| 刘雪娇,王炳源,任永成,赵阳,刘德臣,张冬冬,陈序,刘磊磊,程诚,刘飞燕,周琼桂,陈国桢,洪士皓,刘丹,胡思琦,张明,胡东生.高血压人群中体质指数与全死因死亡风险的队列研究[J].Chinese journal of Epidemiology,2018,39(7):914-919 |
| 高血压人群中体质指数与全死因死亡风险的队列研究 |
| A cohort study on body mass index and risk of all-cause mortality among hypertensive population |
| Received:January 14, 2018 |
| DOI：10.3760/cma.j.issn.0254-6450.2018.07.010 |
| KeyWord: 体质指数 死亡 高血压 肥胖悖论 |
| English Key Word: Body mass index Mortality Hypertension Obesity paradox |
| FundProject:国家自然科学基金（81373074，81402752，81673260） |
| Author Name | Affiliation | E-mail | | Liu Xuejiao | Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China | | | Wang Bingyuan | Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China | | | Ren Yongcheng | Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China | | | Zhao Yang | Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China | | | Liu Dechen | Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China | | | Zhang Dongdong | Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China | | | Chen Xu | Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China | | | Liu Leilei | Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China | | | Cheng Cheng | Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China | | | Liu Feiyan | Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen 518060, China | | | Zhou Qionggui | Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen 518060, China | | | Chen Guozhen | Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen 518060, China | | | Hong Shihao | Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen 518060, China | | | Liu Dan | Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen 518060, China | | | Hu Siqi | Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen 518060, China | | | Zhang Ming | Department of Preventive Medicine, Shenzhen University Health Sciences Center, Shenzhen 518060, China | | | Hu Dongsheng | Department of Epidemiology and Health Statistics, College of Public Health, Zhengzhou University, Zhengzhou 450001, China | hud@szu.edu.cn |
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| Abstract: |
| 目的 探讨高血压队列人群中BMI和全死因死亡风险的关系。方法 研究对象为河南省某农村地区高血压队列人群，应用Cox风险比例回归模型计算基线时不同BMI水平人群随访期间的全死因死亡比例HR值及其95% CI，并采用限制性立方样条模型拟合BMI与全死因死亡风险的剂量-反应关系。结果 5 461名高血压队列人群累积随访31 048.38人年，平均随访6年，随访期间死亡589人。控制潜在的混杂因素后，以基线正常体重组（18.5 kg/m2 < BMI < 24.0 kg/m2）为参照，低体重组（BMI<18.5 kg/m2）、超重组（24.0 kg/m2 < BMI < 28.0 kg/m2）和肥胖组（BMI≥28 kg/m2）人群发生死亡的HR值（95% CI）分别为0.83（0.37～1.87）、0.81（0.67～0.97）和0.72（0.56～0.91）。限制性立方样条模型分析结果显示，在高血压队列人群中，基线BMI和全死因死亡风险关联强度呈现倒“S”形非线性剂量反应关系（非线性检验P<0.001）。结论 超重和肥胖可能是高血压人群死亡风险的保护因素，与“肥胖悖论”一致。 |
| English Abstract: |
| Objective To investigate the relationship between body mass index (BMI) and all-cause mortality in hypertensive population. Methods All participants were selected from a prospective cohort study based on a rural population from Henan province, China. Cox proportional hazards regression models were used to estimate the associations of different levels of BMI stratification with all-cause mortality. Restricted cubic spline models were used to detect the dose-response relation. Results Among the 5 461 hypertensive patients, a total of 31 048.38 person-years follow-up was conducted. The median of follow-up time was 6 years, and 589 deaths occurred during the follow-up period. Compared to normal weight group (18.5 kg/m2 < BMI < 24.0 kg/m2) the multivariate-adjusted hazard ratios for all-cause mortality associated with BMI levels (<18.5 kg/m2, 24-28 kg/m2, and ≥ 28 kg/m2) were 0.83 (95%CI:0.37-1.87), 0.81 (95%CI:0.67-0.97), and 0.72 (95%CI:0.56-0.91), respectively. The dose-response analysis showed a nonlinear, reverse "S" shaped relationship (non-linearity P<0.001). Conclusion Overweight or obese might have a protective effect on all-cause mortality in hypertensive population, which supports the "obesity paradox" phenomenon. |
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