心源性猝死影响因素的巢式病例对照研究

张李珍; 尹春; 李思宇; 吴喜江; 陈亚荣; 沈淑娟; 王仲阁; 陈蕊蕊; 李靖; 许璐璐; 胡雨佳; 白亚娜

doi:10.16462/j.cnki.zhjbkz.2023.10.007

心源性猝死影响因素的巢式病例对照研究

doi: 10.16462/j.cnki.zhjbkz.2023.10.007

1.
兰州大学公共卫生学院流行病与卫生统计学研究所，兰州 730000
2.
金川集团职工医院，金昌 737100

基金项目:

金川集团公司职工代谢性疾病全程管理体系建设 Jinkezong2020-02

详细信息

通讯作者:
白亚娜，E-mail: baiyana@lzu.edu.cn

中图分类号: R183
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出版历程
- 收稿日期: 2022-01-09
- 修回日期: 2022-06-22
- 网络出版日期: 2023-10-23
- 刊出日期: 2023-10-10

A nested case-control study on the influencing factors of sudden cardiac death

1.
Department of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou 730000, China
2.
Workers′ Hospital of Jinchuan Group, Jinchang 737100, China

Funds:

Construction of the Whole-process Management System for Metabolic Diseases Among Staffs in Jinchuan Group Co Ltd Jinkezong2020-02

More Information

Corresponding author: BAI Yana, E-mail: baiyana@lzu.edu.cn

摘要

摘要: 目的基于队列人群研究心源性猝死(sudden cardiac death, SCD)的影响因素，为SCD的预防和病因学研究提供科学依据。方法采用巢式病例对照研究的方法，以金昌队列2011―2019年三次随访新发52例SCD者为病例组，按照年龄(±2岁)及同性别1∶4个体匹配的方法，以同期随访未发生SCD者的208例为对照组。用条件logistic回归分析模型分析金昌队列人群发生SCD的影响因素，并通过限制性立方样条(restricted cubic spline, RCS)模型拟合SCD发病风险的剂量-反应关系曲线。结果多因素条件logistic回归分析模型分析结果显示：三酰甘油(triglycerides, TG)(OR=2.94, 95% CI: 1.15~7.51)、低密度脂蛋白胆固醇(low density lipoprotein cholesterol, LDL-C)(OR=2.70, 95% CI: 1.18~6.22)、糖尿病(OR=5.59, 95% CI: 1.79~17.46)和心电图异常(OR=5.54, 95% CI: 2.11~14.56)是SCD的危险因素；文化程度在高中及以上(OR=0.33, 95% CI: 0.12~0.88)是SCD的保护因素。RCS结果显示：空腹血糖(fasting plasma glucose, FPG)、TG与SCD发病风险间呈正向线性剂量-反应关系(P_总趋势<0.05，P_非线性>0.05)。结论 TG、LDL-C、糖尿病、心电图异常和文化程度与SCD的发生有关且FPG、TG与SCD的发生风险间存在线性剂量-反应关系。
- 金昌队列 /
- 巢式病例对照研究 /
- 心源性猝死 /
- 影响因素 /
- 剂量-反应关系
Abstract: Objective To study the influencing factors of sudden cardiac death (SCD) based on the cohort population, and to provide basic data for the prevention and etiological research of SCD. Methods A nested case-control study was conducted, involving 52 newly diagnosed cases of SCD during three follow-up visits from 2011 to 2019 in Jinchang cohort. And 208 participants without SCD during the same period of follow-up were selected as the control group according to the matching method of age (±2 years) and 1∶4 individuals of the same sex. Conditional logistic regression model was used to analyze the influencing factors of SCD in Jinchang cohort, and the dose-response relationship of SCD risk was fitted by restricted cubic spline (RCS) models. Results Multivariate conditional logistic regression analysis showed that triglycerides (TG) (OR=2.94, 95% CI: 1.15-7.51), low density lipoprotein cholesterol (LDL-C) (OR=2.70, 95% CI: 1.18-6.22), diabetes (OR=5.59, 95% CI: 1.79-17.46) and abnormal electrocardiogram (OR=5.54, 95% CI: 2.11-14.56) were risk factors for SCD. Education level in high school and above (OR=0.33, 95% CI: 0.12-0.88) was a protective factor for SCD. RCS analysis showed that there was a positive linear dose-response relationship between fasting plasma glucose (FPG), TG and the risk of SCD (general trend P<0.05, non-linear P>0.05). Conclusions TG, LDL-C, diabetes, abnormal electrocardiogram and education level were related to the occurrence of SCD, and there was a dose-response relationship between FPG, TG and the risk of SCD.
- Jinchang cohort /
- Nested case-control study /
- Sudden cardiac death /
- Influencing factors /
- Dose-response relationship

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图 1 FPG、TG、LDL-C与SCD发病风险间的剂量-反应关系

1. FPG: 空腹血糖; TG: 三酰甘油; LDL-C: 低密度脂蛋白胆固醇; OR: 比值比; SCD: 心源性猝死。
2. FPG的参考点为7.00 mmoL/L，TG的参考点为1.70 mmoL/L，LDL-C的参考点为3.40 mmoL/L。调整了吸烟、冠心病、高血压、BMI、文化程度、职业、HDL-C、糖尿病(仅TG和LDL-C调整)、TG (仅FPG和LDL-C调整)、LDL-C (仅PFG和TG调整)和心电图。

Figure 1. Dose-response relationship between FPG, TG, LDL-C and the risk of SCD

1. FPG: fasting plasma glucose; TG: triglycerides; LDL-C: low density lipoprotein cholesterol; OR: odds ratio; SCD: sudden cardiac death.
2. The reference point of FPG is 7.00 mmoL/L, the reference point of TG is 1.70 mmoL/L and the reference point of LDL-C is 3.40 mmoL/L. Adjusted for smoking, coronary heart disease, hypertension, BMI, education, occupation, HDL-C, diabetes (adjusted for TG and LDL-C only), TG (adjusted for FPG and LDL-C only), LDL-C (adjusted for PFG and TG only), and electrocardiogram.

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表 1 研究对象的基线特征

Table 1. Baseline characteristics of study subjects

基线特征 Baseline characteristics	新发病例组^① New cases group ^① (n=52)	对照组^① Control group ^① (n=208)	合计^① Total ^① (n=260)	t/χ²/Z值 value	P值 value
年龄/岁 Age/years	55.92±15.37	55.87±14.61	55.88±14.73	-0.03	0.980
性别 Sex				0	1.000
男 Male	49(94.23)	196(94.23)	231(88.85)
女 Female	3(5.77)	12(5.77)	29(11.15)
职业 Occupation				3.12	0.413
工人 Worker	38(73.08)	125(60.10)	163(62.69)
干部 Administrator	9(17.31)	55(26.44)	64(24.62)
技术人员 Technical staff	3(5.77)	19(9.13)	22(8.46)
服务人员 Service staff	2(3.84)	9(4.33)	11(4.23)
文化程度 Educational level				10.12	0.038
小学及以下 Primary school and below	12(23.08)	31(14.90)	43(16.54)
初中 Junior school	18(34.61)	47(22.60)	65(25.00)
高中/中专 Senior school/Technical secondary school	9(17.31)	63(30.29)	72(27.69)
大专及以上 Junior college or above	13(25.00)	67(32.21)	80(30.77)
吸烟 Smoking				6.15	0.013
否 No	18(34.62)	112(53.85)	130(50.00)
是 Yes	34(65.38)	96(26.15)	130(50.00)
饮酒 Drinking				0.29	0.593
否 No	34(65.38)	144(69.23)	178(68.46)
是 Yes	18(34.62)	64(30.77)	82(31.54)
饮茶 Drinking tea				1.43	0.232
否 No	18(34.62)	91(43.75)	109(41.92)
是 Yes	34(65.38)	117(56.25)	151(58.08)
心电图 Electrocardiogram				10.49	0.001
正常 Normal	18(34.62)	124(59.62)	142(54.62)
异常 Abnormal	34(65.38)	84(40.38)	118(45.38)
高血压 Hypertension				2.01	0.157
否 No	32(61.54)	149(71.63)	181(69.62)
是 Yes	20(38.46)	59(28.37)	79(30.38)
糖尿病 Diabetes				9.32	0.002
否 No	41(78.85)	195(93.75)	236(90.77)
是 Yes	11(21.15)	13(6.25)	24(9.23)
冠心病 Coronary heart disease				3.26	0.071
否 No	46(88.46)	198(95.19)	244(93.85)
是 Yes	6(11.54)	10(4.81)	16(6.15)
高脂血症Hyperlipemia				0.17	0.682
否 No	42(80.77)	173(83.17)	215(82.69)
是 Yes	10(19.23)	35(16.83)	45(17.31)
高血压家族史 Family history of hypertension				0.17	0.595
否 No	37(71.15)	140(67.31)	177(68.08)
是 Yes	15(28.85)	68(32.69)	83(31.92)
糖尿病家族史 Family history of diabetes				0.93	0.335
否 No	49(94.23)	187(89.90)	236(90.77)
是 Yes	3(5.77)	21(10.10)	24(9.23)
收缩压/mmHg SBP/mmHg	137.83±24.13	131.60±21.76	132.85±22.35	-1.81	0.072
舒张压/mmHg DBP/mmHg	85.19±17.11	82.85±12.82	83.32±13.78	-0.92	0.359
BMI/(kg·m^-2)	24.44±3.26	24.75±3.05	24.69±3.09	0.64	0.526
TC/(mmol·L^-1)	4.70(4.03, 5.38)	4.60(4.10, 5.20)	4.60(4.10, 5.20)	-0.97	0.331
TG/(mmol·L^-1)	1.90(1.50, 3.10)	1.60(1.20, 2.20)	1.70(1.22, 2.30)	-2.28	0.022
LDL-C/(mmol·L^-1)	3.28(2.60, 3.65)	2.89(2.39, 3.51)	2.94(2.43, 3.59)	-1.87	0.062
HDL-C/(mmol·L^-1)	1.27(1.12, 1.46)	1.23(1.06, 1.41)	1.23(1.06, 1.42)	-1.00	0.318
FPG/(mmol·L^-1)	5.50(4.90, 6.90)	5.30(4.93, 6.00)	5.30(4.90, 6.18)	-1.40	0.161
注：BMI, 体质指数；TC, 总胆固醇；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；FPG, 空腹血糖。 ①符合正态分布的资料用x±s表示; 不符合正态分布的资料用[M(P₂₅, P₇₅)]表示; 全部分类资料用[人数(构成比/%)]表示。 Note: BMI, body mass index; TC, total cholesterol; TG, triglycerides; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; FPG, fasting plasma glucose. ① Data conforming to the normal distribution is represented by x±s; data not conforming to the normal distribution is represented by [M(P₂₅, P₇₅)]; All categorical data are expressed as [Number of people (proportion/%)].

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表 2 心源性猝死的基线疾病及行为因素的单因素条件logistic回归分析

Table 2. Univariate conditional logistic regression analysis of baseline disease and behavioral factors of SCD

变量 Variable	新发病例组^① New cases group ^① (n=52)	对照组^① Control group ^① (n=208)	Wald χ²值 value	OR值 value (95% CI)	P值 value
文化程度 Educational level
初中及以下 Junior high school and below	30(57.69)	78(37.50)		1.00
高中及以上 High school and above	22(42.31)	130(62.50)	7.49	0.39(0.20~0.77)	0.006
职业 Occupation
工人 Worker	38(73.08)	125(60.10)	3.61	1.00	0.307
干部 Administrator	9(17.31)	55(26.44)	2.88	0.49(0.21~1.12)	0.090
技术人员 Technical staff	3(5.77)	19(9.13)	1.38	0.46(0.12~1.69)	0.240
服务人员 Service staff	2(3.84)	9(4.33)	0.07	0.81(0.16~4.01)	0.790
吸烟 Smoking
否 No	18(34.62)	112(53.85)		1.00
是 Yes	34(65.38)	96(26.15)	6.49	2.40(1.22~4.70)	0.011
饮酒 Drinking
否 No	34(65.38)	144(69.23)		1.00
是 Yes	18(34.62)	64(30.77)	0.29	1.19(0.62~2.27)	0.593
饮茶 Drinking tea
否 No	18(34.62)	91(43.75)		1.00
是 Yes	34(65.38)	117(56.25)	1.53	1.52(0.78~2.95)	0.216
高血压 Hypertension
否 No	32(61.54)	149(71.63)		1.00
是 Yes	20(38.46)	59(28.37)	2.13	1.64(0.85~3.16)	0.144
糖尿病 Diabetes
否 No	41(78.85)	195(93.75)		1.00
是 Yes	11(21.15)	13(6.25)	9.45	4.08(1.66~9.99)	0.002
冠心病 Coronary heart disease
否 No	46(88.46)	198(95.19)		1.00
是 Yes	6(11.54)	10(4.81)	3.36	2.99(0.93~9.66)	0.067
高脂血症 Hyperlipemia
否 No	42(80.77)	173(83.17)		1.00
是 Yes	10(19.23)	35(16.83)	0.17	1.18(0.54~2.59)	0.679
高血压家族史 Family history of hypertension
否 No	37(71.15)	140(67.31)		1.00
是 Yes	15(28.85)	68(32.69)	0.28	0.84(0.43~1.63)	0.597
糖尿病家族史 Family history of diabetes
否 No	49(94.23)	187(89.90)		1.00
是 Yes	3(5.77)	21(10.10)	0.88	0.55(0.16~1.91)	0.349
注：①采用[人数(构成比/%)]表示。 Note: ①[Number of people (proportion/%)].

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表 3 SCD基线生理生化指标的单因素条件logistic回归分析

Table 3. Univariate conditional logistic regression analysis of baseline physiological and biochemical indexes of SCD

变量 Variable	新发病例组^① New cases group ^① (n=52)	对照组^① Control group ^① (n=208)	Wald χ²值 value	OR值 value (95% CI)	P值 value
收缩压/mmHg SBP/mmHg
正常 Normal	33(63.46)	151(72.60)		1.00
异常 Abnormal	19(36.54)	57(27.40)	1.86	1.61(0.81~3.21)	0.173
舒张压/mmHg DBP/mmHg
正常 Normal	34(65.38)	150(72.12)		1.00
异常 Abnormal	18(34.62)	58(27.88)	0.90	1.37(0.72~2.61)	0.342
心电图 Electrocardiogram
正常 Normal	18(34.62)	124(59.62)		1.00
异常 Abnormal	34(65.38)	84(40.38)	10.50	3.06(1.56~6.01)	0.001
TC/(mmol·L^-1)
正常 Normal	37(71.15)	150(72.12)		1.00
异常 Abnormal	15(28.85)	58(27.88)	0.02	1.05(0.54~2.05)	0.890
TG/(mmol·L^-1)
正常 Normal	17(32.69)	109(52.40)		1.00
异常 Abnormal	35(67.31)	99(47.60)	6.69	2.39(1.24~4.61)	0.010
LDL-C/(mmol·L^-1)
正常 Normal	26(50.00)	144(69.23)		1.00
异常 Abnormal	26(50.00)	64(30.77)	6.42	2.21(1.20~4.08)	0.011
HDL-C/(mmol·L^-1)
正常 Normal	43(82.69)	171(82.21)		1.00
异常 Abnormal	9(17.31)	37(17.79)	0.01	0.96(0.41~2.27)	0.931
BMI/(kg·m^-2)
<24.0	19(36.54)	85(40.86)	2.07	1.00
24.0~<28.0	27(51.92)	87(41.83)	1.01	1.41(0.72~2.75)	0.315
≥28.0	6(11.54)	36(17.31)	0.33	0.75(0.28~2.02)	0.570
注：SCD, 心源性猝死；TC: 总胆固醇；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；BMI: 体质指数。 ①采用[例数(构成比/%)]表示。 Note: SCD, sudden cardiac death; TC, total cholesterol; TG, triglycerides; LDL-C, low density lipoprotein cholesterol; HDL-C, high density lipoprotein cholesterol; BMI: body mass index. ①[Number of people (proportion/%)].

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表 4 心源性猝死的多因素条件logistic回归分析

Table 4. Multivariate conditional logistic regression analysis of SCD

变量 Variable	β	s_x	Wald χ²值 value	OR值 value (95% CI)	P值 value
TG/(mmol·L^-1)
正常 Normal				1.00
异常 Abnormal	1.08	0.48	5.11	2.94(1.15~7.51)	0.024
LDL-C/(mmol·L^-1)
正常 Normal				1.00
异常 Abnormal	0.99	0.43	5.47	2.70(1.18~6.22)	0.019
HDL-C/(mmol·L^-1)
正常 Normal				1.00
异常 Abnormal	0.44	0.61	0.51	1.55(0.47~5.15)	0.474
BMI/(kg·m^-2)
<24.0			4.92	1.00	0.085
24.0~<28.0	0.51	0.44	1.39	1.67(0.71~3.92)	0.238
≥28.0	-0.83	0.62	1.78	0.43(0.13~1.48)	0.182
心电图 Electrocardiogram
正常 Normal				1.00
异常 Abnormal	1.71	0.49	12.07	5.54(2.11~14.56)	0.001
糖尿病 Diabetes
否 No				1.00
是 Yes	1.72	0.58	8.76	5.59(1.79~17.46)	0.003
冠心病 Coronary heart disease
否 No				1.00
是 Yes	1.22	0.85	2.07	3.39(0.64~17.86)	0.150
高血压 Hypertension
否 No				1.00
是 Yes	-0.30	0.47	0.41	0.74(0.30~1.85)	0.523
吸烟 Smoking
否 No				1.00
是 Yes	0.50	0.44	1.32	1.65(0.70~3.87)	0.251
文化程度 Educational level
初中及以下 Junior high school and below				1.00
高中及以上 High school and above	-0.11	0.50	4.90	0.33(0.12~0.88)	0.027
职业 Occupation
工人 Worker			0.70	1.00	0.873
干部 Administrator	-0.40	0.60	0.43	0.67(0.21~2.19)	0.511
技术人员 Technical staff	-0.66	0.89	0.55	0.52(0.09~2.94)	0.456
服务人员 Service staff	0.06	0.94	0	1.06(0.17~6.70)	0.951
注：SCD, 心源性猝死；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；BMI: 体质指数。 Note: SCD, sudden cardiac death; TG, triglycerides; LDL-C, low Density Lipoprotein Cholesterol; HDL-C, high density lipoprotein cholesterol; BMI, body mass index.

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