北京地区社区人群同型半胱氨酸水平与心血管事件的相关性研究

发布时间：2018-06-04 00:22

本文选题：心血管事件 + 同型半胱氨酸　；参考：《中国人民解放军医学院》2015年博士论文

【摘要】：背景：心血管疾病(cardiovascular disease,CVD)一直是威胁着人类的生命和健康的主要杀手。近年来,随着人民生活水平的提高和社会老龄化的进程,心血管疾病的发生也逐年增加。因此人们越来越重视动脉粥样硬化性心血管病的早期诊断和早期治疗,以降低该类疾病的病残率和病死率,改善患者预后。动脉僵硬度已成为心血管疾病和动脉粥样硬化疾病的独立预测指标,目前认为颈股动脉脉搏波传导速度(carotid-femoral PWV,cfPWV)是检测动脉硬化程度的“黄金标准”。高血浆同型半胱氨酸(homocysteine,Hey)水平已经被视为是另一个预测心血管疾病及其死亡率的危险因素。随着对心血管疾病的发病机理的深入研究,在防控心血管事件的诸多措施中,评估和干预心血管疾病的危险因素就显的尤为重要。目前有研究提出血浆同型半胱氨酸水平提高同样可导致动脉粥样硬化,对心血管疾病的有一定的预测作用。因此同型半胱氨酸与心血管事件(major adverse cardiovascular events,MACE)发生的相关性研究成为热点。目的：既往研究显示同型半胱氨酸水平与动脉粥样硬化呈正相关,是心血管事件的独立危险因素。Hcy与心血管事件的关系多停留在横断面研究,在人群中Hcy对心血管事件的预测作用鲜有报道,尤其是在社区人群中。本课题目的是确定在社区人群中Hcy水平与动脉僵硬度、心血管事件等的关系,探讨Hcy水平对动脉僵硬度和心血管事件的预测作用。方法：2007年9月至2009年1月,在北京市两个社区人群进行健康体检,建立了数据完整的1680例心血管疾病危险因素相关数据库。在2013年2月至9月进行随访,最终1499例受试者完成随访(随访率89.2%)。在这些基线及随访资料完整的社区人群中,除去死亡的52例有1447例随访前及随访后数据完整人群观察血浆Hcy水平与动脉僵硬度的关系,以及这两项指标变化值之间的关系。在这1499例人群中观察血浆Hcy水平与心血管事件、全因死亡、心肌梗死及卒中发生的关系。基线及随访数据分析计量资料采用t检验,计数资料采用x2检验,Hcy水平与动脉僵硬度的关系采用Logistic分析进行统计学处理,Hcy水平与心血管事件发生数据采用Cox回归分析进行统计学处理。结果：在1499例社区受试者(平均年龄61.4岁,男性630例,女性869例,平均随访4.8年)新发主要心血管事件157例,全因死亡52例,心血管事件死亡24例,新发心肌梗塞39例,新发卒中63例。①多元线性回归分析显示,基线Hcy与随访cfPWV显著相关(β=0.817,P=0.01 5)；Logistic回归分析显示,校正混杂因素后,与Hcy最低四分位水平相比,第三、四分位水平动脉硬化发生风险增加,其优势比(odds ratio,OR)分别为：第三分位(OR=1.833,95%可信区间[confidence interval,CI]:1.069-3.142,P=0.028),第四分位(OR=2.304,95% CI：1.261-4.209,P=0.00)；与Hcy最低四分位水平相比,第二、三、四分位水平cfPWV增加发生优势比(OR)分别为：第二分位(OR=1.656,95% CI：1.011-2.711,P=0.045),第三分位(OR=1.757,95%CI：1.097-2.813,P=0.019),第四分位(OR=1.756,95%CI： 1.058-2.915,P=0.029)②Cox回归分析发现：在校正了传统危险因素及药物治疗后,Hcy是不良心血管事件的独立预测因素(风险比[hazard ratio, HR]=1.022,95%CI:1.002-1.048, P=0.035),与心血管死亡事件相关(HR=1.271, 95%CI:1.019-1.587, P=0.034),也与全因死亡事件相关(HR=1.061,95%CI: 1.008-1.116, P=0.022)。在老年人群中结果一致。结论：在社区人群中,同型半胱氨酸水平是表示中央动脉僵硬度cfPWV的独立预测指标,血浆同型半胱氨酸水平与cfPWV的增加值(cf PWV δ)显著相关。为临床预测动脉硬化程度提供新的预测指标和理论依据。Hcy是MACE的独立预测因素,与心血管死亡有关。提示检测血浆Hcy对预测社区一般人群心血管事件的发生有重要意义,也时为临床预测、诊断心血管事件的发生及严重程度提供新的思路和有效的参考指标。
[Abstract]:Background: cardiovascular disease (CVD) is a major killer of human life and health. In recent years, with the improvement of the people's living standard and the aging of the society, the incidence of cardiovascular disease is increasing year by year. Early treatment to reduce the morbidity and mortality of the disease and improve the prognosis of the patients. Arterial stiffness has become an independent predictor of cardiovascular and atherosclerotic diseases. The carotid artery pulse wave velocity (carotid-femoral PWV, cfPWV) is considered as the "golden standard" for detecting the degree of arteriosclerosis. Homocysteine (Hey) levels have been considered as another risk factor for predicting cardiovascular disease and mortality. With the in-depth study of the pathogenesis of cardiovascular disease, the risk factors for assessing and intervening cardiovascular disease are particularly important in many measures to prevent and control cardiovascular events. Raised plasma homocysteine levels also lead to atherosclerosis and have a certain predictive effect on cardiovascular disease. Therefore, the correlation between homocysteine and cardiovascular events (major adverse cardiovascular events, MACE) is a hot spot. Atherosclerosis is a positive correlation, an independent risk factor for cardiovascular events, the relationship between.Hcy and cardiovascular events is mostly in cross-sectional study. The predictive role of Hcy on cardiovascular events is rarely reported in the population, especially in community populations. The purpose of this study is to determine the level of Hcy and arterial stiffness and cardiovascular disease in the community population. The predictive effect of Hcy level on arterial stiffness and cardiovascular events was investigated. Methods: from September 2007 to January 2009, a health check-up was conducted in two community groups in Beijing. A data complete database of 1680 cardiovascular disease risk factors was established. The follow-up was conducted from February 2013 to September, and 1499 subjects were finally tested. The follow-up (follow-up rate of 89.2%) was completed. In the community population with complete baseline and follow-up data, 52 cases of the removal of death had 1447 cases before and after the follow-up data to observe the relationship between plasma Hcy level and arterial stiffness, and the correlation between the changes in the values of the two indicators. The levels of plasma Hcy were observed in the 1499 population. The relationship between cardiovascular events, all causes of death, myocardial infarction and stroke. Baseline and follow-up data were analyzed by t test, x2 test was used for counting data. The relationship between Hcy level and arterial stiffness was statistically processed by Logistic analysis. The Hcy level and cardiovascular events data were analyzed by Cox regression analysis. Results: there were 157 new major cardiovascular events in 1499 community subjects (average age 61.4, male 630, female 869, average follow-up 4.8 years), 52 deaths, 24 cardiovascular events, 39 new myocardial infarction, and 63 cases of new stroke. (1) multivariate linear regression analysis showed that baseline Hcy was significantly associated with follow-up (cfPWV). Beta =0.817, P=0.01 5); Logistic regression analysis showed that after correction of confounding factors, compared with the lowest Hcy level of Hcy, the risk of third, fourth division level arteriosclerosis was increased, and its dominance (odds ratio, OR) was third (OR=1.833,95% confidence interval [confidence interval, CI]: 1.069-3.142, fourth). 4,95% CI:1.261-4.209, P=0.00); compared with the lowest four sub level of Hcy, second, third, four sub level cfPWV increased the dominance ratio (OR), respectively: Second Division (OR=1.656,95% CI:1.011-2.711, P=0.045), third division (OR=1.757,95%CI:1.097-2.813, P= 0.019), fourth (OR=1.756,95%CI:1.058-2.915,) After the correction of traditional risk factors and drug treatment, Hcy was an independent predictor of adverse cardiovascular events (risk than [hazard ratio, HR]=1.022,95%CI:1.002-1.048, P=0.035), associated with cardiovascular death (HR=1.271, 95%CI:1.019-1.587, P=0.034), and associated with all causes of death (HR=1.061,95%CI: 1.008). -1.116, P=0.022). Conclusion: homocysteine levels are independent predictors of central arterial stiffness cfPWV in the community population. Plasma homocysteine levels are significantly associated with the increase in the value of cfPWV (CF PWV delta). It provides a new predictor and theory for the clinical pretest of arteriosclerosis. .Hcy is an independent predictor of MACE and is associated with cardiovascular death. It is suggested that the detection of plasma Hcy is important for predicting the occurrence of cardiovascular events in community general population. It also provides new ideas and effective reference indicators for clinical prediction, the diagnosis of cardiovascular events and the severity of cardiovascular events.
【学位授予单位】：中国人民解放军医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R54

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