同型半胱氨酸在口腔健康状态与颈动脉内膜中层厚度关系中的中介效应分析

罗凌风; 黄秋敏; 孙仲汉; 梅振东; 郑琰; 张增利; 史丽妙

doi:10.16462/j.cnki.zhjbkz.2023.08.018

同型半胱氨酸在口腔健康状态与颈动脉内膜中层厚度关系中的中介效应分析

doi: 10.16462/j.cnki.zhjbkz.2023.08.018

1.
苏州大学医学部公共卫生学院劳动卫生与环境卫生学系，苏州 215123
2.
复旦大学生命科学学院人类遗传学与人类学系，上海 200433
3.
绍兴文理学院附属医院医保办公室，绍兴 312000

基金项目:

国家重点研发计划 2020YFC2005001

详细信息

通讯作者:
史丽妙，E-mail: 1002984107@qq.com

中图分类号: R780.1;R543.4
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- PDF下载量: 15
- 被引次数: 0
出版历程
- 收稿日期: 2021-09-08
- 修回日期: 2022-03-12
- 网络出版日期: 2023-09-02
- 刊出日期: 2023-08-10

The mediation analysis of homocysteine in the realtionship between oral health status and carotid intima-media thickness

1.
Occupational Health and Environmental Hygiene Department, School of Public Health, Medical College of Soochow University, Suzhou 215123, China
2.
Department of Anthropology and Human Genetics, School of Life Sciences, Fudan University, Shanghai 200433, China
3.
Medicaid & Health Care Service Office, Affiliated Hospital of Shaoxing University of Arts and Sciences, Shaoxing 312000, China

Funds:

National Key Research and Development Program of China 2020YFC2005001

More Information

Corresponding author: SHI Li-miao, E-mail: 1002984107@qq.com

摘要

摘要: 目的探讨口腔健康状态与颈动脉内膜中层厚度(carotid intima-media thickness, cIMT)的关系，以及血清同型半胱氨酸(homo-cysteine, HCY)在其中的中介作用。方法利用2019年6月15日―2020年1月12日浙江省绍兴市某医院体检项目参与者数据，将691名≥50岁具备完整的口腔检查结果、cIMT检查结论及相关数据者作为研究对象。采用多因素logistic回归分析模型分析口腔健康状态与cIMT的关联。采用Bootstrap方法检验血清HCY在口腔健康状态和cIMT关系中的中介效应。结果多因素logistic回归分析模型调整协变量后，口腔不健康组检出cIMT增厚的可能性是口腔健康组的2.04倍(OR=2.04, 95% CI: 1.48~2.81)。中介效应分析结果显示，血清HCY在口腔健康状态与cIMT的关联中发挥了部分中介效应(间接效应=0.04, 95% CI: 0.01~0.06, P < 0.001)，占总效应的21.89%(P < 0.001)。结论口腔不健康状态可能与cIMT增厚相关，且血清HCY在其中发挥了一定的中介作用。
- 颈动脉内膜中层厚度 /
- 口腔健康状态 /
- 同型半胱氨酸 /
- 中介效应
Abstract: Objective The objective of this study was to explore the associations between oral health status and carotid intima-media thickness (cIMT), as well as to discern the potential mediating role of homocysteine (HCY) in these associations. Methods A total of 691 participants were included in the study, all aged 50 years and above, who underwent physical examinations in a hospital in Shaoxing City, Zhejiang Province, between June 15, 2019, and January 12, 2020. These participants provided complete oral and cIMT examination data. The associations between oral health status and cIMT were analyzed using multivariate logistic regression models. Bootstrap methods were utilized to assess the mediating effect of serum HCY levels on the relationship between oral health status and cIMT. Results After adjusting potential covariates by logistic regression models, it was found that the odds of abnormal cIMT was 2.04 times higher in the group with poor oral health, compared with the group exhibiting good oral health (OR=2.04, 95% CI: 1.48-2.81). The mediating analysis results showed that the serum HCY levels played a mediating role in the association between oral health status and cIMT (indirect effect=0.04, 95% CI: 0.01-0.06, P < 0.001), accounting for 21.89% of the total effect (P < 0.001). Conclusions Poor oral health may increase the probability of cIMT thickening, with higher serum HCY levels partially mediating this association.
- Carotid intima-media thickness /
- Oral health status /
- Homocysteine /
- The mediation effect

HTML全文

图 1 2019―2020年浙江省绍兴市某医院体检人群血清HCY在口腔健康状态与cIMT关联中的中介效应

1. HCY：同型半胱氨酸；2. cIMT：颈动脉内膜中层厚度；3. 数值1.16代表自变量口腔健康状态与中介变量HCY的回归系数；4. 数值0.70与0.16代表自变量口腔健康状态与中介变量HCY和cIMT状态的回归系数。

Figure 1. The mediating effect of serum HCY in the association between oral health status and cIMT in the physical examination population in a hospital in Shaoxing City, Zhejiang Province, from 2019 to 2020

1. HCY: homo-cysteine; 2. cIMT: carotid intima-media thickness; 3. The value 1.16 represents the regression coefficient between the independent variable oral health status and the intermediate variable HCY; 4. Values 0.70 and 0.16 represent regression coefficients of oral health status of independent variables and HCY and cIMT status of intermediate variables.

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表 1 2019―2020年浙江省绍兴市某医院体检人群的基本特征

Table 1. The basic characteristics of the physical examination population in a hospital in Shaoxing City, Zhejiang Province, from 2019 to 2020

特征Characteristics	cIMT正常[人数(占比/%)]/[ M(P₂₅, P₇₅)] Normal cIMT [Number of people (proportion/%)]/[M(P₂₅, P₇₅)](n=372)	cIMT增厚[人数(占比/%)]/[ M(P₂₅, P₇₅)] Thickened cIMT[Number of people (proportion/%)]/[M(P₂₅, P₇₅)](n=319)	χ²/Z值 value	P值 value
年龄/岁Age/years	65.01(60.02, 71.54)	68.52(62.01, 75.10)	3.95	< 0.001
性别Sex			0.42	0.518
男Male	191(51.34)	155(48.59)
女Female	181(48.66)	164(51.41)
BMI/(kg·m^-2)	23.25(21.56, 25.17)	23.54(21.43, 25.33)	0.49	0.627
HDL-C/(mmol·L^-1)	1.35(1.25, 1.58)	1.28(1.10, 1.55)	-2.06	0.036
LDL-C/(mmol·L^-1)	2.81(2.34, 3.36)	3.02(2.38, 3.54)	2.48	0.013
TC/(mmol·L^-1)	4.91(4.37, 5.56)	4.85(4.18, 5.49)	-1.15	0.252
TG/(mmol·L^-1)	1.32(0.99, 1.84)	1.30(0.93, 1.80)	-0.62	0.535
UA/(μmol·L^-1)	335.50(282.00, 383.25)	335.00(281.50, 391.50)	0.67	0.500
HCY/(μmol·L^-1)	13.00(12.00, 16.00)	15.00(13.00, 18.00)	9.32	< 0.001
eGFR/[mL·min^-1(1.73 m²)^-1]	79.44(63.58, 93.95)	82.82(65.26, 92.99)	0.56	0.573
SBP/mmHg	136.00(123.00, 150.00)	135.00(124.00, 149.00)	-0.80	0.425
DBP/mmHg	78.00(69.00, 84.00)	75.00(67.00, 81.50)	-3.74	< 0.001
HbA1c/%	5.70(5.50, 6.10)	5.60(5.40, 5.80)	-4.20	< 0.001
口腔健康Oral health			18.35	< 0.001
是Yes	139(37.37)	172(53.92)
否No	233(62.63)	147(46.08)
高血压Hypertension			1.54×10^-6	0.987
是Yes	225(60.48)	192(60.19)
否No	147(39.52)	127(39.81)
T2DM Diabetes mellitus type 2			1.25	0.261
是Yes	79(21.24)	56(17.55)
否No	293(78.76)	263(82.45)
注：BMI, 体质指数；HDL-C, 高密度脂蛋白胆固醇; LDL-C, 低密度脂蛋白胆固醇；TC, 总胆固醇；TG, 三酰甘油；UA, 尿酸；HCY, 同型半胱氨酸；eGFR, 肾小球滤过率；SBP, 收缩压；DBP, 舒张压；HbA1c, 糖化血红蛋白；T2DM, 2型糖尿病；cIMT, 颈动脉内膜中层厚度。 Note: BMI, body mass index; HDL-C, high density liptein cholesterol; LDL-C, low density lipoprotein cholesterol; TC, total cholesterol; TG, triglyceride; UA, uric acid; HCY, homo-cysteine; eGFR, estimated glomerular filtration rate; SBP, systolic blood pressure; DBP, diastolic blood pressure; HbA1c, glycated hemoglobin; T2DM, diabetes mellitus type 2; cIMT, carotid intima-media thickness.

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表 2 2019―2020年浙江省绍兴市某医院体检人群口腔健康状态、血清HCY与cIMT的关联性分析

Table 2. Analysis of the associations between oral health status, serum HCY and cIMT in the physical examination population in a hospital in Shaoxing City, Zhejiang Province, from 2019 to 2020

变量Variable	OR值(95% CI) OR value (95% CI)	Wald值 value	P值 value	变量Variable	OR值(95% CI) OR value (95% CI)	Wald值 value	P值 value
年龄/岁Age/years	1.06(1.04~1.08)	28.79	< 0.001	口腔健康Oral health		19.02
性别Sex		0.51		否No	1.00
女Female	1.00			是Yes	2.04(1.48~2.81)		< 0.001
男Male	1.05(0.67~1.64)		0.671	高血压Hypertension		0.03
HCY/(μmol·L^-1)	1.09(1.05~1.14)	53.23	< 0.001	否No	1.00
eGFR/[mL·min^-1(1.73 m²)^-1]	1.02(1.01~1.04)	10.98	< 0.001	是Yes	1.03(0.74~1.42)		0.881
BMI/(kg·m^-2)	1.00(0.94~1.06)	0.01	0.678	T2DM diabetes mellitus type 2		1.92
HDL-C/(mmol·L^-1)	0.64(0.38~1.07)	2.87	0.421	否No	1.00
LDL-C/(mmol·L^-1)	1.39(1.15~1.70)	11.35	0.001	是Yes	0.76(0.51~1.12)		0.184
注：HCY, 同型半胱氨酸；cIMT, 颈动脉内膜中层厚度；eGFR, 肾小球滤过率；BMI, 体质指数；HDL-C, 高密度脂蛋白胆固醇。LDL-C, 低密度脂蛋白胆固醇；T2DM, 2型糖尿病。 Note: HCY, homo-cysteine; cIMT, carotid intima-media thickness; eGFR, estimated glomerular filtration rate; BMI, body mass index; HDL-C, high density liptein cholesterol; LDL-C, low density lipoprotein cholesterol; T2DM, diabetes mellitus type 2.

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