C反应蛋白-甘油三酯葡萄糖指数变化和相对脂肪质量轨迹与新发脑卒中风险的关联:CHARLS队列研究

Association of C-reactive protein-triglyceride-glucose index changes and relative fat mass trajectories with the risk of new-onset stroke:the CHARLS cohort study

摘要:

目的]探讨中老年人群C反应蛋白-甘油三酯葡萄糖指数(CTI)纵向变化和相对脂肪质量(RFM)纵向轨迹与新发脑卒中风险的关联。 [方法]使用中国健康与养老追踪调查(CHARLS)数据进行分析。根据2011年和2015年两次测量的CTI,通过K-mean聚类确定CTI变化类别。根据2011年、2013年和2015年三次测量RFM,通过潜类别混合增长模型拟合RFM轨迹。多因素Logistic回归分别用于评估CTI类别、RFM轨迹以及CTI类别联合RFM轨迹与新发脑卒中的风险效应。相对超额风险分析探索CTI类别与RFM轨迹对新发脑卒中风险的交互作用。ROC曲线分析用于评估CTI类别和RFM轨迹对新发脑卒中的区分度。 [结果]对4 823名符合纳排标准的参与者进行分析,在3年中位随访时间内,393名参与者出现了新发脑卒中。在调整混杂因素后的Logistic回归分析结果显示,相较于CTI水平持续最低的类别1,持续最高的CTI类别3与新发脑卒中风险增加70%(OR＝1.0,5%CI:1.24～2.34),而RFM高稳定组(轨迹3)相较于低稳定组(轨迹1)风险增加62%(OR＝1.2,5%CI:1.04～2.64)；联合分析显示,同时处于类别3和轨迹3的参与者与同时处于类别1和轨迹1的参与者相比,其新发脑卒中风险显著上升(OR＝3.3,5%CI:1.98～6.96)。相对超额风险分析显示,CTI类别与RFM轨迹存在显著的加性交互作用和协同效应。ROC曲线分析显示,CTI类别联合RFM轨迹对新发脑卒中的预测具有一定的区分度(AUC＝0.617)。[结论]CTI与RFM持续处于高水平状态与新发脑卒中的风险增加显著相关,持续监测CTI和RFM对新发脑卒中的防治具有重要意义。

Abstract:

Aim To investigate the association between the longitudinal changes of C-reactive protein-triglyceride-glucose index (CTI) and the longitudinal trajectories of relative fat mass (RFM) with the risk of new-onset stroke in middle-aged and elderly populations. Methods The study used data from the China Health and Retirement Longitudinal Study (CHARLS) for analysis. Based on two measurements of CTI in 2011 and 2015, the K-mean clustering was used to identify the categories of CTI changes. Based on three measurements of RFM in 1,3 and 2015, latent class mixed-growth modeling was applied to fit the RFM trajectory. Multivariate Logistic regression was used to assess the risk effects of CTI categories, RFM trajectories, and their combination on new-onset stroke. Relative excess risk analysis was conducted to evaluate the interaction between CTI categories and RFM trajectories. ROC curve analysis was performed to evaluate the discriminatory power of CTI categories and RFM trajectories for new-onset stroke. Results Of the 4 823 participants meeting the inclusion and exclusion criteria, 393 developed new-onset stroke during a median follow-up of 3 years. After adjusting for confounding factors, Logistic regression analysis showed that compared to category 1 with consistently low CTI levels, category 3 with consistently high CTI levels had a 70% increased risk of new-onset stroke (OR＝1.0,5%CI:1.24～2.34), while the RFM high stability group (trajectory 3) had a 62% increased risk compared to the low stability group (trajectory 1) (OR＝1.2,5%CI:1.04～2.64). Joint analysis showed that participants in category 3 and trajectory 3 had a significantly higher risk of new-onset stroke than those in category 1 and trajectory 1 (OR＝3.3,5%CI:1.98～6.96). The relative excess risk interaction analysis revealed that there was a significant additive interaction and synergistic effect between CTI categories and RFM trajectories. ROC curve analysis showed that CTI categories combined with RFM trajectories had a certain discriminatory power for new-onset stroke (AUC＝0.617). Conclusion The sustained high levels of CTI and RFM are significantly associated with an increased risk of new-onset stroke, and continuous monitoring of CTI and RFM is of great significance for the prevention and treatment of new-onset stroke.