乘模型探索RHR过快和血脂异常的交互作用。RHR过快定义为RHR>90次/min；血脂异常定义为TC、TG、LDL-C升高或HDL-C降低。结果共1 645例HIV/AIDS患者纳入分析，其中正常高值血压和高血压的患病率分别为42.8%和28.1%。15.8%(260/1 645)的研究对象的RHR过快，59.2%(974/1 645)存在血脂异常。多分类Logistic回归分析模型结果显示，调整年龄、性别、BMI、腰臀比和TC之后，TG升高和RHR过快是正常高值血压(aOR=1.56, 95% CI：1.14~2.13, P=0.005；aOR=1.60, 95% CI：1.06~2.43, P=0.026)和高血压(aOR=1.94, 95% CI：1.37~2.75, P < 0.001；aOR=1.95, 95% CI：1.20~3.18, P=0.007)的独立影响因素。同时，TG升高和RHR过快对正常高值血压(P=0.017)和高血压(P=0.032)均存在负向相乘交互作用。TC、LDL-C及HDL-C异常与RHR过快对正常高值血压和高血压均未观察到交互作用。结论 RHR过快和TG升高是HIV/AIDS患者正常高值血压和高血压的独立危险因素。此外，RHR过快和TG升高之间存在负向的相乘交互作用，提示RHR过快可能降低TG引起致高血压发生的阈值，其机制需要进一步研究去阐明。
- 艾滋病 /
- 静息心率 /
- 血脂异常 /
- 高血压 /
- 交互作用
Abstract: Objective To assess the associations of elevated resting heart rate (RHR) and dyslipidemia and their interactions with prehypertension and hypertension among HIV/AIDS patients. Methods A cross-sectional assessment was conducted among 1 645 HIV/AIDS patients over 30 years old from the baseline survey of Comparative HIV and Aging Research in Taizhou (CHART) between 2017 to 2019. Multinomial Logistic regression model was used to assess the factors associated with prehypertension and hypertension. Multiplicative model was used to explore the interaction between elevated RHR and dyslipidemia. Elevated RHR was defined as > 90 beats/min; dyslipidemia was defined as elevated total cholesterol (TC), triglycerides (TG), low-density lipoprotein cholesterol (LDL-C) or decreased high-density lipoprotein cholesterol (HDL-C) levels. Results Among 1 645 HIV/AIDS patients, prevalence of prehypertension and hypertension were 42.8% and 28.1%, respectively. 15.8% (260/1 645) of the subjects had elevated RHR, and 59.2% (974/1 645) had dyslipidemia. After adjusting for age, sex, body mass index, waist to hip ratio and TC, elevated TG and elevated RHR were independently associated with prehypertension (aOR=1.56, 95% CI: 1.14-2.13, P=0.005; aOR=1.60, 95% CI: 1.06-2.43, P=0.026) and hypertension (aOR=1.94, 95% CI: 1.37-2.75, P < 0.001; aOR=1.95, 95% CI: 1.20-3.18, P=0.007), and there was a negative multiplicative interaction between elevated TG and elevated RHR with prehypertension (P=0.017) and hypertension (P=0.032). No interaction was observed between abnormal TC, LDL-C, HDL-C and elevated RHR on prehypertension and hypertension. Conclusion Elevated RHR and elevated TC are independently associated with prehypertension and hypertension in HIV/AIDS patients. The negative interactions between elevated RHR and elevated TC on prehypertension and hypertension suggest that faster RHR is likely to reduce the threshold for TG levels to cause hypertension. Further studies are needed to reveal the underlying mechanism between RHR, TG and hypertension.
- Acquired immunodeficiency syndrome /
- Resting heart rate /
- Dyslipidemia /
- Hypertension /
- Interaction

HTML全文

图 1 TG和RHR对正常高值血压(A)和高血压(B)的交互作用分析

Figure 1. Interactions of TG and RHR on prehypertension(A) and hypertension (B)

下载: 全尺寸图片幻灯片

表 1 不同静息心率水平HIV/AIDS患者基本特征[n(%)]

Table 1. Basic characteristics of HIV/AIDS patients at different resting heart rate levels [n(%)]

特征	合计	静息心率		t/χ²/Z值	P值
特征	合计	正常(n=1 385)	过快(n=260)	t/χ²/Z值	P值
年龄(岁)	49.1±12.3	49.7±12.2	46.0±11.9	21.06	< 0.001
性别				0.03	0.872
女	386(23.5)	326(84.5)	60(15.5)
男	1 259(76.5)	1 059(84.1)	200(15.9)
文化程度				15.31	< 0.001
小学及以下	713(43.3)	629(88.2)	84(11.8)
初中及以上	932(56.7)	756(81.1)	176(18.9)
腰围[M(P₂₅, P₇₅), cm]	83.0(77.5, 88.0)	83.0(78.0, 88.0)	82.1(76.3, 88.0)	1.14	0.285
臀围[M(P₂₅, P₇₅), cm]	92.7(89.0, 96.5)	93.0(89.0, 97.0)	92.0(87.1, 96.0)	5.62	0.018
腰臀比[M(P₂₅, P₇₅)]	0.9(0.8, 0.9)	0.9(0.8, 0.9)	0.9(0.8, 0.9)	0.59	0.442
腹部肥胖				2.00	0.158
否	781(47.5)	668(85.5)	113(14.5)
是	864(52.5)	717(83.0)	147(17.0)
BMI[M(P₂₅, P₇₅), kg/m²]	22.2(20.4, 24.2)	22.3(20.4, 24.2)	21.9(20.2, 24.0)	2.28	0.131
BMI分组(kg/m²)				1.39	0.498
正常	1 060(64.4)	886(83.6)	174(16.4)
偏低	118(7.2)	98(83.1)	20(16.9)
偏高	467(28.4)	401(85.9)	66(14.1)
吸烟				16.32	< 0.001
否	939(57.1)	761(81.0)	178(19.0)
是	706(42.9)	624(88.4)	82(11.6)
饮酒				11.37	< 0.001
否	1 498(91.1)	1 247(83.2)	251(16.8)
是	147(8.9)	138(93.9)	9(6.1)
运动				1.47	0.225
否	1 159(70.5)	984(84.9)	175(15.1)
是	486(29.5)	401(82.5)	85(17.5)
正常高值血压				0.51	0.774
否	941(57.2)	796(84.6)	145(15.4)
是	704(42.8)	589(84.0)	115(16.0)
高血压				0.02	0.883
否	1 183(71.9)	997(84.3)	186(15.7)
是	462(28.1)	388(84.0)	74(16.0)
糖尿病				4.17	0.041
否	1 508(91.7)	1 278(84.7)	230(15.3)
是	137(8.3)	107(78.1)	30(21.9)
TC[M(P₂₅, P₇₅), mmol/L]	4.6(4.1, 5.3)	4.7(4.1, 5.3)	4.6(4.0, 5.5)	0.00	0.955
TC分组(mmol/L)				0.14	0.712
< 6.2	1 509(91.7)	1 272(84.3)	237(15.7)
≥6.2	136(8.3)	113(83.1)	23(16.9)
TG[M(P₂₅, P₇₅), mmol/L]	1.7(1.2, 2.6)	1.7(1.1, 2.5)	1.8(1.3, 3.0)	9.39	0.002
TG分组(mmol/L)				4.63	0.031
< 2.3	1 125(68.4)	962(85.5)	163(14.5)
≥2.3	520(31.6)	423(81.3)	97(18.7)
LDL-C[M(P₂₅, P₇₅), mmol/L]	2.4(2.0, 2.9)	2.4(2.0, 2.9)	2.5(2.0, 2.9)	0.38	0.537
LDL-C分组(mmol/L)				1.92	0.165
< 4.1	1 592(96.8)	1 344(84.4)	248(15.6)
≥4.1	53(3.2)	41(77.4)	12(22.6)
HDL-C[M(P₂₅, P₇₅), mmol/L]	1.0(0.9, 1.3)	1.0(0.9, 1.3)	1.0(0.8, 1.2)	7.31	0.007
HDL-C分组(mmol/L)				4.24	0.039
< 1.0	733(44.6)	602(82.1)	131(17.9)
≥1.0	912(55.4)	783(85.9)	129(14.1)
血脂异常				6.17	0.013
否	671(40.8)	583(86.9)	88(13.1)
是	974(59.2)	802(82.3)	172(17.6)
基线CD4⁺T淋巴细胞计数(个/μl)				0.02	0.883
< 350	765(46.5)	643(84.1)	122(15.9)
≥350	880(53.5)	742(84.3)	138(15.7)
注：对于分类变量，括号外为例数，括号内为构成比；对于不符合正态分布的连续型变量，括号外为中位数，括号内为四分位数。

下载: 导出CSV

表 2 静息心率与高血压和正常高值血压的关联分析

Table 2. Analysis of resting heart rate with hypertension and prehypertension

模型	RHR(次/min)
模型	正常(n=1 385)	过快(n=260)
模型1
高血压比正常血压	1.00	1.49(1.01~2.20) ^a
正常高值血压比正常血压	1.00	1.24(0.89~1.73)
模型2
高血压比正常血压	1.00	1.45(0.98~2.14) ^b
正常高值血压比正常血压	1.00	1.21(0.87~1.69)
模型3
高血压比正常血压	1.00	1.02(1.01~1.03) ^c
正常高值血压比正常血压	1.00	1.01(1.00~1.02) ^a
模型4
高血压比正常血压	1.00	1.02(1.01~1.03) ^c
正常高值血压比正常血压	1.00	1.01(1.00~1.02) ^b
注：^a P < 0.05; ^b P < 0.1; ^c P < 0.01；模型1和模型3校正的因素有年龄、性别、腹部肥胖、BMI，RHR作为分类变量纳入；模型2和模型4校正的因素有年龄、性别、腹部肥胖、BMI、TC、TG，RHR作为连续型变量纳入。

下载: 导出CSV

表 3 脂质与静息心率相乘交互作用探索

Table 3. Interactions between lipids and resting heart rate

变量	正常高值血压		高血压
变量	aOR(95% CI)值	P值	aOR(95% CI)值	P值
TC×RHR	0.74(0.21~2.59)	0.637	0.69(0.18~2.71)	0.598
TG×RHR	0.43(0.21~0.86)	0.017	0.42(0.19~0.93)	0.032
LDL-C×RHR	0.41(0.06~2.66)	0.353	0.84(0.14~4.91)	0.843
HDL-C×RHR	1.85(0.95~3.60)	0.072	1.56(0.72~3.37)	0.261
注：多因素模型均校正了年龄、性别、BMI、腰臀比。

下载: 导出CSV

表 4 不同静息心率水平不同TG的HIV/AIDS患者正常高值血压和高血压患病情况

Table 4. Prevalence of prehypertension and hypertension in HIV / AIDS patients with different triglycerides at different resting heart rate levels

TG(mmol/L)	RHR正常			RHR过快
TG(mmol/L)	人数	正常高值	高血压	人数	正常高值	高血压
< 2.3	962	395(41.1)	239(24.8)	163	75(46.0)	49(30.1)
≥2.3	423	194(45.9)	149(35.2)	97	40(41.2)	29(29.9)
合计	1 125	589(52.3)	388(34.5)	260	115(44.2)	78(30.0)

下载: 导出CSV

参考文献(25)

[1]	Gallant J, Hsue PY, Shreay S, et al. Comorbidities among US patients with prevalent HIV infection-a trend analysis[J]. J Infect Dis, 2017, 216(12): 1525-1533. DOI: 10.1093/infdis/jix518.
[2]	Bauer S, Mwanza MW, Chilengi R, et al. Awareness and management of elevated blood pressure among human immunodeficiency virus-infected adults receiving antiretroviral therapy in urban Zambia: a call to action[J]. Glob Health Action, 2017, 10(1): 1359923. DOI: 10.1080/16549716.2017.1359923.
[3]	Calcagno A, Piconi S, Focà E, et al. Role of normalized T-Cell subsets in predicting comorbidities in a large cohort of geriatric HIV-infected patients[J]. J Acquir Immune Defic Syndr, 2017, 76(3): 338-342. DOI: 10.1097/QAI.0000000000001496.
[4]	余燕云. 艾滋病抗病毒治疗者高血压患病及影响因素研究[D]. 昆明: 昆明医科大学, 2018. Yu YY. Prevalence of hypertension and associated factors among AIDS patients with antiviral therapy[D]. Kunming: Kunming Medical University, 2018.
[5]	Fahme SA, Bloomfield GS, Peck R. Hypertension in HIV-Infected adults novel pathophysiologic mechanisms[J]. Hypertension, 2018, 72(1): 44-55. DOI: 10.1161/HYPERTENSIONAHA.118.10893.
[6]	Kemal A, Teshome MS, Ahmed M, et al. Dyslipidemia and associated factors among adult patients on antiretroviral therapy in Armed Force Comprehensive and Specialized Hospital, Addis Ababa, Ethiopia[J]. HIV AIDS, 2020, 12: 221-231. DOI: 10.2147/HIV.S252391.
[7]	He DM, Fan FF, Jia J, et al. Lipid profiles and the risk of new-onset hypertension in a Chinese community-based cohort[J]. Nutr Metab Cardiovasc Dis, 2021, 31(3): 911-920. DOI: 10.1016/j.numecd.2020.11.026.
[8]	DeLalio LJ, Sved AF, Sean D Stocker SD. Sympathetic nervous system contributions to hypertension: updates and therapeutic relevance[J]. Can J Cardiol, 2020, 36(5): 712-720. DOI: 10.1016/j.cjca.2020.03.003.
[9]	Böhm M, Reil JC, Deedwania P, et al. Resting heart rate: risk indicator and emerging risk factor in cardiovascular disease[J]. Am J Med, 2015, 128(3): 219-228. DOI: 10.1016/j.amjmed.2014.09.016.
[10]	Eikelis N, Lambert EA, Phillips S, et al. Muscle sympathetic nerve activity is associated with elements of the plasma lipidomic profile in young asian adults[J]. J Clin Endocrinol Metab, 2017, 102(6): 2059-2068. DOI: 10.1210/jc.2016-3738.
[11]	Nestel PJ, Khan AA, Straznicky NE, et al. Markers of sympathetic nervous system activity associate with complex plasma lipids in metabolic syndrome subjects[J]. Atherosclerosis, 2017, 256: 21-28. DOI: 10.1016/j.atherosclerosis.2016.11.032.
[12]	Li S, Guo B, Chen H, et al. The role of the triglyceride (triacylglycerol) glucose index in the development of cardiovascular events: a retrospective cohort analysis[J]. Sci Rep, 2019, 9(1): 7320. DOI: 10.1038/s41598-019-43776-5.
[13]	中国高血压防治指南修订委员会, 高血压联盟(中国), 中华医学会心血管病学分会, 等. 中国高血压防治指南(2018年修订版)[J]. 中国心血管杂志, 2019, 24(1): 24-56. DOI: 10.3969/j.issn.1007-5410.2019.01.002. Writing Group of 2018 Chinese Guidelines for the Management of Hypertension, Chinese Hypertension League, Chinese Society of Cardiology, et al. 2018 Chinese guidelines for the management of hypertension[J]. Chin J Cardiovasc Med, 2019, 24(1): 24-56. DOI: 10.3969/j.issn.1007-5410.2019.01.002.
[14]	诸骏仁, 高润霖, 赵水平, 等. 中国成人血脂异常防治指南(2016年修订版)[J]. 中华健康管理学杂志, 2017, 11(1): 7-28. DOI: 10.3760/cma.j.issn.1671-7368.2017.01.006. Zhu JR, Gao RL, Zhao SP, et al. 2016 Chinese guideline for the management of dyslipidemia in adults[J]. Chin J Health Management, 2017, 11(1): 7-28. DOI: 10.3760/cma.j.issn.1671-7368.2017.01.006.
[15]	Wallace LMK, Theou O, Godin J, et al. Investigation of frailty as a moderator of the relationship between neuropathology and dementia in Alzheimer's disease: a cross-sectional analysis of data from the Rush Memory and Aging Project[J]. Lancet Neurol, 2019, 18(2): 177-184. DOI: 10.1016/S1474-4422(18)30371-5.
[16]	徐小慧, 单淑晴, 时允, 等. 云南省德宏州接受抗病毒治疗的HIV感染者高血压患病率及其影响因素[J]. 中国初级卫生保健, 2020, 34(4): 48-51. DOI: 10.3969/j.issn.1001-568X.2020.04.0015. Xu XH, Shan SQ, Shi Y, et al. Prevalence and associated factors of hypertension among HIV-infected individuals receiving combination antiretroviral therapy in Dehong Prefecture, Yunnan Province[J]. Chinese Primary Health Care, 2020, 34(4): 48-51. DOI: 10.3969/j.issn.1001-568X.2020.04.0015.
[17]	Shi YY, Zhou W, Liu XJ, et al. Resting heart rate and the risk of hypertension and heart failure: a dose-response meta-analysis of prospective studies[J]. J Hypertens, 2018, 36(5): 995-1004. DOI: 10.1097/HJH.0000000000001627.
[18]	Custodis F, Schirmer SH, Baumhäkel M, et al. Vascular pathophysiology in response to increased heart rate[J]. J Am Coll Cardiol, 2010, 56(24): 1973-1983. DOI: 10.1016/j.jacc.2010.09.014.
[19]	Ding Y, Zhu B, Lin H, et al. HIV infection and electrocardiogram abnormalities: baseline assessment from the CHART cohort[J]. Clin Microbiol Infect, 2020, 26(12): 1689. e1-e7. DOI: 10.1016/j.cmi.2020.03.005.
[20]	Duro M, Sarmento-Castro R, Almeida C, et al. Lipid profile changes by high activity anti-retroviral therapy[J]. Clin Biochem, 2013, 46(9): 740-744. DOI: 10.1016/j.clinbiochem.2012.12.017.
[21]	Nduka C, Sarki A, Uthman O, et al. Impact of antiretroviral therapy on serum lipoprotein levels and dyslipidemias: a systematic review and meta-analysis[J]. Int J Cardiol, 2015, 199: 307-318. DOI: 10.1016/j.ijcard.2015.07.052.
[22]	肖江, 郜桂菊, 李鑫, 等. 高效抗逆转录病毒治疗对艾滋病患者机体代谢的影响[J]. 中华实验和临床感染病杂志(电子版), 2011, 5(2): 133-141. DOI: 10.3877/cma.j.issn.1674-1358.2011.02.002. Xiao J, Gao GJ, Li X, et al. Analysis on metabolic consequence in patients with HIV infection after highly active antiretrovirus therapy[J]. Chin J Exp Clin Infec Dis(Electronic Edition), 2011, 5(2): 133-141. DOI: 10.3877/cma.j.issn.1674-1358.2011.02.002.
[23]	Ekoru K, Young EH, Dillon DG, et al. HIV treatment is associated with a two-fold higher probability of raised triglycerides: pooled analyses in 21 023 individuals in sub-Saharan Africa[J]. Glob Health Epidemiol Genom, 2018, e3-e7. DOI: 10.1017/gheg.2018.7.
[24]	Oort SV, Beulens JWJ, Ballegooijen AJV, et al. Association of cardiovascular risk factors and lifestyle behaviors with hypertension: a mendelian randomization study[J]. Hypertension, 2020, 76(6): 1971-1979. DOI: 10.1161/HYPERTENSIONAHA.120.15761.
[25]	Kajikawa M, Maruhashi T, Matsumoto T, et al. Relationship between serum triglyceride levels and endothelial function in a large community-based study[J]. Atherosclerosis, 2016, 249: 70-75. DOI: 10.1016/j.atherosclerosis.2016.03.035.