中国非动脉硬化性心血管疾病人群脂蛋白（a）水平分布特征及影响因素

柯雅蕾; 潘烺; 吕筠; 孙点剑一; 裴培; 陈怡平; 杨玲; 杜怀东; Robert Clarke; 陈君石; 陈铮鸣; 章晓; 陈婷; 李润琴; 齐丽彤; 李立明; 余灿清; 代表中国慢性病前瞻性研究项目协作组

Abstract

柯雅蕾,潘烺,吕筠,孙点剑一,裴培,陈怡平,杨玲,杜怀东,Robert Clarke,陈君石,陈铮鸣,章晓,陈婷,李润琴,齐丽彤,李立明,余灿清,代表中国慢性病前瞻性研究项目协作组.中国非动脉硬化性心血管疾病人群脂蛋白（a）水平分布特征及影响因素[J].Chinese journal of Epidemiology,2024,45(6):779-786

中国非动脉硬化性心血管疾病人群脂蛋白（a）水平分布特征及影响因素

Distribution and influencing factors of lipoprotein (a) levels in non-arteriosclerotic cardiovascular disease population in China

Received:January 05, 2024

DOI：10.3760/cma.j.cn112338-20240105-00004

KeyWord: 脂蛋白（a）非动脉硬化性心血管疾病人群分布影响因素

English Key Word: Lipoprotein (a) Non-arteriosclerotic cardiovascular disease population Distribution Influencing factor

FundProject:国家自然科学基金（82192904，82192901，82192900）；国家重点研发计划“精准医学研究”重点专项（2016YFC0900500）；中国香港Kadoorie Charitable基金

Author Name	Affiliation	E-mail
Ke Yalei	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China
Pan Lang	Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
Lyu Jun	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
Sun Dianjianyi	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
Pei Pei	Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
Chen Yiping	Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
Yang Ling	Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
Du Huaidong	Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
Robert Clarke	Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
Chen Junshi	China National Center for Food Safety Risk Assessment, Beijing 100022, China
Chen Zhengming	Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom
Zhang Xiao	Beijing Novartis Pharma Company Limited, Beijing 102200, China
Chen Ting	Beijing Novartis Pharma Company Limited, Beijing 102200, China
Li Runqin	Beijing Novartis Pharma Company Limited, Beijing 102200, China
Qi Litong	Department of Cardiovascular Diseases, Peking University First Hospital, Beijing 100034, China
Li Liming	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
Yu Canqing	Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China	yucanqing@pku.edu.cn
for the China Kadoorie Biobank Collaborative Group	1 Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing 100191, China 2 Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China 3 Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China 4 Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, United Kingdom 5 China National Center for Food Safety Risk Assessment, Beijing 100022, China 6 Beijing Novartis Pharma Company Limited, Beijing 102200, China 7 Department of Cardiovascular Diseases, Peking University First Hospital, Beijing 100034, China

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Abstract:

目的描述中国非动脉硬化性心血管疾病（ASCVD）人群脂蛋白（a）［Lp（a）］的分布并分析其影响因素。方法基于中国慢性病前瞻性研究项目的一项巢式病例对照研究，选取其中进行了血液生化指标检测的对照人群进行分析，使用参比实验室检定的多克隆抗体比浊法测定Lp（a）水平，≥75.0 nmol/L定义为高Lp（a）。采用多因素logistic回归模型分析Lp（a）水平的影响因素。结果在纳入研究的5 870名非ASCVD人群中，Lp（a）水平呈正偏态分布，M（Q₁，Q₃）为17.5（8.8，43.5）nmol/L。多因素logistic回归分析结果显示，女性与高Lp（a）相关（OR=1.23，95%CI：1.05~1.43），中心性肥胖者的高Lp（a）风险降低（OR=0.68，95%CI：0.52~0.89）。随TC、LDL-C、载脂蛋白A1（Apo A1）和载脂蛋白B（Apo B）水平升高，高Lp（a）风险增加，各升高组的OR值（95%CI）分别为2.40（1.76~3.24）、2.68（1.36~4.93）、1.29（1.03~1.61）和1.65（1.27~2.13）；HDL-C降低组高Lp（a）风险降低，OR值（95%CI）为0.76（0.61~0.94）；而TG、Apo A1与Apo B的比值（Apo A1/B）与高Lp（a）风险呈负相关，TG升高组的OR值（95%CI）为0.73（0.60~0.89），Apo A1/B升高组的OR值（95%CI）为0.60（0.50~0.72）；Lp（a）水平与血脂指标（除Apo A1外）的相关性均存在线性趋势（线性趋势检验P≤0.001）。未发现行为生活方式因素如饮食、吸烟、体力活动水平与Lp（a）水平存在统计学关联。结论Lp（a）水平与性别及中心性肥胖有关，但受行为生活方式因素影响较小。

English Abstract:

Objective　To describe the distribution of lipoprotein (a) [Lp(a)] levels in non-arteriosclerotic cardiovascular disease (ASCVD) population in China and explore its influencing factors. Methods　This study was based on a nested case-control study in the CKB study measured plasma biomarkers. Lp(a) levels was measured using a polyclonal antibody-based turbidimetric assay certified by the reference laboratory and ≥75.0 nmol/L defined as high Lp(a). Multiple logistic regression model was used to examine the factors related to Lp(a) levels. Results　Among the 5 870 non-ASCVD population included in the analysis, Lp(a) levels showed a right-skewed distribution, with a M (Q₁, Q₃) of 17.5 (8.8, 43.5) nmol/L. The multiple logistic regression analysis found that female was associated with high Lp(a) (OR=1.23, 95%CI: 1.05-1.43). The risk of increased Lp(a) levels in subjects with abdominal obesity was significantly reduced (OR=0.68, 95%CI: 0.52-0.89). As TC, LDL-C, apolipoprotein A1(Apo A1), and apolipoprotein B(Apo B) levels increased, the risk of high Lp(a) increased, with OR (95%CI) for each elevated group was 2.40 (1.76-3.24), 2.68 (1.36-4.93), 1.29 (1.03-1.61), and 1.65 (1.27-2.13), respectively. The risk of high Lp(a) was reduced in the HDL-C lowering group with an OR(95%CI) of 0.76 (0.61-0.94). In contrast, an increase in TG levels and the ratio of Apo A1/Apo B(Apo A1/B) was negatively correlated with the risk of high Lp(a), with OR(95%CI) of 0.73 (0.60-0.89) for elevated triglyceride group, andOR(95%CI) of 0.60 (0.50-0.72) for the Apo A1/B ratio increase group (linear trend test P≤0.001 except for Apo A1). However, no correlation was found between Lp(a) levels and lifestyle factors such as diet, smoking, and physical activity. Conclusions　Lp(a) levels were associated with sex and abdominal obesity, but less with lifestyle behaviors.

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