家族遺傳性血脂異常病人心血管代謝風險之世代研究

中文摘要研究之重要性：家族遺傳性血脂異常的病人由於脂蛋白受體異常，會使總膽固醇及低密度脂蛋白異常升高。若未經治療及持續控制，將有相當高的機率於成年早期發生早發性心血管疾病，甚至死亡。臨床治療以藥物控制脂質濃度，但非藥物治療之相關因子及生活型態對於心血管代謝的風險仍急待探討。研究目的：探討血脂異常病人生活型態、身體組成、血糖、血脂之間的關聯性，以深入瞭解生活習慣與心血管代謝風險的影響。研究方法：本研究設計為回溯式世代追蹤研究，採用病歷回顧法合併問卷資料分析，針對2012年至2016年間，曾於北部高血脂門診就診並被診斷為家族遺傳性血脂異常之病人，蒐集其人口學資料、相關疾病確診時間、血液生化檢驗結果、身體組成測量值，以及過去生活型態調查，進行資料收集及登錄建檔，以描述性統計、邏輯斯迴歸及存活分析等方法進行分析。研究結果：本研究共納入336位家族遺傳性血脂異常病人，包括125位男性及211位女性，平均年齡分別為53.04（±12.95）歲、61.47（±11.65）歲。本研究共81位病人發生心血管疾病事件，佔24.1％。心血管疾病風險之多變項迴歸分析結果，共五個變項有統計顯著的勝算比：年齡（AOR：1.05，95％ Cl：1.03-1.08）、男性（AOR：3.26、95％ Cl：1.71-6.13）、糖尿病（AOR：2.52、95％ Cl：1.32-4.80）、睡眠困難（AOR：2.17，95％ Cl：1.22-3.87）等，劇有統計顯著性（p<0.05）；而運動習慣則是有統計顯著的保護效果（AOR：0.41，95％ Cl：0.23-0.74）。本研究亦發現合併肌少症的病人有較高的心血管疾病風險，調整後的勝算比為2.23（95％ Cl：1.03-4.80）。本研究家族遺傳性血脂異常病人在確診後共75人被診斷第二型糖尿病，佔22.3％。進一步針對第二型糖尿病之危險因子進行多變項迴歸分析，男性勝算比2.85（95％ Cl：1.29-6.33）、高三酸甘油酯濃度1.01（95％ Cl：1.00-1.01）、高密度脂蛋白濃度0.97（95％ Cl：0.94-0.99）、高血壓3.24（95％ Cl：1.61-6.56）、習慣飲酒0.06（95％ Cl：0.01-0.37）。以高密度脂蛋白和飲酒習慣具有保護此類病人避免罹患第二型糖尿病的效果。而嚴重肥胖者和高腰圍合併高三酸甘油酯者亦有較高之風險，在多變項模型中分別為2.21（95％ Cl：1.14-4.27）、2.93（95％ Cl：1.05-8.12）。結論：本研究針對家族遺傳性血脂異常病人，分析其心血管代謝疾病之風險因子，包括心血管疾病和第二型糖尿病。生活習慣和身體組成都與此類病人心血管代謝疾病風險相關。因此，臨床人員面對此類病人時，除了降血脂藥物的使用，更應注意身體組成的檢測，以及生活型態的衛教。

關鍵字

家族遺傳性血脂異常；心血管代謝風險

並列摘要

Background: Patients with familial hyperlipidemia (FH) showed significantly increased level of plasma total cholesterol and low-density lipoprotein because of the abnormality of low-density lipoprotein receptor (LDLR). Therefore, they may experience cardiovascular morbidity and mortality at a young age if not being well treated. Because of the treatment strategy for FH patients is focusing on the lipid-lowering drug, other cardiometabolic risk factors and their relationship between cardiometabolic disease still remain unknown. Objective: The study aims to identify risk factors for cardiometabolic disease for FH patients. Therefore, the relationship between lifestyle, body composition, blood sugar, lippoprotein and cardiometabolic risk for FH patients were examined. Method: We conducted a retrospective cohort-study in between 2012-2016 who had been diagnosed with FH by clinical lipid specialist. The data collection were using chart review and self-report questionnaire, including (1)basic demography, (2)diagnostic time for related diseases (3)baseline and the latest clinical measurements, (4) anthropometric characteristics and body composition, and (5) questionnaire survey for lifestyles. Results: During the follow-up, 336 adult patients were enrolled, including 125 males and 211 females (mean age was 53.04±12.95 in men, 61.47±11.65 in women). There were 81(24.1%) patients suffered from cardiovascular events. Factors which statistically significant associated with cardiovascular event regard to multi-variable logistic model were: age (AOR: 1.05, 95%Cl: 1.03-1.08), male (AOR: 3.26, 95%Cl: 1.71-6.13), diabetes (AOR: 2.52, 95%Cl: 1.32-4.80), sleep difficulty (AOR: 2.17, 95%Cl: 1.22-3.87), habitual exercise (AOR: 0.41, 95%Cl: 0.23-0.74). Additionally, patients combined with FH and sarcopenia had the higher risk of developing cardiovascular event than those did not, the adjusted odds ratio was 2.23(95％ Cl：1.03-4.80). There were 75(22.3%) patients were diagnosed with type Ⅱ diabetes mellitus. Factors associated with diabetes in FH patients under multi-variable logistic model were: male (AOR: 2.85, 95%Cl: 1.29-6.33), latest triglyceride (AOR: 1.01, 95%Cl: 1.00-1.01), latest HDL-C (AOR: 0.97, 95%Cl: 0.94-0.99), hypertension (AOR: 3.24, 95%Cl: 1.61-6.56), alcohol consumption (AOR: 0.05, 95%Cl: 0.01-0.37). Finally, when it comes to anthropometric characteristics and body composition, our finding suggested that FH patients with BMI≥30kg/m2 or high triglyceride combined with high waist circumference (HTGWC) may indicate a 3-fold (AOR: 2.93, 95%Cl: 1.05-8.12) and 2-fold (AOR: 2.21, 95%Cl: 1.14-4.27) serious risk of diabetes. Conclusions: Our study revealed the relationship between cardiometabolic risk factors and cardiometabolic disease in FH patients. In FH individuals, there were still a lot of cardiometabolic risk factors other than high LDL-C. In order to improve the morbidity and mortality of FH patients, clinical staff should be aware of those factors to minimize the occurrence of cardiometabolic disease.

並列關鍵字

Familial Hyperlipidemia ； Cardiometabolic Risks

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