醫療從業人員以三酸甘油脂與高密度膽固醇之比值預測十年心血管疾病風險之探討

目的：根據世界衛生組織統計，心血管疾病為最常見的死亡原因，在2016年約有17.9百萬人死於心血管疾病，約占所有死亡人數的31％，造成心血管疾病的危險因子有很多，高血脂為重要的危險因子之一，本研究藉由分析北部某醫院員工的體檢資料，歸納出可能影響勞工心血管疾病風險的相關因子，並進一步探討三酸甘油脂與高密度膽固醇之比值與十年心血管疾病風險之相關性。方法：本研究為橫斷式研究，蒐集北部某醫院醫療從業人員的年度健檢報告，從民國103年到107年共收錄1312位員工，以佛萊明漢心血管危險預估分數（Framingham risk score，FRS）來預測十年心血管疾病風險，將員工分為低（FRS＜10％）、中（FRS：10～20％）、高（FRS≥20％）風險三組來比較其組內差異，以卡方檢定（chi square test）和單因子變異數分析（one-way Anova）來分析三組間的類別變項和連續變項的差異，其次利用皮爾森相關係數分析三酸甘油脂與高密度膽固醇之比值和佛萊明漢心血管危險預估分數的關係，最後以多變項邏輯斯迴歸（multivariate logistic regression）來分析三酸甘油脂與高密度膽固醇之比值是否為十年心血管疾病中高風險（FRS≥10％）的獨立危險因子。結果：本研究共有1312人納入分析，平均年齡為42.39±8.90歲，男性有501人（38.19％），結果發現不論是年齡、血壓、腰圍、身體質量指數BMI、總膽固醇、三酸甘油脂、高密度膽固醇、三酸甘油脂與高密度膽固醇之比值、空腹血糖、血清轉胺酶、性別、抽菸有無、高血壓史、糖尿病史、高血脂史在低風險族群（FRS＜10％）與中高風險族群（（FRS≥10％）有統計學上的顯著差異（P-value＜0.001）。佛萊明漢心血管危險預估分數和三酸甘油脂與高密度膽固醇之比值呈現中度正相關（皮爾森相關係數r＝0.43），在校正其他心血管危險因子後，三酸甘油脂與高密度膽固醇之比值的勝算比為1.18，95％信賴區間為1.04－1.34，p＝0.01。結論：本研究顯示三酸甘油脂與高密度膽固醇之比值為十年心血管疾病中高風險的獨立危險因子，因此在醫療從業人員健檢時，即使低密度膽固醇正常，仍然要考慮三酸甘油脂與高密度膽固醇之比值來評估心血管疾病之風險。

關鍵字

醫療從業人員；心血管疾病；佛萊明漢心血管危險預估分數；三酸甘油脂與高密度膽固醇之比值

並列摘要

Background and purpose: According to the World Health Organization, cardiovascular disease is the most common cause of death. In 2016, about 17.9 million people died of cardiovascular disease, accounting for 31% of all deaths. There are many risk factors for cardiovascular disease. Hyperlipidemia is one of the important risk factors. In this study, we collect the annual health checkup data of employees in Taoyuan hospital, and summarize the risk factors that may affect the risk of cardiovascular disease in labor. Furthermore, the purpose of this study is to explore the relationship between the ratio of triglyceride to high-density cholesterol and the risk of 10-years of cardiovascular disease. Method: This cross-sectional study included data of health-care employees annual health checkup data form one of northern Taiwan hospital between 2014 to 2018. The enrolled participate were divided into three groups including low, intermediate, and high cardiovascular risk factor by Framingham risk score. We used Chi-square test and one-way Anova to compare the demographic and clinical lab characteristics of the three groups. Pearson correlation was performed to analyze the relationship between the ratio of triglyceride to high-density cholesterol and the risk of 10-years of cardiovascular disease. Finally, we conducted the multivariable logistic regression analysis to establish relationship between the ratio of triglyceride to high-density cholesterol and equal or more 10% of Framingham risk score. Results and discussion: The total sample size is 1312 with an average age of 42.39±8.90 years and 501 men (38.19%). Demographic and clinical lab characteristics revealed that age, blood pressure, waist circumference, body mass index, total cholesterol, triglycerides, high-density cholesterol, the ratio of triglyceride to high-density cholesterol, fasting blood glucose, serum alanine aminotransferase, sex, smoking, history of hypertension, history of diabetes, and history of hyperlipidemia were significantly difference between three groups (p＜0.001). The Framingham risk score and the ratio of triglyceride to high density cholesterol showed a moderate positive correlation (Pearson correlation coefficient, r=0.43). Through multivariable logistic regression analysis, after adjusting the risk factors of cardiovascular risks, we still found the ratio of triglyceride to high-density cholesterol an independent risk factor in Framingham risk score intermediate to high group. (Adjusted odd ratio: 1.18, 95% confidence interval:1.04~1.34, p=0.01). Conclusion: This study shows that the ratio of triglyceride to high-density cholesterol is an independent risk factor for the risk of 10-year cardiovascular disease.

並列關鍵字

Health-Care Employees ； cardiovascular disease ； Framingham risk score ； the ratio of triglyceride to high-density cholesterol

國際替代計量

醫療從業人員以三酸甘油脂與高密度膽固醇之比值預測十年心血管疾病風險之探討

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