2025 年第 9 期 第 20 卷

肠道微生物群膳食指数和心力衰竭的关联分析

Association between dietary index of gut microbiota and heart failure

作者：陈思源尹宁杨海楠范谦

英文作者：Chen Siyuan Yin Ning Yang Hainan Fan Qian

单位：首都医科大学附属北京安贞医院心内科国家心血管疾病临床医学研究中心，北京100029

英文单位：Department of Cardiology Beijing Anzhen Hospital Capital Medical University National Clinical Research Center for Cardiovascular Diseases Beijing 100029 China

关键词：肠道微生物群膳食指数；心力衰竭；横断面研究；美国国家健康与营养调查

英文关键词：Dietaryindexofgutmicrobiota;Heartfailure;Cross-sectionalstudy;UnitedStatesNationalHealthandNutritionExaminationSurvey

• 摘要：

• 目的 采用横断面研究方式探讨肠道微生物群膳食指数(DI-GM)与心力衰竭的相关性。方法 本研究数据源自美国国家健康与营养调查数据库2007—2020年数据。研究对象纳入标准为年龄20～80岁，经排除缺失心力衰竭患病信息、未完成2 d 24 h膳食回顾及缺失DI-GM计算所需数据的样本后，共纳入33 665例研究对象。依据个体访谈病史问卷判断心力衰竭，基于2次膳食回顾访谈数据计算DI-GM。采用多因素Logistic回归分析探讨DI-GM与心力衰竭患病的相关性，构建限制性立方样条模型以明确二者间是否存在非线性关系。按年龄、性别等进行亚组分析并评估交互作用。结果 最终纳入33 665例参与者中心力衰竭患病率为3.3%（1 122例），DI-GM加权得分5(4,6)分。根据是否合并心力衰竭将参与者分为心力衰竭组和非心力衰竭组。心力衰竭组在年龄、性别、种族、教育水平、婚姻情况、家庭收入/贫困线、体重指数、健康行为及疾病史等方面与非心力衰竭组差异均有统计学意义(均P＜0.05)，且心力衰竭组DI-GM加权得分低于非心力衰竭组（P=0.002）。加权多变量Logistic回归分析结果显示，不同模型调整协变量后，DI-GM得分升高均与心力衰竭风险降低相关（均P＜0.05）。DI-GM分组分析表明，随得分升高心力衰竭风险下降（趋势效应P值均＜0.001）。限制性立方样条模型分析显示DI-GM得分与心力衰竭风险显著关联且呈线性关系（非线性检验P=0.522）。亚组分析未发现DI-GM与心力衰竭关联在各亚组中有显著交互作用（均P＞0.05）。结论 DI-GM与心力衰竭风险独立相关，高水平DI-GM对心力衰竭患病具有保护作用。

• Objective To investigate the association between dietary index of gut microbiota (DI-GM) and heart failure in a cross-sectional study. Methods The data of this study were collected from the United States National Health and Nutrition Examination Survey database 2007-2020. The inclusion criteria were 20-80 years old, 33 665 subjects were included after excluding those missing information on heart failure, incomplete 2 d 24 h dietary recall, and missing data required for DI-GM calculation. DI-GM was calculated based on the data from two dietary retrospective interviews. Multivariate Logistic regression analysis was used to explore the relationship between DI-GM and heart failure. A restricted cubic spline model was constructed to determine the non-linear relationship between DI-GM and heart failure. Subgroup analysis by age, sex, etc., and interaction was evaluated. Results A total of 33 665 participants were included in this study. The prevalence of heart failure was 3.3%(1 122 cases) and the weighted DI-GM score was 5(4,6). According to the presence or absence of heart failure, the patients were divided into heart failure group and non-heart failure group. There were significant differences in age, gender, race, education level, marital status, family income/poverty line, body mass index, health behavior, and disease history between the heart failure group and the non-heart failure group (all P＜0.05), and the weighted score of DI-GM in the heart failure group was lower than that in the non-heart failure group (P=0.002). The results  of weighted multivariate Logistic regression analysis showed that after adjusting for covariates in different models, the increase in DI-GM was associated with a reduced risk of heart failure (all P＜0.05). The DI-GM subgroup analysis showed that the risk of heart failure decreased with the increase of scores (the P-values for trend were all less than 0.001). The restricted cubic spline model showed a linear association between DI-GM and the risk of heart failure (nonlinearity test P=0.522). Subgroup analysis showed no significant interaction between DI-GM and heart failure in each subgroup (all P＞0.05). Conclusion DI-GM is independently associated with the risk of heart failure, and high level of DI-GM has a protective effect on heart failure.