北京社区人群促红细胞生成素相关因素及其与10年心血管疾病风险的关系

doi:10.19723/j.issn.1671-167X.2023.06.018

摘要/Abstract

摘要：

目的: 了解北京社区人群内源性促红细胞生成素(erythropoietin, EPO)的相关因素及其与10年心血管疾病发病风险的关系。方法: 数据来源于2011年12月至2012年4月北京大学第一医院动脉粥样硬化队列的基线资料, 采用多因素线性回归模型分析内源性EPO的相关因素, 应用中国动脉粥样硬化性心血管疾病风险预测(prediction for atherosclerotic cardiovascular disease risk in China, China-PAR)模型计算研究对象10年心血管疾病发病风险, 以5%、10%为切点定义低、中、高风险分层。结果: 共纳入4 013名基线无心脑血管疾病、无贫血、肾功能未见异常的研究对象, 女性占比62.2%(2 496人), 平均年龄(55.9±8.2)岁, 平均EPO水平为12.8(9.3~17.4) IU/L。10年心血管疾病风险高危者占比25.1% (998人)。多因素回归结果显示, 血红蛋白(β=-0.05, 95%CI: -0.07~-0.04)和肾小球滤过率≥90 mL/(min·1.73 m²)(β=-0.05, 95%CI: -0.07~-0.04)与EPO水平呈显著负相关, 高血压(β=0.08, 95%CI: 0.05~0.12)和肥胖(β=0.14, 95%CI: 0.09~0.18)与内源性EPO水平升高显著相关。10年心血管疾病风险与内源性EPO水平呈显著正相关(β=0.07, 95%CI: 0.05~0.09), 中危者以及高危者内源性EPO水平均显著高于与低危者(P均 < 0.05)。结论: 北京市社区居民内源性EPO水平与血红蛋白、肾功能、肥胖及高血压呈显著相关性, 10年心血管疾病风险中、高危者内源性EPO水平显著高于低危者, 可能是心血管疾病风险标志物。

关键词: 促红细胞生成素, 心血管疾病, 风险, 高血压, 肥胖

Abstract:

Objective: To investigate the associated factors of endogenous erythropoietin (EPO) and its association with 10-year risks of atherosclerotic cardiovascular disease in a Chinese community-based general population. Methods: The participants of this study were from an atherosclerosis cohort survey which was established by the Department of Cardiology, Peking University First Hospital in 2011. The cohort survey was performed in the Gucheng and Pingguoyuan communities of Shijingshan district in Beijing, China. The inclusion criteria of this study were: (1) endogenous EPO was measured; (2) health questionnaire data and other clinical data were complete; (3) participatants who had cardiovascular or cerebrovascular diseases (defined as self-reported coronary heart disease, stroke or transient ischemic attack) or anemia or estimated glomerular filtration rate (eGFR) < 60 mL/(min·1.73 m²) at baseline were excluded. Multivariate linear regression model was used to examine the associated factors of endogenous EPO. The participants were grouped into low (< 5%), moderate (5%-10%) and high risk (≥10%) groups, based on predicted 10-year cardiovascular disease risk using the prediction for atherosclerotic cardiovascular disease risk in China (China-PAR) equations. Results: A total of 4 013 participants were included. Mean age of them was (55.9±8.2) years, 62.2% (n=2 496) of them were female, and 46.3% (n=1 859), 70.9% (n=2 845), 21.9% (n=879) had hypertension, dyslipidemia and diabetes, individually. The average body mass index was (26.1±3.3) kg/m². The median of EPO level was 12.8 (9.3-17.4) IU/L and 25.1% (n=998) were at high 10-years risk of cardiovascular disease. Hemoglobin (β=-0.05, 95%CI: -0.07 to -0.04) and eGFR ≥90 mL/(min·1.73 m²) (β=-0.05, 95%CI: -0.07 to -0.04) were associated with lower in transformed EPO levels while hypertension (β=0.08, 95%CI: 0.05 to 0.12) and obesity (β=0.14, 95%CI: 0.09 to 0.18) were associated with higher in transformed EPO levels in multivariate linear regression analyses. Ten-year cardiovascular disease risks were positively associated with in transformed EPO levels (β=0.07, 95%CI: 0.05 to 0.09). The participants at moderate and high cardiovascular disease risks had significant higher EPO levels than the low risk group (all P < 0.05). Conclusion: In community-based Beijing populations, endogenous EPO was associated with hemoglobin, renal function, obesity and hypertension. Individuals at high 10-years cardiovascular disease risks have higher endogenous EPO levels. Endogenous EPO may be a potential risk marker of cardiovascular disease.

Key words: Erythropoietin, Cardiovascular disease, Risk, Hypertension, Obesity

中图分类号:

R754

陈楚云,孙蓬飞,赵静,贾佳,范芳芳,王春燕,李建平,姜一梦,霍勇,张岩. 北京社区人群促红细胞生成素相关因素及其与10年心血管疾病风险的关系[J]. 北京大学学报（医学版）, 2023, 55(6): 1068-1073.

Chu-yun CHEN,Peng-fei SUN,Jing ZHAO,Jia JIA,Fang-fang FAN,Chun-yan WANG,Jian-ping LI,Yi-meng JIANG,Yong HUO,Yan ZHANG. Related factors of endogenous erythropoietin and its association with 10-year risks of cardiovascular disease in a community-based Chinese study[J]. Journal of Peking University (Health Sciences), 2023, 55(6): 1068-1073.

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Items	Low (n=1 338)	Moderate (n=1 337)	High (n=1 338)	χ²/F	P
Age/years, ${\bar x}$±s	54.8±7.8	56.1±7.9	56.7±8.7	33.80	< 0.001
Female, n(%)	767 (57.3)	842 (63.0)	887 (66.3)	23.40	< 0.001
Body mass index/(kg/m²), ${\bar x}$±s	25.6±3.2	26.1±3.2	26.5±3.5	57.93	< 0.001
Smoking, n(%)	328 (24.5)	270 (20.2)	233 (17.4)	20.86	< 0.001
Hemoglobin/(g/L), ${\bar x}$±s	137.8±15.0	135.5±14.5	133.0±14.5	71.89	< 0.001
eGFR/[mL/(min·1.73 m²)], ${\bar x}$±s	96.8±10.4	96.0±11.0	95.4±11.8	10.98	0.004
Disease, n(%)
Hypertension	533 (39.8)	631 (47.2)	695 (51.9)	40.05	< 0.001
Dyslipidemia	939 (70.2)	947 (70.8)	959 (71.7)	0.73	0.695
Diabetes	260 (19.4)	285 (21.3)	334 (25.0)	12.37	0.002

Variables	Univariate			Multivariate
Variables	β	95% CI	P	β	95% CI	P
Female	0.09	0.05 to 0.12	< 0.001	0.02	-0.03 to 0.07	0.362
Age/years
< 50	Ref			Ref
50- < 60	0.01	-0.03 to 0.05	0.55	-0.01	-0.05 to 0.03	0.676
≥60	0.11	0.07 to 0.16	< 0.001	0.05	-0.00 to 0.10	0.060
Body mass index/(kg/m²)
< 24	Ref			Ref
24- < 28	0.08	0.04 to 0.12	< 0.001	0.08	0.04 to 0.12	< 0.001
≥28	0.15	0.11 to 0.20	< 0.001	0.14	0.09 to 0.18	< 0.001
Hemoglobin/(g/L)	-0.05	-0.06 to -0.04	< 0.001	-0.05	-0.07 to -0.04	< 0.001
Smoking	-0.09	-0.13 to -0.05	< 0.001	0.00	-0.05 to 0.05	0.979
eGFR/[mL/(min·1.73 m²)]
60- < 90	Ref			Ref
≥90	-0.07	-0.11 to -0.03	< 0.001	-0.04	-0.08 to -0.00	0.035
Hypertension	0.11	0.08 to 0.15	< 0.001	0.08	0.05 to 0.12	< 0.001
Diabetes	0.06	0.02 to 0.10	0.002	0.02	-0.02 to 0.07	0.248
Dyslipidemia	0.02	-0.01 to 0.06	0.208	0.00	-0.04 to 0.04	0.992

10-year cardiovascular disease risk	Model Ⅰ			Model Ⅱ
10-year cardiovascular disease risk	β	95% CI	P	β	95% CI	P
ln(10-year cardiovascular disease risk)	0.04	0.03-0.06	< 0.001	0.07	0.05-0.09	< 0.001
10-year cardiovascular disease risk stratification
Low risk	Ref			Ref
Moderate risk	0.05	0.01-0.09	0.010	0.09	0.05-0.13	< 0.001
High risk	0.08	0.04-0.12	< 0.001	0.12	0.07-0.16	< 0.001