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超重/肥胖和血脂异常交互作用对西藏藏族人群高血压患病风险的影响

周亚希,  熊海,  钟怀昌,  万洋,  廖玉琪

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文章导航 > 四川大学学报（医学版）  > 2023 >  54(3): 585-590
周亚希, 熊海, 钟怀昌, 等. 超重/肥胖和血脂异常交互作用对西藏藏族人群高血压患病风险的影响[J]. 四川大学学报（医学版）, 2023, 54(3): 585-590. doi: 10.12182/20230560504
引用本文: 周亚希, 熊海, 钟怀昌, 等. 超重/肥胖和血脂异常交互作用对西藏藏族人群高血压患病风险的影响[J]. 四川大学学报（医学版）, 2023, 54(3): 585-590. doi: 10.12182/20230560504
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ZHOU Ya-xi, XIONG Hai, ZHONG Huai-chang, et al. Effect of the Interaction Between Overweight/Obesity and Dyslipidemia on the Risk of Hypertension in Tibetan Population Living in Tibet[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCES), 2023, 54(3): 585-590. doi: 10.12182/20230560504
Citation: ZHOU Ya-xi, XIONG Hai, ZHONG Huai-chang, et al. Effect of the Interaction Between Overweight/Obesity and Dyslipidemia on the Risk of Hypertension in Tibetan Population Living in Tibet[J]. JOURNAL OF SICHUAN UNIVERSITY (MEDICAL SCIENCES), 2023, 54(3): 585-590. doi: 10.12182/20230560504
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超重/肥胖和血脂异常交互作用对西藏藏族人群高血压患病风险的影响

doi: 10.12182/20230560504
  • 1.

    四川大学华西公共卫生学院/四川大学华西第四医院 老年医学/神经内科 （成都 610041）

  • 2.

    西藏大学医学院 （拉萨 850000）

基金项目: 中央财政支持地方高校改革发展专项基金（No. 00060585、No. 00060695/051）和西藏阿里地区科技局科技计划项目（No. ALKJ-BJCZ-2019-02）资助
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    通讯作者:

    E-mail：xhxysq@126.com

Effect of the Interaction Between Overweight/Obesity and Dyslipidemia on the Risk of Hypertension in Tibetan Population Living in Tibet

  • 1.

    Department of Gerontology/Neurology, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China

  • 2.

    School of Medicine, Tibet University, Lhasa 850000, China

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    摘要
  • 摘要:   目的  探讨超重/肥胖与血脂异常可能的交互作用，为高血压患病风险与超重/肥胖、血脂异常交互作用提供一定的证据。  方法  采用多阶段分层整群随机抽样方法，在西藏阿里地区、那曲市和山南市随机抽取研究人群，共纳入了4047名数据完整的藏族居民为调查对象，通过问卷获取调查对象的相关信息，并进行身高、体质量指数、血压测量及采集空腹静脉血等。采用多因素逻辑回归模型分析超重/肥胖和血脂异常与高血压的独立效应，分层分析和相加交互作用模型评价两因素交互作用对高血压患病风险的影响。  结果  西藏地区藏族居民高血压、超重/肥胖和血脂异常的总患病率分别为29.3%、46.2%和40.9%，超重/肥胖〔比值比（OR）=2.151 〕和血脂异常（OR=1.240）是高血压患病的危险因素。相加交互效应评价结果显示超重/肥胖和血脂异常对高血压的加法交互作用有统计学意义（P=0.028），协同指数为1.318。  结论  超重/肥胖和血脂异常是高血压患病的危险因素，两因素间存在相加交互作用。
    Abstract:   Objective   To explore the possible interaction between overweight/obesity and dyslipidemia and to provide some evidence for the interaction of the risk of hypertension with overweight/obesity and dyslipidemia.   Methods   By using multi-stage stratified cluster random sampling method, the subjects of the study were randomly selected from Naqu city, Shannan city, and Ali prefecture, Tibet. A total of 4047 Tibetans with complete data were included. Investigators obtained relevant information on the subjects through questionnaire surveys, measured their height, body mass index, and blood pressure, and collected fasting venous blood samples. The multivariate logistic regression model was used to analyze the independent effects of overweight/obesity and dyslipidemia and hypertension. Stratified analysis and an additive interaction model were used to evaluate the effect of two-factor interaction on the risk of hypertension.   Results   The overall prevalence of hypertension, overweight/obesity, and dyslipidemia among Tibetans living in Tibet was 29.3%, 46.2%, and 40.9%, respectively. Overweight/obesity (odds ratio [OR]=2.151) and dyslipidemia (OR=1.240) were risk factors of hypertension. Evaluation results of the effect of additive interaction showed significant additive interaction of overweight/obesity and dyslipidemia on hypertension (P=0.028), with the synergy index (SI) being 1.318.   Conclusion   Overweight/obesity and dyslipidemia are risk factors for having hypertension and there is an additive interaction between dyslipidemia and overweight/obesity.
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  • 表  1  调查对象的基线特征

    Table  1.   Baseline data of the survey respondents

    VariableTotal/case or $ \bar x \pm s $ Hypertension/case (%) or $ \bar x \pm s $χ2/tP
    No (n=2861)Yes (n=1186)
    Sex 13.947 0.001
    　Men 1688 1140 (67.5) 548 (32.5)
    　Women 2359 1721 (73) 615 (27)
    Age/yr. 43.01±14.329 39.38±13.013 51.76±13.561 −26.737 <0.001
    Type of residence 0.933 0.818
    　Cities and towns 237 170 (71.7) 67 (28.3)
    　Rural area 2133 1515 (71.0) 618 (29.0)
    　Pasturing area 1437 1012 (70.4) 425 (29.6)
    　Farming and stockbreeding areas 240 164 (68.3) 76 (31.7)
    Highest education achieved 66.642 <0.001
    　Illiterate 2857 1935 (67.7) 922 (32.3)
    　Primary school 586 423 (72.2) 163 (27.8)
    　Junior middle school 231 192 (83.1) 39 (16.9)
    　Senior middle school 104 92 (88.5) 12 (11.5)
    　Vocational high school/technical school 37 27 (73) 10 (27)
    　Junior college 126 97 (77) 29 (23)
    　Bachelor degree or above 106 95 (89.6) 11 (10.4)
    Employment status 25.915 <0.001
    　Employed 1458 1076 (73.8) 382 (26.2)
    　Retired 125 84 (67.2) 41 (32.8)
    　Full-time equivalence 165 135 (81.8) 30 (18.2)
    　Unemployed 98 62 (63.3) 36 (36.7)
    Farmers/herdsmen 2201 1504 (68.3) 697 (31.7)
    Marital status 63.373 <0.001
    　Never married 523 428 (81.8) 95 (18.2)
    　Married 3418 2370 (69.3) 1048 (30.7)
    　Widowhood 43 33 (76.7) 10 (23.3)
    　Divorced 52 20 (38.5) 32 (61.5)
    　Other 11 10 (90.9) 1 (9.1)
    Annual gross income/CNY 1.848 0.870
    　<12000 1068 765 (71.6) 303 (28.4)
    　12000-19999 1409 983 (69.8) 426 (30.2)
    　20000-59999 1343 952 (70.9) 391 (29.1)
    　60000-99999 93 66 (71) 27 (29)
    　100000-200000 80 59 (73.8) 21 (26.3)
    　>200000 54 36 (66.7) 18 (33.3)
    Altitude 10.919 0.004
    　<4500 1483 1011 (68.2) 472 (31.8)
    　4500 1193 883 (74) 310 (26)
    　>4500 1371 967 (70.5) 404 (29.5)
    Low income 0.076 0.783
    　No 1152 818 (71) 334 (29)
    　Yes 2895 2043 (70.9) 852 (29.4)
    Insurance 0.016 0.900
    　No 125 89 (71.2) 36 (28.8)
    　Yes 3922 2772 (70.7) 1150 (29.3)
    Physical exercise 13.569 0.009
    　Almost never 2555 1772 (69.4) 783 (30.6)
    　<1 time/week 332 240 (72.3) 92 (27.7)
    　1-2 times/week 230 183 (79.6) 47 (20.4)
    　3-5 times/week 155 118 (76.1) 37 (23.9)
    　Almost daily 775 548 (70.7) 227 (29.3)
    Smoking 20.107 <0.001
    　No smoking 402 293 (72.9) 109 (27.1)
    　Quit smoking 174 97 (55.7) 77 (44.3)
    　Smoking 3471 2471 (71.2) 1000 (28.8)
    Drinking 8.795 0.012
    　No drinking 507 353 (69.6) 154 (30.4)
    　Quit drinking 157 95 (60.5) 62 (39.5)
    　Drinking 3383 2413 (71.3) 970 (28.7)
    SBP/mmHg 122.51±20.724 113.99±11.456 143.08±23.464 40.744 <0.001
    DBP/mmHg 80.53±13.417 74.76±8.459 94.45±12.942 48.171 <0.001
    TC/(mmol/L) 5.54±2.121 5.41±1.849 5.86±2.635 5.493 <0.001
    TG/(mmol/L) 1.08±0.770 1.01±0.715 1.25±0.864 8.601 <0.001
    HDL-C/(mmol/L) 1.65±0.560 1.66±0.600 1.63±0.590 1.178 0.239
    LDL-C/(mmol/L) 2.79±1.200 2.68±0.991 3.05±1.558 7.730 <0.001
    Hcy/(μmol/L) 21.40±10.490 20.69±10.170 23.10±11.04 6.460 <0.001
    Overweight/obesity 106.773 <0.001
    　No 2179 1748 (80.2) 431 (19.8)
    　Yes 1868 1113 (59.6) 755 (40.4)
    HHcy 41.465 <0.001
    　No 946 744 (79.1) 197 (20.9)
    　Yes 3101 2117 (68.2) 989 (31.8)
    Hyperglycemia 16.906 <0.001
    　No 3891 2773 (71.3) 1117 (28.7)
    　Yes 156 88 (56.1) 69 (43.9)
    Dyslipidemia 44.243 <0.001
    　No 2391 1785 (74.7) 606 (25.3)
    　Yes 1656 1076 (65) 580 (35)
    　SBP: systolic blood pressure; DBP: diastolic blood pressure; TC: total cholesterol; TG: triglyceride; HDL-C: high-density lipoproteincholesterol; LDL-C: low-density lipoproteincholesterol; HHcy: hyperhomocysteinemia. 1 mmHg=0.133 kPa.
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    表  2  超重/肥胖、血脂异常与高血压的关联分析

    Table  2.   Relationship between overweight/obesity and dyslipidemia and hypertension

    VariableModel 1Model 2Model 3
    OR (95% CI)POR (95% CI)POR (95% CI)P
    Overweight/obesity
    　No Ref Ref
    　Yes 2.751 (2.391, 3.165) <0.001 2.514 (2.165, 2.918) <0.001 2.151 (1.846, 2.506) <0.001
    Dyslipidemia
    　No Ref Ref
    　Yes 1.588 (1.385, 1.820) <0.001 1.330 (1.145, 1.544) <0.001 1.240 (1.063, 1.447) <0.001
    　Model 1 was not adjusted; Model 2 was adjusted for traditional risk factors such as age, gender, smoking, alcohol consumption, HHcy, dyslipidemia and hyperglycemia; Model was 3 fully adjusted for confounding factors such as age, gender, educational level, employment, marital status, altitude, smoking and drinking.
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    表  3  超重/肥胖、血脂异常对高血压的相加交互作用

    Table  3.   Interaction effect of overweight/obesity and dyslipidemia on hypertension

    Variable 1Variable 2Model 1 Model 2
    OR (95% CI)POR (95% CI)P
    Dyslipidemia Overweight/obesity
    No No Ref Ref
    Yes 1.8 (1.5, 2.3) <0.001 1.6 (1.3, 2.0) <0.001
    Yes No 3.2 (2.6, 3.9) <0.001 2.6 (2.1, 3.2) <0.001
    Yes 3.9 (3.3, 4.7) <0.001 3.9 (2.3, 3.6) <0.001
    P 0.004 0.028
    RERI 0.7 (0.140, 1.240)b
    API 0.179 (0.036, 0.318)b
    SI 1.318 (1.438, 2.571)b
    　Model 1 was not adjusted; Model 2 was fully adjusted for confounding factors, including age, sex, education, employment, marital status, altitude, smoking, and drinking; b all came from additive interaction.
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  • 收稿日期:  2022-10-12
  • 修回日期:  2023-04-21
  • 网络出版日期:  2023-05-20
  • 刊出日期:  2023-05-20

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