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Article(id=1240413925892747531, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202503303, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1742227200000, receivedDateStr=2025-03-18, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773667325708, onlineDateStr=2026-03-16, pubDate=1754755200000, pubDateStr=2025-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773667325708, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773667325708, creator=13701087609, updateTime=1773667325708, updator=13701087609, issue=Issue{id=1240413921266429979, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='15', pageStart='2689', pageEnd='2880', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1773667324606, creator=13701087609, updateTime=1773667356299, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240414054267802325, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240414054267802326, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240413921266429979, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2737, endPage=2742, ext={EN=ArticleExt(id=1240413926165377323, articleId=1240413925892747531, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Association between serum triglyceride to high-density lipoprotein cholesterol ratio and incident hypertension in middle-aged and elderly Chinese adults, columnId=1240413921954295836, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the association between the ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) and the incidence of hypertension in middle-aged and elderly Chinese adults, and to provide a reference for the development of hypertension intervention strategies.

Methods

This study included 6 231 participants from the baseline and 2015 follow-up data of the China Health and Retirement Longitudinal Study (CHARLS). Logistic regression models were used to analyze the relationship between the TG/HDL-C ratio and the prevalence of hypertension in middle-aged and elderly populations. After excluding individuals diagnosed with hypertension before 2015, the cumulative TG/HDL-C ratio was calculated, and logistic regression models were employed to analyze the relationship between the cumulative TG/HDL-C ratio and the incidence of hypertension. Additionally, restricted cubic spline (RCS) models were used to fit the dose-response relationship between the cumulative TG/HDL-C ratio and the risk of hypertension in middle-aged and elderly populations.

Results

From 2011 to 2015, 2 438 individuals (39.13%) were diagnosed with hypertension, and in 2015, 625 individuals (16.48%) developed hypertension. Logistic regression analysis revealed that an elevated TG/HDL-C ratio was significantly associated with an increased risk of hypertension (OR=1.02, 95% CI: 1.02-1.03). The highest quartile of the TG/HDL-C ratio was identified as a risk factor for hypertension (OR=1.34，95% CI：1.02-1.74). Furthermore, a linear association was observed between the cumulative TG/HDL-C ratio and the incidence of hypertension (P-nonlinear=0.232).

Conclusion

An elevated TG/HDL-C ratio is a risk factor for hypertension in middle-aged and elderly Chinese adults.

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目的

探讨中国中老年人群三酰甘油和高密度脂蛋白胆固醇（triglycerides/high-density lipoprotein cholesterol，TG/HDL-C）比值与高血压发生的关联，为制定高血压的干预措施提供参考依据。

方法

本研究纳入6 231名参与中国健康与养老追踪调查（CHARLS）基线数据和2015年随访数据的调查者，采用logistic回归模型分析中老年人群TG/HDL-C比值与高血压患病的关系。排除2015年前患有高血压的人群后，计算TG/HDL-C累积比值并采用logistic回归模型分析中老年人群TG/HDL-C累积比值与高血压发病的关系，并采用限制性立方样条模型拟合TG/HDL-C累积比值与中老年人群高血压发生风险的剂量反应关系。

结果

2011—2015年高血压患病人数为2 438人（39.13%），2015年高血压发病人数为625人（16.48%）。Logistic回归分析结果显示，TG/HDL-C比值升高与高血压的患病风险增加密切相关（OR=1.02，95%CI：1.02 ~ 1.03）；TG/HDL-C最高四分位数组是高血压发病的风险因素（OR=1.34，95%CI：1.02 ~ 1.74）；TG/HDL-C累积比值与高血压发生情况呈线性关联（P- nonlinear = 0.232）。

结论

TG/HDL-C比值升高是中国中老年人群高血压发病的危险因素。

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贾思艳，E-mail:
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=4/yaoYOh1WzILGOcbMM7tg==, magXml=rfDnxwhR0Vl6iVcsq2aCkA==, pdfUrl=null, pdf=nZZKddeLicK4148+7GTCnQ==, pdfFileSize=626704, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=kMkEI8IBEmbFggN3iWmRZA==, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=oLMbWAFb4ixA/ItHRvo0gQ==, mapNumber=null, authorCompany=null, fund=null, authors=

刘念（1987—），女，硕士，医师，研究方向：流行病与统计学

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J Am Nutr Assoc, 2025, 10: 1-11., articleTitle=Metabolic status and hypertension: the impact of insulin Resistance-Related indices on blood pressure regulation and hypertension risk, refAbstract=null)], funds=[Fund(id=1240424349010817447, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413925892747531, awardId=20240104, language=CN, fundingSource=四川省妇幼保健院2024年院内科技创新基金重点项目(20240104), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1240424344652935421, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413925892747531, xref=1., ext=[AuthorCompanyExt(id=1240424344657129726, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413925892747531, companyId=1240424344652935421, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Department of Hospital Infection Control, The People's Hospital of Deyang, Deyang, Sichuan 618000, China), AuthorCompanyExt(id=1240424344665518336, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413925892747531, companyId=1240424344652935421, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.德阳市人民医院 医院感染管理科，四川 德阳 618000)]), AuthorCompany(id=1240424344741015811, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413925892747531, xref=2., ext=[AuthorCompanyExt(id=1240424344745210116, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413925892747531, companyId=1240424344741015811, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.四川省妇女儿童医院/成都医学院附属妇女儿童医院 妇幼健康管理部，四川 成都 610000)])], figs=[ArticleFig(id=1240424347920298339, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413925892747531, language=EN, label=Figure 1, caption=Dose-response relationship between cumulative TG/HDL-C ratio and risk of hypertension, figureFileSmall=kc5YNTNXbbpOaKpYSdgMqg==, figureFileBig=WKGMxGPoVwSrc9ls2CWang==, tableContent=null), ArticleFig(id=1240424348062904684, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413925892747531, language=CN, label=图1, caption=TG/HDL-C累积比值与高血压发病风险的剂量反应关系

注：调整协变量性别、年龄、教育程度、婚姻状况、吸烟情况、饮酒情况、是否糖尿病、BMI、总胆固醇、低密度脂蛋白。

, figureFileSmall=kc5YNTNXbbpOaKpYSdgMqg==, figureFileBig=WKGMxGPoVwSrc9ls2CWang==, tableContent=null), ArticleFig(id=1240424348176150902, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413925892747531, language=EN, label=Table 1, caption=

Comparison of baseline characteristics of participants ［M（），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量非高血压（n=3 793）高血压（n=2 438）F/χ2值P值
年龄(岁）57.00 (51.00±63.00)61.00 (55.00±67.75)293.749<0.001
性别4.2850.038
男性1 774 (46.77)1 075 (44.09)
女性2 019 (53.23)1 363 (55.91)
婚姻状况73.096<0.001
已婚3 466 (91.38)2 056 (84.33)
其他327 (8.62)382 (15.67)
教育程度28.160<0.001
小学2 603 (68.63)1 825 (74.85)
高中822 (21.67)429 (17.60)
大专以上368 (9.70)184 (7.55)
吸烟情况0.6530.419
是1 470 (38.76)920 (37.74)
否2 323 (61.24)1 518 (62.26)
饮酒情况20.060<0.001
是1 313 (34.62)712 (29.20)
否2 480 (65.38)1 726 (70.80)
糖尿病患病情况106.286<0.001
是469 (12.36)542 (22.23)
否3 324 (87.64)1 896 (77.77)
BMI（kg/m2）22.62 (20.55±24.88)24.35 (21.92±27.07)321.121<0.001
总胆固醇（mg/dl）188.66 (165.08±212.24)193.69 (170.49±221.14)41.730<0.001
低密度脂蛋白（mg/dl）112.50 (92.40±134.92)116.37 (94.33±141.11)14.125<0.001
TG/HDL-C比值1.93 (1.23±3.25)2.49 (1.49±4.30)143.745<0.001
TG/HDL-C比值分组146.259<0.001
Q1组1 101 (29.03)474 (19.44)
Q2组1 010 (26.63)538 (22.07)
Q3组904 (23.83)653 (26.78)
Q4组778 (20.51)773 (31.71)
TG/HDL-C累积比值6.49 (4.38±10.18)8.00 (5.26±12.72)143.773<0.001
TG/HDL-C累积比值分组137.477<0.001
Q1组1 104 (29.11)472 (19.36)
Q2组1 014 (26.73)547 (22.44)
Q3组881 (23.23)660 (27.07)
Q4组794 (20.93)759 (31.13)
), ArticleFig(id=1240424348306174336, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413925892747531, language=CN, label=表1, caption=

基线人群特征比较［M（），n（%）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量非高血压（n=3 793）高血压（n=2 438）F/χ2值P值
年龄(岁）57.00 (51.00±63.00)61.00 (55.00±67.75)293.749<0.001
性别4.2850.038
男性1 774 (46.77)1 075 (44.09)
女性2 019 (53.23)1 363 (55.91)
婚姻状况73.096<0.001
已婚3 466 (91.38)2 056 (84.33)
其他327 (8.62)382 (15.67)
教育程度28.160<0.001
小学2 603 (68.63)1 825 (74.85)
高中822 (21.67)429 (17.60)
大专以上368 (9.70)184 (7.55)
吸烟情况0.6530.419
是1 470 (38.76)920 (37.74)
否2 323 (61.24)1 518 (62.26)
饮酒情况20.060<0.001
是1 313 (34.62)712 (29.20)
否2 480 (65.38)1 726 (70.80)
糖尿病患病情况106.286<0.001
是469 (12.36)542 (22.23)
否3 324 (87.64)1 896 (77.77)
BMI（kg/m2）22.62 (20.55±24.88)24.35 (21.92±27.07)321.121<0.001
总胆固醇（mg/dl）188.66 (165.08±212.24)193.69 (170.49±221.14)41.730<0.001
低密度脂蛋白（mg/dl）112.50 (92.40±134.92)116.37 (94.33±141.11)14.125<0.001
TG/HDL-C比值1.93 (1.23±3.25)2.49 (1.49±4.30)143.745<0.001
TG/HDL-C比值分组146.259<0.001
Q1组1 101 (29.03)474 (19.44)
Q2组1 010 (26.63)538 (22.07)
Q3组904 (23.83)653 (26.78)
Q4组778 (20.51)773 (31.71)
TG/HDL-C累积比值6.49 (4.38±10.18)8.00 (5.26±12.72)143.773<0.001
TG/HDL-C累积比值分组137.477<0.001
Q1组1 104 (29.11)472 (19.36)
Q2组1 014 (26.73)547 (22.44)
Q3组881 (23.23)660 (27.07)
Q4组794 (20.93)759 (31.13)
), ArticleFig(id=1240424348503306632, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413925892747531, language=EN, label=Table 2, caption=

Analysis of the association between TG/HDL-C ratio and hypertension prevalence

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2
OR (95%CI)P值OR (95%CI)P值
TG/HDL-C1.01 (1.01 ~ 1.01)<0.0011.03 (1.02 ~ 1.03)<0.001
TG/HDL-C比值分组(ref:Q1组)
Q2组1.24 (1.06 ~ 1.44)0.0051.09 (0.93 ~ 1.29)0.281
Q3组1.68 (1.46 ~ 1.96)<0.0011.29 (1.09 ~ 1.51)0.002
Q4组2.30 (1.99 ~ 2.67)<0.0011.40 (1.18 ~ 1.66)<0.001
P for trend<0.001<0.001
), ArticleFig(id=1240424348616552845, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413925892747531, language=CN, label=表2, caption=

TG/HDL-C比值与高血压患病情况分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2
OR (95%CI)P值OR (95%CI)P值
TG/HDL-C1.01 (1.01 ~ 1.01)<0.0011.03 (1.02 ~ 1.03)<0.001
TG/HDL-C比值分组(ref:Q1组)
Q2组1.24 (1.06 ~ 1.44)0.0051.09 (0.93 ~ 1.29)0.281
Q3组1.68 (1.46 ~ 1.96)<0.0011.29 (1.09 ~ 1.51)0.002
Q4组2.30 (1.99 ~ 2.67)<0.0011.40 (1.18 ~ 1.66)<0.001
P for trend<0.001<0.001
), ArticleFig(id=1240424348704633234, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413925892747531, language=EN, label=Table 3, caption=

Analysis of the association between cumulative TG/HDL-C ratio and hypertension prevalence

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2
OR (95%CI)P值OR (95%CI)P值
TG/HDL-C累积比值1.00 (1.00 ~ 1.00)0.1091.00 (1.00 ~ 1.00)0.639
TG/HDL-C累积比值分组(ref:Q1组)
Q2组1.21(0.95 ~ 1.53)0.1201.23 (0.97 ~ 1.57)0.093
Q3组1.22 (0.95 ~ 1.55)0.1181.20 (0.93 ~ 1.55)0.156
Q4组1.51 (1.18 ~ 1.93)0.0011.34 (1.02 ~ 1.74)0.033
P for trend0.0160.051
), ArticleFig(id=1240424348775936407, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240413925892747531, language=CN, label=表3, caption=

TG/HDL-C累积比值与高血压患病情况分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量模型1模型2
OR (95%CI)P值OR (95%CI)P值
TG/HDL-C累积比值1.00 (1.00 ~ 1.00)0.1091.00 (1.00 ~ 1.00)0.639
TG/HDL-C累积比值分组(ref:Q1组)
Q2组1.21(0.95 ~ 1.53)0.1201.23 (0.97 ~ 1.57)0.093
Q3组1.22 (0.95 ~ 1.55)0.1181.20 (0.93 ~ 1.55)0.156
Q4组1.51 (1.18 ~ 1.93)0.0011.34 (1.02 ~ 1.74)0.033
P for trend0.0160.051
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中国中老年人血清三酰甘油/高密度脂蛋白胆固醇比值与高血压发生的关联性研究
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刘念 1 , 贾思艳 2
现代预防医学 | 流行病与统计方法 2025,52(15): 2737-2742
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现代预防医学 | 流行病与统计方法 2025, 52(15): 2737-2742
中国中老年人血清三酰甘油/高密度脂蛋白胆固醇比值与高血压发生的关联性研究
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刘念1, 贾思艳2
作者信息
  • 1.德阳市人民医院 医院感染管理科，四川 德阳 618000
  • 2.四川省妇女儿童医院/成都医学院附属妇女儿童医院 妇幼健康管理部，四川 成都 610000

    • 刘念（1987—），女，硕士，医师，研究方向：流行病与统计学

通讯作者:

贾思艳，E-mail:
Association between serum triglyceride to high-density lipoprotein cholesterol ratio and incident hypertension in middle-aged and elderly Chinese adults
Nian LIU1, Si-yan JIA2
Affiliations
  • Department of Hospital Infection Control, The People's Hospital of Deyang, Deyang, Sichuan 618000, China
出版时间: 2025-08-10 doi: 10.20043/j.cnki.MPM.202503303
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摘要
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目的

探讨中国中老年人群三酰甘油和高密度脂蛋白胆固醇（triglycerides/high-density lipoprotein cholesterol，TG/HDL-C）比值与高血压发生的关联，为制定高血压的干预措施提供参考依据。

方法

本研究纳入6 231名参与中国健康与养老追踪调查（CHARLS）基线数据和2015年随访数据的调查者，采用logistic回归模型分析中老年人群TG/HDL-C比值与高血压患病的关系。排除2015年前患有高血压的人群后，计算TG/HDL-C累积比值并采用logistic回归模型分析中老年人群TG/HDL-C累积比值与高血压发病的关系，并采用限制性立方样条模型拟合TG/HDL-C累积比值与中老年人群高血压发生风险的剂量反应关系。

结果

2011—2015年高血压患病人数为2 438人（39.13%），2015年高血压发病人数为625人（16.48%）。Logistic回归分析结果显示，TG/HDL-C比值升高与高血压的患病风险增加密切相关（OR=1.02，95%CI：1.02 ~ 1.03）；TG/HDL-C最高四分位数组是高血压发病的风险因素（OR=1.34，95%CI：1.02 ~ 1.74）；TG/HDL-C累积比值与高血压发生情况呈线性关联（P- nonlinear = 0.232）。

结论

TG/HDL-C比值升高是中国中老年人群高血压发病的危险因素。

高血压  /  三酰甘油和高密度脂蛋白胆固醇比值  /  中老年人群
Objective

To investigate the association between the ratio of triglycerides (TG) to high-density lipoprotein cholesterol (HDL-C) and the incidence of hypertension in middle-aged and elderly Chinese adults, and to provide a reference for the development of hypertension intervention strategies.

Methods

This study included 6 231 participants from the baseline and 2015 follow-up data of the China Health and Retirement Longitudinal Study (CHARLS). Logistic regression models were used to analyze the relationship between the TG/HDL-C ratio and the prevalence of hypertension in middle-aged and elderly populations. After excluding individuals diagnosed with hypertension before 2015, the cumulative TG/HDL-C ratio was calculated, and logistic regression models were employed to analyze the relationship between the cumulative TG/HDL-C ratio and the incidence of hypertension. Additionally, restricted cubic spline (RCS) models were used to fit the dose-response relationship between the cumulative TG/HDL-C ratio and the risk of hypertension in middle-aged and elderly populations.

Results

From 2011 to 2015, 2 438 individuals (39.13%) were diagnosed with hypertension, and in 2015, 625 individuals (16.48%) developed hypertension. Logistic regression analysis revealed that an elevated TG/HDL-C ratio was significantly associated with an increased risk of hypertension (OR=1.02, 95% CI: 1.02-1.03). The highest quartile of the TG/HDL-C ratio was identified as a risk factor for hypertension (OR=1.34，95% CI：1.02-1.74). Furthermore, a linear association was observed between the cumulative TG/HDL-C ratio and the incidence of hypertension (P-nonlinear=0.232).

Conclusion

An elevated TG/HDL-C ratio is a risk factor for hypertension in middle-aged and elderly Chinese adults.

Hypertension  /  Triglycerides to high-density lipoprotein cholesterol ratio  /  Middle-aged and elderly adults
刘念, 贾思艳. 中国中老年人血清三酰甘油/高密度脂蛋白胆固醇比值与高血压发生的关联性研究. 现代预防医学, 2025 , 52 (15) : 2737 -2742 . DOI: 10.20043/j.cnki.MPM.202503303
Nian LIU, Si-yan JIA. Association between serum triglyceride to high-density lipoprotein cholesterol ratio and incident hypertension in middle-aged and elderly Chinese adults[J]. Modern Preventive Medicine, 2025 , 52 (15) : 2737 -2742 . DOI: 10.20043/j.cnki.MPM.202503303
正文
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高血压作为全球公共卫生领域的重要挑战，其疾病负担与防控成效已引发学界广泛关注[1]。截至2019年全球约有13亿人患有高血压，30～79岁成人的高血压患病率为33.0%[2]。尽管降压药物普及使血压控制取得进展，但疾病流行态势未获根本性扭转，这一矛盾现象在人口老龄化加速的我国尤为突出。据推算我国高血压现患病人数为2.45亿，高血压患者次均住院总费用为7 135.1元[3]。我国高血压患病率呈现上升趋势，但仅有不到三分之一的患者接受治疗[4]。全球疾病负担研究（Global Burden of Disease，GBD 2019）证实，高血压已跃升为首位致死因素，导致全球31%的全因死亡（约1 085万例），我国相关死亡病例更在30年间倍增达259.99万例[5]。值得关注的是，中老年人群呈现“高患病率-低控制率”的防控困境，年龄特异性风险加剧了疾病管理难度[6]。基于此，构建中老年高血压发病风险的早期预警模型，建立高危人群精准筛查体系，对于优化防控资源配置、遏制疾病流行趋势具有重要战略价值，这也成为当前转化医学研究的关键突破方向。
既往研究还发现，各项血脂指标均与心脑血管疾病的发生密切相关，但单项血脂指标只是一种胆固醇或脂蛋白的体现，不能完整反映血脂整体水平与心脑血管疾病的关联，而血脂成分的比值较单一指标能更好地对疾病发生风险进行解释，例如，在预测心血管疾病及其死亡风险事件时，三酰甘油和高密度脂蛋白胆固醇（triglyceride/high-density lipoprotein-cholesterol，TG/HDL-C）比值较单一血脂指标表现出更强的关联性[7]；TG/HDL-C比值为胰岛素依赖性指标，被认为是预测2型糖尿病发病简单有效的指标[8]。目前关于TG/HDL-C与高血压发生情况的研究以横断面为主，纵向研究较少[9]，因此，本研究旨在探讨TG/HDL-C比值与中老年人高血压发生情况之间的关系，评价其对高血压的辅助诊断和预测价值，为临床医生积极防治高血压提供理论依据。
1　对象与方法
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1.1　对象
本研究数据来源于中国健康与养老追踪调查（China Health and Retirement Longitudinal Study，CHARLS）。CHARLS是一项针对中国45岁及以上人群开展的全国性代表性纵向调查。CHARLS基线调查覆盖了全国150个国家/地区、450个村庄/城市社区，涉及10 257户家庭的17 708人，反映了中国中老年人群的总体情况。其全国基线调查于2011 —2012年进行，随后每隔二年开展一次，分别于2013年（第二期）、2015年（第三期）、2018年（第四期）和2020年（第五期）开展了四轮常规问卷的追踪调查。本研究以完成CHARLS数据第一期和第三期随访调查的人群为研究对象，共计6 231人。纳入标准：有完成心脑血管患病情况调查数据和血检数据。排除标准：（1）未完成二期随访；（2）未完成体检和血检；（4）年龄在45岁以下；（5）身体质量指数（body mass index,BMI）大于40作为异常值并排除。
1.2　指标定义
高血压诊断包括：问卷调查内容“是否有医生曾经告诉过您有以下高血压？”或“您目前有没有采用服用中药，服用西药，或吃药以外的其他治疗方法来治疗高血压及其并发症？”，若被调查者回答是，则认为有高血压；按照中国高血压防治指南(2018年修订版)，收缩压≥ 140 mm Hg和(或)舒张压≥90 mm Hg认为有高血压；如果收缩压和舒张压水平属于不同类别，则使用较高的分类类别。
TG/HDL-C比值和TG/HDL-C累积比值均是通过血检指标中三酰甘油(triglyceride,TG)和高密度脂蛋白胆固醇(high density lipoprotein-cholesterol, HDL-C)计算得来。TG/HDL-C累积比值计算方法为：[(TG/HDL-C比值2012+TG/HDL-C比值2015)] /2×(2015-2012)。
1.3　协变量
本研究纳入的协变量包括性别、年龄、教育程度、婚姻状况、吸烟情况、饮酒情况、是否糖尿病、BMI、总胆固醇、低密度脂蛋白。其中，婚姻状况包括已婚和其他（分居、离异、丧偶、未婚、同居），吸烟情况分为不吸烟、吸烟（当前吸烟和既往吸烟），饮酒情况分为不饮酒、饮酒（当前饮酒和既往饮酒）。本研究中当前吸烟和当前饮酒指一直吸烟或饮酒，既往吸烟或既往饮酒指曾经吸烟或饮酒但现在不吸烟或不饮酒，BMI=体重(kg)/身高的二次方(m2)。
1.4　统计方法
本研究统计分析采用R 4.1.3软件完成。描述性分析中计量资料采取（）表示，分类变量以频数和百分比表示。根据数据类型和分布情况，采用单因素方差分析、Kruskal-Wallis检验比较基线变量的特征差异。将TG/HDL-C比值按照四分位数分组，分为Q1组、Q2组、Q3组和Q4组；运用二分类logistic回归（0=非高血压，1=高血压）分析TG/HDL-C比值与高血压、TG/HDL-C累积比值与高血压之间的相关性，协变量经多重共线性检验后纳入分析；采用限制性立方样条（restricted cubic spline，RCS）模型分析TG/HDL-C累积比值与高血压发生之间的线性关系。检验水准α=0.05。
2　结果
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2.1　基线人群特征比较
本研究共纳入研究对象6 231人，平均年龄为(59.11±8.78)岁，高血压患者2 438人，高血压患病率为39.12%。与非高血压组人群相比，高血压组人群年龄、女性、小学教育程度、糖尿病占比、BMI、总胆固醇、低密度脂蛋白、TG/HDL-C和TG/HDL-C累积比值均增加。除吸烟情况外，两组间其他指标差异均存在统计学意义(P<0.05)。见表1。
2.2　TG/HDL-C比值与高血压患病情况分析
以是否患高血压（0=非高血压，1=高血压）为因变量，以TG/HDL-C比值为自变量进行logistic回归分析。经多重共线性检验，所有协变量方差膨胀因子(variance inflation factor，VIF)均<10，提示各变量间不存在共线性。调整协变量后结果显示，TG/HDL-C增加了高血压的患病风险。将TG/HDL-C按照四分位数分组后，以TG/HDL-C Q1组为参照组进行分析，TG/HDL-C Q4组与高血压关联性最强，其次是TG/HDL-C Q3组，TG/HDL-C Q2组与Q1组间差异无统计学意义。见表2。
2.3　TG/HDL-C累积比值与高血压发病情况分析
排除2015年之前患有高血压的2 438名被调查者后，剩余3 793名被调查者中高血压发病人数为625名（16.48%）。采取多因素logistic回归模型分析TG/HDL-C累积比值与2015年高血压发病的关联性，结果显示，与Q1组相比，TG/HDL-C累积比值Q4组与高血压发生的关联最强，且差异有统计学意义，其次是Q2组和Q3组。见表3。
2.4　RCS曲线分析
采用RCS曲线分析TG/HDL-C累积比值与2015年高血压发生情况，结果显示TG/HDL-C累积比值与2015年中老年人群高血压发生情况呈线性关联（P- nonlinear=0.232），即高血压发生率随TG/HDL-C比值累积增加而增加。见图1。
3　讨论
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本研究利用CHARLS数据库基线数据和第三期随访数据，探讨中国中老年人群TG/HDL-C比值与高血压的关联性。研究发现，TG/HDL-C比值是高血压发病的危险因素，随着TG/HDL-C比值增加，高血压患病风险增加。此外，TG/HDL-C累积比值与高血压发病风险呈线性剂量反应关系，且TG/HDL-C累积高比值组高血压的发病风险是较低比值组的1.34倍。
既往研究表明TG/HDL-C比值与心血管疾病发生风险密切相关，但关于TG/HDL-C比值与中老年人群高血压发生风险的相关性研究仍较为有限。一项来自韩国的长达20年的随访研究发现[10]，青少年时期TG/HDL-C比值较高的人群，成年后高血压发生率（18.3%）显著高于TG/HDL-C比值较低组（5.4%）。此外，我国相关横断面研究结果表明[11]，TG/HDL-C比值与老年人群的高血压患病率呈正相关关系；TG/HDL-C比值能够反映高血压患者的动态血压特征，在原发性高血压患者中，年龄越大、24 h平均收缩压越高、空腹血糖水平越高，其TG/HDL-C比值也显著升高[12]，与本研究结果基本一致。
已有大量研究表明，TG/HDL-C比值相较于单一的脂质指标，能够更有效地预测不良心血管事件的发生风险[13]，也能够更全面地反映脂质代谢的综合状态，具有更高的临床应用价值[14]。《中国成人血脂异常防治指南（2016年修订版）》指出[15]，近30年来我国人群的血脂水平呈逐步上升趋势，血脂异常患病率显著增加。TG和HDL水平受遗传因素与环境因素的双重影响，并与种族、年龄、性别及生活习惯（如饮食、运动等）密切相关[16]。仅依赖单项血脂指标（如总胆固醇TC或TG）可能忽视或低估血脂异常对我国人群健康的潜在威胁，尤其是部分患者的TC或TG水平虽处于正常范围，但因HDL-C浓度偏低，仍可能存在心血管疾病的发生风险[17]。TG/HDL-C能更好反映我国中老年人群脂质代谢综合水平及血压水平[18]，而TG浓度升高与HDL-C浓度降低均可引起TG/HDL-C比值的变化。因此，关注中老年人群TG/HDL-C比值的变化情况，对于阻止高血压的发生从而进一步提示心血管疾病的发生风险具有更高的临床应用价值。
尽管本研究尚未发现TG/HDL-C比值与高血压之间存在相关性的确切机制，但胰岛素抵抗和血脂异常可能为两者间相关的原因。胰岛素抵抗可导致肾素-血管紧张素-醛固酮系统（renin-angiotensin-aldosteronesystem，RAAS）与交感神经系统活性异常增强，促进血管的收缩与重塑，导致动脉硬化及血压升高[19]。血脂异常可能会对动脉血管产生毒性，加快动脉粥样硬化进展，从而促进高血压发生[20]。老年人随着年龄增长，各器官功能下降，导致葡萄糖利用差和体内脂肪储存较多。在胰岛素抵抗和高血脂的双重影响下，中老年人群成为高血压的高危人群，而TG/HDL-C比值可以有效评估胰岛素抵抗[21]，并能综合反映人群脂质代谢水平。因此，关注TG/HDL-C比值对于预防中老年人群高血压的发生具有重要提示意义。
综上所述，TG/HDL-C比值是中国中老年人群高血压发生的危险因素，控制TG和HDL-C水平在合适范围内有利于降低高血压的发病风险。但本研究仍存在一定的局限性。一方面，失访人群较多，未能考虑失访人群的特征与研究人群是否存在差异，可能影响结果的外推性。另一方面，由于研究数据受限，本研究未能充分考虑饮食结构、运动频率等潜在混杂因素。因此，未来研究可进一步扩大样本量，完善分析方法，并考虑更多混杂因素，为预防高血压的发生提供循证依据。
基金
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  • 四川省妇幼保健院2024年院内科技创新基金重点项目(20240104)
文献
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2025年第52卷第15期
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doi: 10.20043/j.cnki.MPM.202503303
  • 接收时间：2025-03-18
  • 首发时间：2026-03-16
  • 出版时间：2025-08-10
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  • 收稿日期：2025-03-18
基金
四川省妇幼保健院2024年院内科技创新基金重点项目(20240104)
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    1.德阳市人民医院 医院感染管理科，四川 德阳 618000
    2.四川省妇女儿童医院/成都医学院附属妇女儿童医院 妇幼健康管理部，四川 成都 610000

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