血浆动脉粥样硬化指数轨迹与衰弱前期进展为衰弱的相关性:一项基于社区人群的队列研究OA
Association between the trajectories of the atherogenic index of plasma and pre-frailty progression to frailty:A community-based cohort study
目的 探讨社区老年人群中血浆动脉粥样硬化指数(atherogenic index of plasma,AIP)的长期动态轨迹,并评估其与个体由衰弱前期进展为衰弱期的关联.方法 基于"昆山老龄化电子健康研究"队列的纵向数据,进行回顾性队列分析.研究纳入在2018-2020年被评估为衰弱前期且拥有3次有效年度体检记录,并在2021-2024年至少有1次体检记录的≥65岁老年人,采用增长混合模型(growth mixture modeling,GMM)识别2018-2020年的 AIP长期轨迹.主要结局为2021-2024年随访期间首次进展为衰弱.使用Cox比例风险回归模型分析不同 AIP轨迹组与衰弱进展风险的关系,并对性别、年龄等潜在混杂因素进行调整.同时,进行基于性别、年龄、共病状况的亚组分析.结果 共纳入16 637例衰弱前期老年人,年龄(76.14±5.92)岁,平均随访4.5年.GMM 识别出3条 AIP轨迹:中风险稳定型即中风险稳定组(39.7％)、低风险上升型即低风险上升组(39.9％)和高风险上升型即高风险上升组(20.4％).以中风险稳定组为参照,在调整年龄、性别、教育水平、吸烟及饮酒后,高风险上升组进展为衰弱的风险显著增加(HR=1.100,P=0.006).低风险上升组与衰弱进展关联无统计学意义.亚组分析显示,AIP高风险上升轨迹与衰弱进展的关联在≥65～<75岁(HR=1.128,P=0.024)、无脑卒中史(HR=1.122,P=0.003)、无心血管病史(HR=1.091,P=0.019)及有高血压病史(HR=1.094,P=0.015)的社区老年人群中表现最为显著.结论 在社区衰弱前期老年人群中,呈现高水平且持续上升的 AIP长期轨迹是进展为衰弱状态的独立危险因素.AIP轨迹,尤其是高风险上升型,可作为识别衰弱高风险亚组的有用指标.
Objective This study aimed to investigate the long-term dynamic trajectories of the atherogenic index of plasma(AIP)in a community-dwelling elderly population and assess their association with the risk of progression from pre-frailty to frailty.Methods A retrospective cohort analysis was conducted using longitudinal data from the"Kunshan Aging Research with E-health"(KARE)cohort.Community-dwelling elderly adults aged≥65 years who were assessed as pre-frail between 2018 and 2020,had three valid annual health check-up records,and had at least one health check-up record between 2021 and 2024.Growth Mixture Modeling(GMM)was employed to identify distinct long-term AIP trajectories over the 2018-2020 period.The primary outcome was the first occurrence of frailty during the follow-up from 2021 to 2024.Cox proportional hazards regression models were used to analyze the relationship between different AIP trajectory groups and the risk of frailty progression,adjusting for potential confounders such as age and sex.Subgroup analyses were also performed based on sex,age,education and comorbidities.Results A total of 16 637 pre-frail elderly adults were included,with an age of(76.14±5.92)years,and a mean follow-up of 4.5 years.GMM identified three distinct AIP trajectories:moderate-risk stable(39.7％),low-risk rising(39.9％),and high-risk rising(20.4％).Compared with the moderate-risk stable group,the high-risk ascending group showed a significantly increased risk of progression to frailty after adjusting for age,sex,education level,smoking,and alcohol consumption(HR=1.100,P=0.006).The low-risk rising group showed no significant association with frailty progression.Subgroup analysis revealed that the association between high-risk AIP trajectories and frailty progression was strongest in the≥65-<75 age group(HR=1.128,P=0.024),among individuals without a history of stroke(HR=1.122,P=0.003),no history of cardiovascular disease(HR=1.091,P=0.019),and a history of hypertension(HR=1.094,P=0.015).Conclusions Among community-dwelling pre-frail elderly adults,a long-term trajectory characterized by high and persistently rising AIP levels is an independent risk factor for progression to frailty.AIP trajectories,particularly the high-risk rising pattern,can serve as a useful indicator for identifying high-risk subgroups.
颜丹娜;顾浩宇;赵梦杰;李羽佳;张菁璐;潘颖
江苏大学附属昆山医院全科医学科,江苏 苏州 215300江苏大学附属昆山医院全科医学科,江苏 苏州 215300江苏大学附属昆山医院全科医学科,江苏 苏州 215300昆山市第一人民医院全科医学科,江苏 苏州 215300江苏大学附属昆山医院全科医学科,江苏 苏州 215300江苏大学附属昆山医院全科医学科,江苏 苏州 215300
血浆动脉粥样硬化指数衰弱衰弱前期老年人轨迹
Atherogenic index of plasmaFrailtyPre-frailtyElderlyTrajectory
《中国医学前沿杂志（电子版）》 2026 (4)
41-48,8
苏州市临床试验机构能力提升项目(SLT2023019)姑苏卫生人才计划人才科研项目(GSWS2022106)中央高水平医院临床科研项目(BJ2024144) Suzhou Clinical Trial Institution Capacity Enhancement Project(SLT2023019)Gusu Health Talent Program Scientific Research Project(GSWS2022106)Central High-Level Hospital Clinical Research Project(BJ2024144)
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