新疆医科大学学报

目的 探讨不同体力活动(PA)水平与颈动脉内中膜厚度进展的关系，以期为动脉粥样硬化性心血管疾病的预防和健康管理提供参考。方法 基于新疆地区心脑血管自然人群队列，于2019年7月-2021年9月招募乌鲁木齐市30～74岁的居民，完成心脑血管疾病危险因素测评问卷调查、体格检查、实验室检查、颈部超声检查以及睡眠质量评估。根据研究人群的PA水平，将人群分为低、中等和高PA,每12个月随访1次研究人群的颈动脉内中膜厚度(CIMT),随访终点时间为2024年12月31日。随访终点事件为CIMT进展。采用多因素Cox比例风险回归模型分析CIMT进展的影响因素和不同PA水平与CIMT进展的相关性，并绘制累积进展风险曲线。结果 本研究共纳入1 385名研究对象，其中男性844例(60.94%),女性541例(39.06%),平均年龄为(49.59±8.09)岁，中位随访时间为25个月，随访期间有57人(4.12%)失访，有221人发生CIMT进展事件，进展率为15.96%。Cox比例风险回归分析显示，年龄(HR=1.047,95%CI:1.029～1.065,P<0.001)、超重/肥胖(HR=1.394,95%CI:1.009～1.927,P=0.044)、LDL-C(HR=1.283,95%CI:1.093～1.505,P=0.002)、患有糖尿病(HR=1.699,95%CI:1.249～2.312,P<0.001)、睡眠质量差(HR=1.559,95%CI:1.179～2.062,P=0.002)是CIMT进展的危险因素；调整混杂因素后，与低PA水平人群相比，中等PA水平人群的CIMT进展风险降低31.3%[HR=0.687,95%CI(0.507～0.930),P=0.015]、高PA水平人群的CIMT进展风险降低44.6%[HR=0.554,95%CI(0.380～0.809),P=0.002]。结论 年龄、超重/肥胖、LDL-C、糖尿病、睡眠质量差是CIMT进展的危险因素；与低PA水平相比，中等和高PA水平是CIMT进展的保护因素。

Objective To investigate the relationship between different levels of physical activity(PA) and the progression of carotid artery intima-media thickness, to provide a reference for the prevention and health management of atherosclerotic cardiovascular disease(ASCVD). Methods Based on the natural cohort of cardiovascular and cerebrovascular populations in Xinjiang, residents aged 30-74 years old in Urumqi were recruited from July 2019 to September 2021 to complete the cardiovascular and cerebrovascular disease risk factor assessment questionnaire, physical examination, laboratory examination, neck ultrasound examination and sleep quality assessment. According to the PA level of the study population, the population was divided into 3 PA levels: low, medium and high and the carotid intima-media thickness(CIMT) of the study population was followed up every 12 months, and the follow-up endpoint was December 31, 2024. The endpoint of follow-up was progression of CIMT. The multivariate Cox proportional hazards regression model was used to analyze the correlation between risk factors and different PA levels of CIMT and CIMT progression, and the cumulative risk curve of progression was plotted. Results A total of 1 385 subjects were included in this study, including 844 males(60.94%) and 541 females(39.06%), with an average age of(49.59±8.09) years, a median follow-up time of 25 months, 57(4.12%) lost to follow-up during the follow-up period and 221 patients had CIMT progression events, with a progression rate of 15.96%. Cox proportional hazards regression analysis showed that age(HR=1.047, 95%CI: 1.029～1.065, P<0.001), overweight/obesity(HR=1.394, 95%CI: 1.009～1.927, P=0.044), LDL-C(HR=1.283, 95%CI: 1.093～1.505, P=0.002) and diabetes mellitus(HR=1.699, 95%CI: 1.249～2.312, P<0.001), poor sleep quality(HR=1.559, 95%CI: 1.179～2.062, P=0.002) were risk factors for CIMT progression. After adjusting for confounding factors, the risk of CIMT progression was reduced by 31.3% in the moderate PA level group compared with the low PA level group [HR=0.687, 95%CI(0.507～0.930), P=0.015], and the risk of CIMT progression in the high PA level group was reduced by 44.6% [HR=0.554, 95%CI(0.380～0.809), P=0.002]. Conclusion Age, overweight/obesity, LDL-C, diabetes and poor sleep quality are risk factors for the progression of CIMT. Compared with low PA levels, moderate and high PA levels are protective factors for the progression of CIMT.