血浆致动脉粥样硬化指数和高敏C反应蛋白在心血管疾病中的作用

The Role of AIP and hs-CRP in Cardiovascular Disease

摘要: 背景：高敏C反应蛋白(hs-CRP)、血浆致动脉粥样硬化指数(AIP)在心血管疾病(CVD)的发生发展中起重要作用，但两者在CVD发生中的关系尚不明确。本文探讨了hs-CRP联合AIP与CVD发生的关系及hs-CRP和AIP之间的关系。方法：本研究为前瞻性队列研究，样本来自2011~2012年中国健康与退休纵向研究的9845个样本，根据hs-CRP的临床切点(<1 mg/L, 1~3 mg/L, >3 mg/L)将参与者分为低、中、高炎症风险组；根据AIP的四分位数(Q1~Q4)将参与者分为4组，各组例数分别为2218、1925、2284、3418例，通过Cox比例风险模型、Kaplan-Meier分析计算hs-CRP、AIP与CVD、心脏病和中风风险之间的关联。使用交互分析和中介分析评估AIP与hs-CRP的关系。结果：Cox比例风险回归模型显示，hs-CRP和AIP均与CVD、心脏病(HD)和中风发病风险增加独立相关。与高hs-CRP风险组(>3 mg/L)相比，低hs-CRP风险组(<1 mg/L)参与者发生CVD (HR: 0.70, 95% CI: 0.63~0.77)、HD (HR: 0.75, 95% CI: 0.66~0.84)和中风(HR: 0.59, 95% CI: 0.49~0.72)的风险显著降低；低AIP (Q1)个体相对高AIP (Q4)个体，CVD风险降低(HR: 0.74, 95% CI: 0.67~0.83)、HD (HR: 0.75, 95% CI: 0.67 ~ 0.85)和中风(HR: 0.67, 95% CI: 0.56~0.81)风险降低。联合分层分析中，高hs-CRP风险组且高AIP组CVD风险显著增高(HR: 1.77, 95% CI: 1.54~2.05)。交互分析表明hs-CRP和AIP之间无交互作用；中介分析显示无显著中介效应。结论：hs-CRP和AIP均与CVD、HD和中风发病独立相关，高值会增加发病风险，且二者在预测CVD风险方面呈平行关系，各自独立发挥作用。AIP结合hs-CRP可更准确地评估动脉粥样硬化程度，识别高危CVD人群。

Abstract: Background: High-sensitivity C-reactive protein (hs-CRP) and plasma atherogenic index (AIP) play an important role in the occurrence and progression of cardiovascular disease (CVD), but the relationship between the two in the occurrence of CVD remains unclear. This paper discusses the relationship between hs-CRP combined with AIP and CVD and the relationship between hs-CRP and AIP. Methods: The sample consisted of 9,845 participants from the 2011~2012 China Health and Retirement Longitudinal Study. Based on clinical cut-off points for hs-CRP (<1 mg/L, 1~3 mg/L, >3 mg/L), participants were categorized into low-, medium-, and high-inflammatory risk groups. According to quartiles of AIP (Q1~Q4), participants were divided into four groups, with group sizes of 2218, 1925, 2284, and 3418, respectively. Cox proportional hazards models and Kaplan-Meier analysis were used to evaluate the associations of hs-CRP and AIP with the risk of CVD, heart disease, and stroke. Interaction and mediation analyses were conducted to assess the relationship between AIP and hs-CRP. Results: Results from the Cox proportional hazards regression models showed that both hs-CRP and AIP were independently associated with an increased risk of CVD, heart disease (HD), and stroke. Compared with the high hs-CRP risk group (>3 mg/L), participants in the low hs-CRP risk group (<1 mg/L) had a significantly lower risk of CVD (HR: 0.70, 95% CI: 0.63~0.77), HD (HR: 0.75, 95% CI: 0.66~0.84), and stroke (HR: 0.59, 95% CI: 0.49~0.72). Similarly, individuals with low AIP had a reduced risk of CVD (HR: 0.74, 95% CI: 0.67~0.83), HD (HR: 0.75, 95% CI: 0.67~0.85), and stroke (HR: 0.67, 95% CI: 0.56~0.81) compared to those with high AIP. In the combined stratified analysis, the group with both high hs-CRP and high AIP showed a significantly increased risk of CVD (HR: 1.77, 95% CI: 1.54~2.05). Interaction analysis indicated no interaction between hs-CRP and AIP, and mediation analysis revealed no significant mediating effect. Conclusion: Both hs-CRP and AIP are independently associated with the incidence of CVD, HD, and stroke, with higher levels increasing the risk. They appear to operate in parallel when predicting CVD risk, each acting independently. Combining AIP with hs-CRP can more accurately assess the degree of atherosclerosis and help identify high-risk CVD populations.