心血管病高危人群脂质蓄积指数与颈动脉粥样硬化的相关性

顾亦斌; 顾淑君; 张秋伊; 陈路路

doi:10.16462/j.cnki.zhjbkz.2025.06.007

心血管病高危人群脂质蓄积指数与颈动脉粥样硬化的相关性

doi: 10.16462/j.cnki.zhjbkz.2025.06.007

1.
常熟市疾病预防控制中心慢性病防制科，常熟 215500
2.
江苏省疾病预防控制中心慢性非传染病防制所，南京 210009

基金项目: 中央财政转移支付地方卫生计生服务项目

详细信息

通讯作者:
陈路路，E-mail: chenlulu136@163.com

中图分类号: R181.3+8
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出版历程
- 收稿日期: 2025-01-03
- 修回日期: 2025-02-27
- 网络出版日期: 2025-07-07
- 刊出日期: 2025-06-10

Research on the correlation between lipid accumulation product and carotid atherosclerosis in people with high risk of cardiovascular diseases

1.
Changshu Center for Disease Control and Prevention, Changshu 215500, China
2.
Department of Non-Communicable Chronic Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing 210009, China

Funds: Chinese Central Government Key Project of Public Health Program

More Information

Corresponding author: CHEN Lulu, E-mail: chenlulu136@163.com

摘要

摘要: 目的了解心血管病高危人群脂质蓄积指数(lipid accumulation product index, LAP)与颈动脉粥样硬化发病风险的相关性，为心血管病高危人群的干预提供科学依据。方法基于2015年9月―2016年6月国家心血管病高危人群早期筛查与综合干预项目，通过问卷调查、体格测量、实验室检测和颈动脉超声检查等方法，采用χ²/F检验对不同性别、不同年龄心血管病高危人群的一般情况进行分析，并将可能的混杂因素进行调整，采用多因素logistic回归分析模型探讨LAP与颈动脉粥样硬化的关系。结果相比于男性、>60岁人群，女性、≤60岁人群的LAP更高，差异均有统计学意义(均P < 0.001)。回归分析结果显示，LAP每增加1个标准差，颈动脉斑块的发生风险增加6%(OR=1.06, 95% CI: 1.01~1.12, P=0.026)。交互作用结果显示，相比于女性、不饮酒者，男性、饮酒人群中LAP高者发生颈动脉斑块的风险更高(交互作用均P < 0.05)。结论心血管病高危人群中，LAP与颈动脉斑块呈正相关，且在男性、饮酒者中正相关性更强。
- 脂质蓄积指数 /
- 颈动脉粥样硬化 /
- 男性 /
- 饮酒
Abstract: Objective To learn the correlation between the lipid accumulation product index (LAP) and the risk of carotid atherosclerosis in people with high risk of cardiovascular diseases, and provide scientific basis for intervention in people with high risk of cardiovascular diseases. Methods Based on the programme of screening and intervention subjects with high risk cardiovascular diseases in Jiangsu Province from September 2015 to June 2016, the general situation of high-risk groups of cardiovascular disease in different genders and ages was analyzed by χ² /F test through questionnaires, physical measurements, laboratory tests and carotid ultrasound examination, and the possible confounding factors were adjusted. Multivariate logistic regression model was used to explore the relationship between LAP and carotid atherosclerosis. Results Compared to male and those aged over 60 years old, females and those aged 60 years old or below had a higher LAP index, and the differences were statistically significant (all P < 0.001). Regression analysis showed that for every standard deviation increase in the lipid accumulation product, the risk of carotid artery plaque increased by 6% (OR=1.06, 95% CI: 1.01-1.12, P=0.026). Interaction analysis results showed that compared with female and non-drinking people, male and drinking people with high risk of cardiovascular diseases have a higher risk of carotid plaque (interaction tests P < 0.05, respectively). Conclusions In people with high risk of cardiovascular diseases, the LAP was positively correlated with the carotid plaque, and the positive correlation were stronger in male and alcohol drinking.
- Lipid accumulation product index /
- Carotid atherosclerosis /
- Men /
- Drinking

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表 1 不同性别人群的一般情况描述

Table 1. Description of the general situation of populations of different genders

特征Characteristics	总数Total ^①	性别Gender ^①		χ²/t值value	P值value
特征Characteristics	总数Total ^①	男性Male	女性Female	χ²/t值value	P值value
年龄/岁Age /years	59.4±8.9	59.0±9.5	59.7±8.4	4.00	< 0.001
收缩压Systolic blood pressure/mmHg	164.0±19.9	160.8±20.0	166.4±19.5	14.76	< 0.001
舒张压Diastolic blood pressure /mmHg	91.0±12.2	93.8±12.1	88.9±11.9	21.25	< 0.001
腰围Waist circumference /cm	86.8±9.5	89.2±9.2	85.0±9.3	23.49	< 0.001
BMI/(kg·m^-2)	26.4±3.4	26.3±3.3	26.4±3.5	1.58	0.113
总胆固醇Total cholesterol /(mmol·L^-1)	4.9±1.2	4.6±1.1	5.2±1.2	27.43	< 0.001
三酰甘油Triglycerides /(mmol·L^-1)	1.7±1.0	1.7±1.0	1.7±0.9	2.35	0.019
低密度脂蛋白胆固醇Low density lipoprotein cholesterol /(mmol·L^-1)	2.8±1.0	2.6±0.9	2.9±1.0	20.06	< 0.001
高密度脂蛋白胆固醇High density lipoprotein cholesterol /(mmol·L^-1)	1.3±0.4	1.2±0.4	1.4±0.4	27.79	< 0.001
脂质蓄积指数Lipid accumulation product index	45.7±34.0	43.9±34.7	47.1±33.4	5.00	< 0.001
吸烟Smoking				3 833.84	< 0.001
否No	8 844(77.8)	2 380(49.6)	6 464(98.5)
是Yes	2 518(22.2)	2 417(50.4)	101	(1.5)
饮酒Drinking				3 881.61	< 0.001
否No	8 021(70.6)	1 892(39.4)	6 129(93.4)
是Yes	3 341(29.4)	2 905(60.6)	436	(6.6)
受教育程度Educational attainment				927.84	< 0.001
小学及以下Primary school and below	6 470(56.9)	1 964(40.9)	4 506(68.7)
初中Junior middle school	3 278(28.9)	1 793(37.4)	1 485(22.6)
高中Senior middle school	1 190(10.5)	729(15.2)	461(7.0)
大学University	424(3.7)	311(6.5)	113(1.7)
高血压Hypertension				16.94	< 0.001
否No	1 090(9.6)	524(10.9)	566(8.6)
是Yes	10 272(90.4)	4 273(89.1)	5 999(91.4)
注：①以人数(占比/%)或x±s表示。 Note: ① Number of people(proportion/%) or x±s.

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表 2 不同年龄人群的一般情况描述

Table 2. Description of the general situation of populations in different age groups

特征Characteristics	总数Total ^①	年龄组/岁Age group/years^①		χ²/t值value	P值value
特征Characteristics	总数Total ^①	< 60	≥60	χ²/t值value	P值value
性别Gender				5.11	0.024
男性Male	4 797(42.2)	2 223(43.4)	2 574(41.3)
女性Female	6 565(57.8)	2 902(56.6)	3 663(58.7)
收缩压Systolic blood pressure/mmHg	164.0±19.9	160.3±21.0	167.1±18.4	18.51	< 0.001
舒张压Diastolic blood pressure /mmHg	91.0±12.2	94.3±12.5	88.3±11.3	26.94	< 0.001
腰围Waist circumference /cm	86.8±9.5	87.1±9.5	86.6±9.5	2.66	0.008
BMI/(kg·m^-2)	26.4±3.4	26.6±3.4	26.2±3.4	7.09	< 0.001
总胆固醇Total cholesterol /(mmol·L^-1)	4.9±1.2	4.9±1.2	5.0±1.1	4.34	< 0.001
三酰甘油Triglycerides /(mmol·L^-1)	1.7±1.0	1.8±1.0	1.6±0.9	8.92	< 0.001
低密度脂蛋白胆固醇Low density lipoprotein cholesterol /(mmol·L^-1)	2.8±1.0	2.8±1.0	2.8±1.0	2.84	0.005
高密度脂蛋白胆固醇High density lipoprotein cholesterol /(mmol·L^-1)	1.3±0.4	1.3±0.4	1.4±0.4	14.74	< 0.001
脂质蓄积指数Lipid accumulation product index	45.7±34.0	48.2±35.1	43.8±32.9	6.88	< 0.001
吸烟Smoking				25.03	< 0.001
否No	8 844(77.8)	3 879(75.7)	4 965(79.6)
是Yes	2 518(22.2)	1 246(24.3)	1 272(20.4)
饮酒Drinking				38.01	< 0.001
否No	8 021(70.6)	3 469(67.7)	4 552(73.0)
是Yes	3 341(29.4)	1 656(32.3)	1 685(27.0)
受教育程度Educational attainment				1 604.60	< 0.001
小学及以下Primary school and below	6 470(56.9)	1 876(36.6)	4 594(73.6)
初中Junior middle school	3 278(28.9)	2 112(41.2)	1 166(18.7)
高中Senior middle school	1 190(10.5)	806(15.7)	384(6.2)
大学University	424(3.7)	331(6.5)	93(1.5)
高血压Hypertension				174.49	< 0.001
否No	1 090(9.6)	698(13.6)	392(6.3)
是Yes	10 272(90.4)	4 427(86.4)	5 845(93.7)
注：①以人数(占比/%)或x±s表示。 Note: ① Number of people(proportion/%) or x±s.

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表 3 多因素logistic回归分析变量赋值

Table 3. Variable assignment for multivariate logistic regression analysis

变量Variable	赋值Assignment
性别Gender	1=男性，2=女性1=male, 2=female
吸烟Smoking	0=否，1=是0=no, 1=yes
饮酒Drinking	0=否，1=是0=no, 1=yes
受教育程度Educational attainment	1=小学及以下，2=初中，3=高中，4=大学1=primary school and below, 2=junior middle school, 3=senior middle school, 4=university
高血压Hypertension	0=否，1=是0=no, 1=yes
颈动脉异常Carotid artery abnormality	0=正常，1=异常0=normal, 1=abnormal
颈动脉斑块Carotid artery plaque	0=正常，1=斑块0=normal, 1=plaque
腰围Waist circumference /cm	连续型变量Continuous variable
三酰甘油Triglycerides /(mmol·L^-1)	连续型变量Continuous variable
脂质蓄积指数Lipid accumulation product index	连续型变量Continuous variable
年龄/岁Age /years	连续型变量Continuous variable
收缩压Systolic blood pressure/mmHg	连续型变量Continuous variable
舒张压Diastolic blood pressure /mmHg	连续型变量Continuous variable
BMI/(kg·m^-2)	连续型变量Continuous variable
总胆固醇Total cholesterol /(mmol·L^-1)	连续型变量Continuous variable
低密度脂蛋白胆固醇Low-density lipoprotein cholesterol /(mmol·L^-1)	连续型变量Continuous variable
高密度脂蛋白胆固醇High-density lipoprotein cholesterol /(mmol·L^-1)	连续型变量Continuous variable

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表 4 腰围、三酰甘油、脂质蓄积指数与颈动脉异常和颈动脉斑块的多因素logistic回归分析

Table 4. Multivariate logistic regression analysis of waist circumference, triglycerides, lipid accumulation product index and carotid artery abnormality as well as carotid artery plaque

变量Variable	颈动脉异常Carotid artery abnormality				颈动脉斑块Carotid artery alaque
变量Variable	OR值value (95% CI)^②	P值value	OR值value (95% CI)^③	P值value	OR值value (95% CI)^②	P值value	OR值value (95% CI)^③	P值value
腰围Waist circumference /cm	1.01(1.01~1.01)	< 0.001	1.01(1.00~1.01)	0.083	1.01(1.00~1.01)	< 0.001	1.02(1.01~1.02)	< 0.001
中心性肥胖Central obesity
否No	1.00		1.00		1.00		1.00
是Yes	1.07(0.99~1.15)	0.092	0.98(0.89~1.08)	0.724	1.03(0.95~1.11)	0.463	1.15(1.04~1.28)	0.005
三酰甘油Triglycerides /(mmol·L^-1)	0.96(0.93~1.00)	0.039	0.98(0.93~1.03)	0.348	0.97(0.93~1.01)	0.097	1.01(0.96~1.06)	0.729
三酰甘油分组Triglyceride grouping /(mmol·L^-1)
< 2.3	1.00		1.00		1.00		1.00
≥2.3	0.90(0.82~0.99)	0.030	0.94(0.84~1.06)	0.321	0.88(0.80~0.97)	0.011	0.93(0.82~1.05)	0.238
脂质蓄积指数Lipid accumulation product index^①	0.99(0.95~1.02)	0.479	0.99(0.94~1.05)	0.773	1.05(1.01~1.09)	0.016	1.06(1.01~1.12)	0.026
脂质蓄积指数四分位数分组Quartile grouping of lipid accumulation index
Q1(< 22.96)	1.00		1.00		1.00		1.00
Q2(22.96~＜36.96)	1.02(0.92~1.13)	0.774	1.08(0.96~1.22)	0.192	1.08(0.96~1.21)	0.186	1.15(1.01~1.30)	0.031
Q3(36.96~＜58.00)	1.08(0.98~1.20)	0.134	1.12(0.98~1.28)	0.091	1.21(1.08~1.35)	0.001	1.30(1.14~1.49)	< 0.001
Q4(≥58.00)	1.00(0.90~1.10)	0.936	1.08(0.93~1.26)	0.315	1.22(1.10~1.34)	< 0.001	1.30(1.11~1.52)	< 0.001
注：①进行Z值函数转换；②未调整；③调整年龄、性别、吸烟、饮酒、收缩压、舒张压、BMI、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、受教育程度、高血压。 Note: ① Is transformed using the Z value function; ② Is unadjusted; ③ Is adjusted for age, gender, smoking, drinking, systolic blood pressure, diastolic blood pressure, BMI, total cholesterol, low-density lipoprotein cholesterol, high density lipoprotein cholesterol, educational attainment, and hypertension.

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表 5 脂质蓄积指数^①与颈动脉斑块的分层回归分析

Table 5. Stratified regression analysis of lipid accumulation product index^① and carotid artery plaque

变量Variable	颈动脉斑块Carotid artery plaque		变量Variable	颈动脉斑块Carotid artery plaque
变量Variable	OR值value (95% CI)^②	P_交互值P_interaction value	变量Variable	OR值value (95% CI)^②	P_交互值P_interaction value
性别Gender		0.002	高密度脂蛋白胆固醇High density lipoprotein cholesterol /(mmol·L^-1)		0.268
男性Male	1.16(1.07~1.26)		< 1.0	1.04(0.96~1.14)
女性Female	0.98(0.91, 1.05)		≥1.0	1.11(1.04~1.18)
年龄组/岁Age group/years		0.208	低密度脂蛋白胆固醇Low density lipoprotein cholesterol/(mmol·L^-1)		0.260
< 60	1.02(0.94~1.11)		< 4.1	1.06(1.00~1.12)
≥60	1.07(1.00~1.15)		≥4.1	0.95(0.80~1.14)
吸烟Smoking		0.520	BMI/(kg·m^-2)		0.144
否No	1.04(0.97~1.11)		< 24.0	1.13(0.97~1.31)
是Yes	1.13(1.01~1.25)		≥24.0	1.01(0.96~1.06)
饮酒Drinking		0.004	收缩压Systolic blood pressure/mmHg		0.620
否No	1.02(0.95~1.09)		< 140	1.10(0.95~1.27)
是Yes	1.15(1.05~1.26)		≥140	1.04(0.98~1.09)
总胆固醇Total cholesterol /(mmol·L^-1)		0.994	舒张压Diastolic blood pressure/mmHg		0.410
< 6.2	1.08(1.02~1.14)		< 90	1.02(0.94~1.10)
≥6.2	1.08(0.96~1.21)		≥90	1.06(0.99~1.14)
			高血压Hypertension		0.559
			否No	1.09(0.92~1.30)
			是Yes	1.04(0.98~1.10)
注：①进行Z值函数转换；②剔除对应分层变量后分别调整年龄、性别、吸烟、饮酒、收缩压、舒张压、BMI、总胆固醇、低密度脂蛋白胆固醇、高密度脂蛋白胆固醇、受教育程度、高血压。 Note: ① Is transformed using the Z value function; ② Adjusts for age, gender, smoking, drinking, systolic blood pressure, diastolic blood pressure, BMI, total cholesterol, low-density lipoprotein cholesterol, high density lipoprotein cholesterol, educational attainment, and hypertension after excluding the corresponding stratified variables respectively.

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