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[早期缺血性心脏病患者子女高甘油三酯血症的自身及父母预测因素]

[Own and Parental Predictors of Hypertriglyceridemia in Children of Persons with Early Ischemic Heart Disease].

作者信息

Konnov M V, Deev A D

机构信息

Federal Scientific-Clinical Center of Physico-Chemical Medicine.

Federal State Institution National Research Center for Preventive Medicine.

出版信息

Kardiologiia. 2019 Jul 18;59(7):11-18. doi: 10.18087/cardio.2019.7.10266.

Abstract

AIM

to elucidate predictors of high level of basal triglycerides (TG) in blood of children of persons with early (onset: men ≤55, women ≤60 years) ischemic heart disease (EIHD).

MATERIALS AND METHODS

We examined 316 families: patients (probands) (n=295; 77.9 % after MI) with EIHD, their spouses (n=219; 83.1 % women) and native children of probands (n=413; 55.7 % men) aged 5-38 years. In children aged 5-17 and 18-38 years proband's spouse was mother in 88 and 77 % of cases, respectively. Hypertriglyceridemia in children (HTG) was defined in persons aged 5-17 years as ≥90 percentile (Lipid Research Clinics), ≥18 years - ≥1.7 mmol / l or HTG drug treatment. Predictors of HTG were selected by binary logistical regression with adjustment for age, sex and drugs.

RESULTS

HTG was found in 31 / 158 children aged 5-17 years. Its independent predictors were systolic arterial pressure (odds ratio [OR] of top [>108] vs. two bottom [≤108 mm Hg] tertiles 3.85, 95 % confidence interval [CI] 1.38-10.7, р=0.010), heart rate (HR, OR of top [>78] vs. two bottom [≤78 bpm] tertiles 2.94, 95 % CI 1.20-7.23, р=0.019), and high density lipoprotein cholesterol (HDL-C, OR 0.35, 95 % CI 0.13-0.94; р=0.038) of their children; HR (OR of top [>72] vs. two bottom [≤72 bpm] tertiles 3.56, 95 % CI 1.38-9.11, р=0.008), low density lipoprotein cholesterol (OR 2.49, 95 % CI 1.12-5.52, p=0.025]), and type 2 diabetes (OR 25.9, 95 % CI 1.01-665.3; p=0.049) of the parent - proband's consort. HTG was found in 35 / 255 children aged 18-38 years and was associated with own age (OR 1.10, 95 % CI 1.02-1.19, р=0.012) and male sex (OR 6.21, 95 % CI 2.45-15.8; р=0.000). HTG was independently associated with body mass index (OR top [>25.4] vs. two bottom [≤25.4 kg / m2] tertiles 4.94, 95 % CI 2.13-11.4, р=0.000); basal glycemia (OR top [5.1] vs. two bottom [≤5.1 mmol / l] tertiles 2.52, 95 % CI 1.17-5.43, р=0.019); HDL-C (OR 0.17, CI 0.04-0.81, 0.027); alcohol consumption (OR consuming more than once vs. once a week and less 2.27, 95 % CI 1.02-5.02, p=0.044) of these children; HDL-C (OR 0.19, 95 CI 0.04-0.94; p=0.041) of the proband-parent.

CONCLUSIONS

HTG in children aged 5-38 years with parental early IHD was independently associated mainly with own characteristics, forming components of metabolic syndrome. Attention should be paid to the dominance of maternal transmission in children and adolescents (age group 5-17 years).

摘要

目的

阐明患有早发性(发病年龄:男性≤55岁,女性≤60岁)缺血性心脏病(EIHD)患者子女血液中基础甘油三酯(TG)水平较高的预测因素。

材料与方法

我们研究了316个家庭:患有EIHD的患者(先证者)(n = 295;心肌梗死后占77.9%)、他们的配偶(n = 219;女性占83.1%)以及先证者5 - 38岁的亲生子女(n = 413;男性占55.7%)。在5 - 17岁和18 - 38岁的儿童中,先证者的配偶分别在88%和77%的情况下是母亲。儿童高甘油三酯血症(HTG)在5 - 17岁人群中定义为≥第90百分位数(脂质研究诊所标准),≥18岁为≥1.7 mmol / l或接受HTG药物治疗。通过二元逻辑回归并对年龄、性别和药物进行调整来选择HTG的预测因素。

结果

在158名5 - 17岁儿童中发现31例HTG。其独立预测因素为儿童的收缩压(最高[>108]与两个较低[≤108 mmHg]三分位数相比的比值比[OR]为3.85,95%置信区间[CI]为1.38 - 10.7,p = 0.010)、心率(HR,最高[>78]与两个较低[≤78次/分钟]三分位数相比的OR为2.94,95% CI为1.20 - 7.23,p = 0.019)以及高密度脂蛋白胆固醇(HDL - C,OR为0.35,95% CI为0.13 - 0.94;p = 0.038);先证者配偶的HR(最高[>72]与两个较低[≤72次/分钟]三分位数相比的OR为3.56,95% CI为1.38 - 9.11,p = 0.008)、低密度脂蛋白胆固醇(OR为2.49,95% CI为1.12 - 5.52,p = 0.025])以及2型糖尿病(OR为25.9,95% CI为1.01 - 665.3;p = 0.049)。在255名18 - 38岁儿童中发现35例HTG,其与儿童自身年龄(OR为1.10,95% CI为1.02 - 1.19,p = 0.012)和男性性别(OR为6.21,95% CI为2.45 - 15.8;p = 0.000)相关。HTG与这些儿童的体重指数(最高[>25.4]与两个较低[≤25.4 kg / m²]三分位数相比的OR为4.94,95% CI为2.13 - 11.4,p = 0.000)、基础血糖(最高[5.1]与两个较低[≤5.1 mmol / l]三分位数相比的OR为2.52,95% CI为1.17 - 5.43,p = 0.019)、HDL - C(OR为0.17,CI为0.04 - 0.81,0.027)、饮酒量(每周饮酒超过一次与每周一次及更少相比的OR为2.27,95% CI为1.02 - 5.02,p = 0.044)独立相关;与先证者父母的HDL - C(OR为0.19,95 CI为0.04 - 0.94;p = 0.041)相关。

结论

父母患有早发性缺血性心脏病的5 - 38岁儿童的HTG主要与自身特征独立相关,这些特征构成代谢综合征的组成部分。应关注儿童和青少年(5 - 17岁年龄组)中母系遗传的主导性。

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