中国老年人群甘油三酯和高密度脂蛋白胆固醇比值与认知功能减退的关系：一项基于CHARLS数据库的Cox队列研究

Association between triglyceride/high-density lipoprotein cholesterol ratio and cognitive decline in the elderly population in China: A Cox cohort study based on the CHARLS database

摘要:

目的 探讨中国老年人群中甘油三酯与高密度脂蛋白胆固醇（TG/HDL-C）比值与认知功能减退的关系。方法 纳入来自CHARLS队列的816名参与者。应用了Cox比例风险回归模型评估TG/HDL-C比值与认知功能减退之间的潜在相关性。采用限制性立方样条（RCS）曲线拟合TG/HDL-C比值与中老年人群认知障碍减退风险的剂量反应关系。该研究还进行了彻底的敏感性和亚组分析。结果 在对各种风险因素进行调整后，结果显示TG/HDL-C比值与60岁及以上人群认知功能减退的风险相关。以Q1组（TG/HDL-C比值<1.371）为参照，Q2组（TG/HDL-C比值1.372～2.184）、Q3组（TG/HDL-C比值2.185～3.581）和Q4组（TG/HDL-C比值>3.581）的风险比（HR）在模型1、模型2、模型3中高于Q1组（均P<0.05）。其中，Q2组相对于Q1组的HR最高。RCS回归分析表明，TG/HDL-C比值与认知功能减退存在非线性关系，拐点位于比值为2.48处。具体而言，低于此阈值的比值与认知功能减退风险增加相关1.47（95%置信区间：1.17～1.86，P=0.001）；当比值超过此阈值时，预测能力减弱（P=0.66）。敏感性分析证实了这些发现的稳健性。此外，相比受教育程度高的人群，受教育程度低的人群中TG/HDL-C比值与认知功能减退风险的相关性更强。结论 TG/HDL-C比值与中国老年人群中的认知功能减退存在显著的非线性关联，并且认知功能减退的风险增加与TG/HDL-C比值低于2.48的阈值相关。这为预防老年患者认知障碍提供了有效的策略。

Abstract:

Objective To investigate the association between triglyceride/high-density lipoprotein cholesterol （TG/HDL-C） ratio and cognitive decline in the elderly population in China.Methods A total of 816 participants from the CHARLS cohort were included in this study. The Cox proportional-hazards regression model was used to assess the potential association between TG/HDL-C ratio and cognitive decline. The restricted cubic spline （RCS） curve was used to fit the dose-response relationship between TG/HDL-C ratio and the risk of cognitive decline in the middle-aged and elderly populations. Sensitivity and subgroup analyses were also performed in this study.Results After adjustment for various risk factors， the results showed that TG/HDL-C ratio was significantly associated with the risk of cognitive decline in individuals aged 60 years and above. Using the Q1 group （TG/HDL-C ratio<1.371） as the reference， the hazard ratio （HR） for the Q2 group （TG/HDL-C ratio 1.372-2.184）， Q3 group （TG/HDL-C ratio 2.185-3.581）， and Q4 group （TG/HDL-C ratio>3.581） were significantly higher than that of the Q1 group in Model 1， Model 2， and Model 3 （all P<0.05）. Notably， the HR for the Q2 group relative to the Q1 group was the highest among these groups. The RCS regression analysis revealed a non-linear relationship between TG/HDL-C ratio and cognitive decline 1.47（95%CI： 1.17-1.86，P=0.001）， with a turning point at a ratio of 2.48. Specifically， TG/HDL-C ratio below this threshold was associated with an increased risk of cognitive decline， while the predictive ability of TG/HDL-C ratio weakened when it exceeded this threshold （P=0.66）. The sensitivity analysis confirmed the robustness of these findings. In addition， the association between TG/HDL-C ratio and the risk of cognitive decline was stronger in individuals with a lower educational level compared with those with a higher educational level.Conclusions There is a significant non-linear association between TG/HDL-C ratio and cognitive decline in the elderly Chinese population， and the increase in the risk of cognitive decline is associated with a TG/HDL-C ratio below the threshold of 2.48. These findings help to provide effective strategies for the prevention of cognitive impairment in elderly patients.