新疆克孜勒苏柯尔克孜自治州三个民族急性心肌梗死患者的临床特征和冠状动脉病变特点的分析
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摘要
目的探讨新疆克孜勒苏柯尔克孜自治州(新疆克州)汉族、维吾尔族(维族)和柯尔克孜族(柯族)急性心肌梗死(AMI)患者的临床特征及其冠状动脉病变特点。方法收集2017年1月至2019年1月在南京医科大学附属克州人民医院临床考虑急性心肌梗死行冠状动脉造影确诊为AMI的病例,并进行回顾性研究,其中男性150例,女性42例;年龄30～89岁,平均(61.99±12.07)岁。根据民族不同,将全体患者分为汉族组(40例)、维族组(100例)与柯族组(52例),将男性患者分为汉族男性组(28例)、维族男性组(78例)与柯族男性组(44例);根据年龄不同,将患者分为青年组(年龄≤44周岁,14例)与非青年组(年龄>44周岁,178例);根据病情转归预后不同,将患者分为生存组(167例)与死亡组(25例)。分析汉族、维族和柯族三组患者的体重指数(body mass index,BMI)、饮酒史、动脉血压、白细胞计数(white blood cell,WBC)、红细胞计数(red blood cell,RBC)、血红蛋白(hemoglobin,Hb)、血小板计数(platelet,PLT);心肌肌钙蛋白T(cardiac troponin T,cTnT)、同型半胱氨酸(homocysteine,Hcy)、B型脑钠肽(B-type natriuretic peptide,BNP)等临床特征,比较汉族、维族和柯族三组患者之间,汉族男性、维族男性与柯族男性三组患者之间,青年组与非青年组患者之间,生存组与死亡组患者之间病变血管支数分布、罪犯血管分布、冠脉病变分型分布及Gensini评分。结果共纳入192例AMI患者,其中汉族40例(20.83%),维吾尔族100例(52.08%),柯族52例(27.08%)。(1)少数民族(维族和柯族)患者体重指数(BMI)水平高于汉族组患者(P均<0.05);少数民族两组患者饮酒率高于汉族组患者(P均<0.017);少数民族患者红细胞(RBC)计数、血小板(PLT)计数及心肌肌钙蛋白T(cTnT)水平均高于汉族组患者(P均<0.05)。(2)柯族组患者血压>维族组患者血压>汉族组患者血压(P均<0.05)。(3)维族组患者白细胞(WBC)计数高于汉族组患者(P<0.05);维族组患者同型半胱氨酸(Hcy)水平高于柯汉两族组患者(P均<0.05);柯族组患者B型脑钠肽(BNP)水平高于汉族组患者(P<0.05)。(4)维汉两族组患者三支病变比例高于柯族组患者(P均<0.05),柯族组患者单支病变比例高于维汉两族组患者(P均<0.05);青年组患者单支病变最为多见,单支病变比例高于非青年组患者(P<0.05),而非青年组患者以三支病变最为多见,非青年组患者三支病变比例高于青年组患者(P<0.05);维汉两族组患者Gensini评分高于柯族组患者(P<0.05);生存组患者Gensini评分低于死亡组患者(P均<0.05)。结论新疆克州地区汉族、维族及柯族三个民族AMI患者间临床特征及冠脉病变特点存在差异,维族、汉族AMI患者的三支病变的发病率均较柯族高,冠脉病变严重程度均较柯族重。在临床工作中,对于不同民族的AMI患者,应采取有针对性的个体化防治措施。
Objective To investigate clinical features and characteristics of coronary artery lesions of Han, Uygur and Khalkhas patients with acute myocardial infarction(AMI) in Kizilsu Kirgiz Autonomous Prefecture of Xinjiang Uygur Autonomous Region. Methods A retrospective study was conducted among the patients diagnosed with AMI and performed coronary angiography between January 2017 and January 2019 in Kizilsu Kirgiz Autonomous Prefecture People's Hospital. There were 150 males and 42 females, aged from 30 to 89 years, with an average age of(61.99±12.07) years old. According to different ethnic groups, the patients were divided into Han group(40 cases), Uygur group(100 cases) and Kirgiz group(52 cases). Male patients were divided into Han male group(28 cases), Uyghur male group(78 cases) and Kirgiz male group(44 cases); according to different ages, the patients were divided into the youth group(age ≤ 44 years old, 14 cases) and the non-youth group(age>44 years old, 178 cases); according to the outcome of the disease, the patients were divided into the survival group(167 cases) and the death group(25 cases). The clinical characteristics of Han, Uygur and Kirgiz, including body mass index(BMI), drinking history, arterial blood pressure, white blood cell count(WBC), red blood cell count(RBC), hemoglobin(Hb), platelet count(PLT), cardiac troponin T(cTnT), homocysteine(Hcy), and type B brain natriuretic peptide(BNP), were analyzed. The distribution of diseased vessels, the distribution of criminal blood vessels, the distribution of coronary lesions and Gensini score between groups were compared. Results A total of 192 patients with AMI were enrolled, including 40 cases of Han, 100 cases of Uygur, and 52 cases of kirgiz. The body mass index(BMI) levels of the two minority groups were higher than that of Han group(P<0.05); the drinking rates of the two minority groups were higher than that of Han group(P<0.017); the counts of red blood cells(RBC) and platelets(PLT), the levels of cardiac troponin T(cTnT) were higher in the two minority groups than that in Han group(P<0.05). Blood pressure in Kirgiz group was higher than that in Uygur group and Han group(P<0.05). The count of white blood cells(WBC) in Uygur group was higher than that in Han group(P<0.05); the level of homocysteine(Hcy) in Uygur group was higher than that in Kirgiz and Han groups(P<0.05); the level of B-type natriuretic peptide(BNP) in Kirgiz group was higher than that in Han group(P<0.05). The proportion of three-vessel disease in Uygur and Han groups was higher than that in Kirgiz group(P<0.05) and the proportion of single-vessel disease in Kirgiz group was higher than that in Uygur and Han groups(P<0.05); the single-vessel disease was the most common in the youth group, and the proportion of single-vessel disease was higher than that in the non-youth group(P<0.05); the three-vessel disease was the most common in the non-youth group,which had a higher proportion of three-vessel disease than the young group(P<0.05); the Gensini scores of patients in Uygur and Han group were higher than that in Kirgiz group(P<0.05); the Gensini score in the survival group was lower than that in the death group(P<0.05). Conclusions There are ethnic differences in clinical features and coronary lesions among AMI patients in Kizilsu Kirgiz Autonomous Prefecture of Xinjiang Uygur Autonomous Region. The incidence of three-vessel disease in Uygur and Han patients with AMI is higher than that of Kirgiz and the severity of coronary artery lesions is heavier than that of Kirgiz. In clinical practice, targeted individualized prevention and treatment measures should be taken for AMI patients of different races.
Objective To investigate clinical features and characteristics of coronary artery lesions of Han, Uygur and Khalkhas patients with acute myocardial infarction(AMI) in Kizilsu Kirgiz Autonomous Prefecture of Xinjiang Uygur Autonomous Region. Methods A retrospective study was conducted among the patients diagnosed with AMI and performed coronary angiography between January 2017 and January 2019 in Kizilsu Kirgiz Autonomous Prefecture People's Hospital. There were 150 males and 42 females, aged from 30 to 89 years, with an average age of(61.99±12.07) years old. According to different ethnic groups, the patients were divided into Han group(40 cases), Uygur group(100 cases) and Kirgiz group(52 cases). Male patients were divided into Han male group(28 cases), Uyghur male group(78 cases) and Kirgiz male group(44 cases); according to different ages, the patients were divided into the youth group(age ≤ 44 years old, 14 cases) and the non-youth group(age>44 years old, 178 cases); according to the outcome of the disease, the patients were divided into the survival group(167 cases) and the death group(25 cases). The clinical characteristics of Han, Uygur and Kirgiz, including body mass index(BMI), drinking history, arterial blood pressure, white blood cell count(WBC), red blood cell count(RBC), hemoglobin(Hb), platelet count(PLT), cardiac troponin T(cTnT), homocysteine(Hcy), and type B brain natriuretic peptide(BNP), were analyzed. The distribution of diseased vessels, the distribution of criminal blood vessels, the distribution of coronary lesions and Gensini score between groups were compared. Results A total of 192 patients with AMI were enrolled, including 40 cases of Han, 100 cases of Uygur, and 52 cases of kirgiz. The body mass index(BMI) levels of the two minority groups were higher than that of Han group(P<0.05); the drinking rates of the two minority groups were higher than that of Han group(P<0.017); the counts of red blood cells(RBC) and platelets(PLT), the levels of cardiac troponin T(cTnT) were higher in the two minority groups than that in Han group(P<0.05). Blood pressure in Kirgiz group was higher than that in Uygur group and Han group(P<0.05). The count of white blood cells(WBC) in Uygur group was higher than that in Han group(P<0.05); the level of homocysteine(Hcy) in Uygur group was higher than that in Kirgiz and Han groups(P<0.05); the level of B-type natriuretic peptide(BNP) in Kirgiz group was higher than that in Han group(P<0.05). The proportion of three-vessel disease in Uygur and Han groups was higher than that in Kirgiz group(P<0.05) and the proportion of single-vessel disease in Kirgiz group was higher than that in Uygur and Han groups(P<0.05); the single-vessel disease was the most common in the youth group, and the proportion of single-vessel disease was higher than that in the non-youth group(P<0.05); the three-vessel disease was the most common in the non-youth group,which had a higher proportion of three-vessel disease than the young group(P<0.05); the Gensini scores of patients in Uygur and Han group were higher than that in Kirgiz group(P<0.05); the Gensini score in the survival group was lower than that in the death group(P<0.05). Conclusions There are ethnic differences in clinical features and coronary lesions among AMI patients in Kizilsu Kirgiz Autonomous Prefecture of Xinjiang Uygur Autonomous Region. The incidence of three-vessel disease in Uygur and Han patients with AMI is higher than that of Kirgiz and the severity of coronary artery lesions is heavier than that of Kirgiz. In clinical practice, targeted individualized prevention and treatment measures should be taken for AMI patients of different races.
引文
1 Thygesen K,Alpert JS,Jaffe AS,et al.Third universal definition of myocardial infarction[J].Circulation,2012,60(16):2020- 2035.
2 Thygesen K,Alpert JS,Jaffe AS,et al.Fourth universal definition of myocardial infarction (2018)[J].Circulation,2018,138(20):e618- e651.
3 Reed GW,Rossi JE,Cannon CP.Acute myocardial infarction[J].Lancet,2017,389(10065):197- 210.
4 Benjamin EJ,Muntner P,Alonso A,et al.Heart disease and stroke statistics- 2019 update:a report from the american heart association[J].Circulation,2019,139(10):e56- e528.
5 王文,朱曼璐,王拥军,等.《中国心血管病报告2012》概要[J].中国循环杂志,2013,28(6):408- 412.
6 陈伟伟,高润霖,刘力生,等.《中国心血管病报告2017》概要[J].中国循环杂志,2018,33(1):1- 8.
7 刘浩,武刚,翟雪芹,等.早发冠心病急性心肌梗死的危险因素及临床特点分析[J].中国全科医学,2012,15(11):1205- 1208.
8 曲凌光,尚佳,葛利军,等.回族与汉族早发冠心病冠状动脉病变及心血管危险因素的比较分析[J].中国循证医学杂志,2013,13(7):797- 800.
9 Gijsberts CM,Seneviratna A,de Carvalho LP,et al.Ethnicity modifies associations between cardiovascular risk factors and disease severity in parallel dutch and singapore coronary cohorts[J].PLoS One,2015,10(7):e0132278.
10 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.推荐在我国采用心肌梗死全球统一定义[J].中华心血管病杂志,2008,36(10):867- 869.
11 中国成人血脂异常防治指南制定联合委员会.中国成人血脂异常防治指南[J].中华心血管病杂志,2007,35(5):390- 419.
12 《中国高血压防治指南》修订委员会.中国高血压防治指南2018年修订版[J].心脑血管病防治,2019,19(1):1- 44.
13 中华医学会糖尿病分会.中国2型糖尿病防治指南(2017年版)[J].中国实用内科杂志,2018,38(4):292- 344.
14 中国肥胖问题工作组.中国成人超重和肥胖症预防与控制指南(节录)[J].营养学报,2004,26(1):1- 4.
15 Wang J,Liu ZQ,He PY,et al.Analysis of the risk factors and characteristics of coronary artery disease of han,uygur and kazak patients with acute myocardial infarction in xinjiang district[J].Int J Clin Exp Med,2015,8(2):2831- 2838.
16 Judkins MP.Selective coronary arteriography.I.A percutaneous transfemoral technic[J].Radiology,1967,89(5):815- 824.
17 Guidelines for percutaneous transluminal coronary angioplasty.A report of the american college of cardiology/american heart association task force on assessment of diagnostic and therapeutic cardiovascular procedures (subcommittee on percutaneous transluminal coronary angioplasty)[J].J Am Coll Cardiol,1988,12(2):529- 545.
18 Gensini GG.A more meaningful scoring system for determining the severity of coronary heart disease[J].Am J Cardiol,1983,51(3):606.
19 刘阳,周涵黎,黄光强,等.洋葱多肽及蛋白对T2DM小鼠降血糖及降血脂作用研究[J].食品科技,2017,42(9):227- 232.
20 赵青跃,胡进明.高原不同海拔地区正常人血压变化的分析[J].青海医药杂志,2010,40(7):25- 26.
21 王晓明,陈念,石红玲.冠状动脉解剖、供血特点与常见冠状动脉病变及其心电图特征[J/CD].心电图杂志(电子版),2014,3(3):182- 186.
22 Makaryus AN,Jauhar R,Tortez LM,et al.Comparison of the diameters of the major epicardial coronary arteries by angiogram in asian- indians versus european americans <40 years of age undergoing percutaneous coronary artery intervention[J].Am J Cardiol,2017,120(6):924- 926.
23 黄文军,刘俊明,谢伟,等.汉族、维吾尔族、哈萨克族冠心病患者冠状动脉病变的临床研究[J].中国介入心脏病学杂志,2012,20(4):212- 216.
24 曲凌光.回族与汉族冠心病危险因素和冠脉病变特点对比分析[D].银川:宁夏医科大学,2013.
25 江时森,吕磊,Juergens C,等.中国人和澳大利亚人冠状动脉病变对比研究[J].中华心血管病杂志,2007,35(5):447- 450.
26 Jinnouchi H,Sakakura K,Wada H,et al.Clinical features of myocardial infarction in young japanese patients[J].Int Heart J,2013,54(3):123- 128.
27 程桂芬.心肌梗塞发生部位的临床分析[J].实用心脑肺血管病杂志,1997,5(2):61.
28 罗仁,茶春喜,梁金排.不同年龄组维吾尔族与汉族冠心病患者的危险因素与冠状动脉病变特征分析[J].重庆医学,2014,43(4):445- 447,450.
29 刘博,张源明.乌鲁木齐地区维吾尔族与汉族早发冠心病患者危险因素相关研究[J].中华实用诊断与治疗杂志,2011,25(3):243- 244+247.
30 Wong CP,Loh SY,Loh KK,et al.Acute myocardial infarction:Clinical features and outcomes in young adults in Singapore[J].World J Cardiol,2012,4(6):206- 210.
31 Pang J,Zhang Z,Zheng T,et al.The clinical,angiographic and prognosis characteristics of elderly patients with acute ST- segment elevation myocardial infarction- - the first elderly STEMI population study in northwest China[J].Int J Cardiol,2015,179:326- 328.
32 Chua SK,Hung HF,Shyu KG,et al.Acute ST- elevation myocardial infarction in young patients:15 years of experience in a single center[J].Clin Cardiol,2010,33(3):140- 148.
33 苏玉娟,李春雨,姜婷,等.新疆维吾尔自治区克州地区三个民族急性心肌梗死患者的危险因素分析[J/CD].中华卫生应急电子杂志,2018,4(4):204- 211.
2 Thygesen K,Alpert JS,Jaffe AS,et al.Fourth universal definition of myocardial infarction (2018)[J].Circulation,2018,138(20):e618- e651.
3 Reed GW,Rossi JE,Cannon CP.Acute myocardial infarction[J].Lancet,2017,389(10065):197- 210.
4 Benjamin EJ,Muntner P,Alonso A,et al.Heart disease and stroke statistics- 2019 update:a report from the american heart association[J].Circulation,2019,139(10):e56- e528.
5 王文,朱曼璐,王拥军,等.《中国心血管病报告2012》概要[J].中国循环杂志,2013,28(6):408- 412.
6 陈伟伟,高润霖,刘力生,等.《中国心血管病报告2017》概要[J].中国循环杂志,2018,33(1):1- 8.
7 刘浩,武刚,翟雪芹,等.早发冠心病急性心肌梗死的危险因素及临床特点分析[J].中国全科医学,2012,15(11):1205- 1208.
8 曲凌光,尚佳,葛利军,等.回族与汉族早发冠心病冠状动脉病变及心血管危险因素的比较分析[J].中国循证医学杂志,2013,13(7):797- 800.
9 Gijsberts CM,Seneviratna A,de Carvalho LP,et al.Ethnicity modifies associations between cardiovascular risk factors and disease severity in parallel dutch and singapore coronary cohorts[J].PLoS One,2015,10(7):e0132278.
10 中华医学会心血管病学分会,中华心血管病杂志编辑委员会.推荐在我国采用心肌梗死全球统一定义[J].中华心血管病杂志,2008,36(10):867- 869.
11 中国成人血脂异常防治指南制定联合委员会.中国成人血脂异常防治指南[J].中华心血管病杂志,2007,35(5):390- 419.
12 《中国高血压防治指南》修订委员会.中国高血压防治指南2018年修订版[J].心脑血管病防治,2019,19(1):1- 44.
13 中华医学会糖尿病分会.中国2型糖尿病防治指南(2017年版)[J].中国实用内科杂志,2018,38(4):292- 344.
14 中国肥胖问题工作组.中国成人超重和肥胖症预防与控制指南(节录)[J].营养学报,2004,26(1):1- 4.
15 Wang J,Liu ZQ,He PY,et al.Analysis of the risk factors and characteristics of coronary artery disease of han,uygur and kazak patients with acute myocardial infarction in xinjiang district[J].Int J Clin Exp Med,2015,8(2):2831- 2838.
16 Judkins MP.Selective coronary arteriography.I.A percutaneous transfemoral technic[J].Radiology,1967,89(5):815- 824.
17 Guidelines for percutaneous transluminal coronary angioplasty.A report of the american college of cardiology/american heart association task force on assessment of diagnostic and therapeutic cardiovascular procedures (subcommittee on percutaneous transluminal coronary angioplasty)[J].J Am Coll Cardiol,1988,12(2):529- 545.
18 Gensini GG.A more meaningful scoring system for determining the severity of coronary heart disease[J].Am J Cardiol,1983,51(3):606.
19 刘阳,周涵黎,黄光强,等.洋葱多肽及蛋白对T2DM小鼠降血糖及降血脂作用研究[J].食品科技,2017,42(9):227- 232.
20 赵青跃,胡进明.高原不同海拔地区正常人血压变化的分析[J].青海医药杂志,2010,40(7):25- 26.
21 王晓明,陈念,石红玲.冠状动脉解剖、供血特点与常见冠状动脉病变及其心电图特征[J/CD].心电图杂志(电子版),2014,3(3):182- 186.
22 Makaryus AN,Jauhar R,Tortez LM,et al.Comparison of the diameters of the major epicardial coronary arteries by angiogram in asian- indians versus european americans <40 years of age undergoing percutaneous coronary artery intervention[J].Am J Cardiol,2017,120(6):924- 926.
23 黄文军,刘俊明,谢伟,等.汉族、维吾尔族、哈萨克族冠心病患者冠状动脉病变的临床研究[J].中国介入心脏病学杂志,2012,20(4):212- 216.
24 曲凌光.回族与汉族冠心病危险因素和冠脉病变特点对比分析[D].银川:宁夏医科大学,2013.
25 江时森,吕磊,Juergens C,等.中国人和澳大利亚人冠状动脉病变对比研究[J].中华心血管病杂志,2007,35(5):447- 450.
26 Jinnouchi H,Sakakura K,Wada H,et al.Clinical features of myocardial infarction in young japanese patients[J].Int Heart J,2013,54(3):123- 128.
27 程桂芬.心肌梗塞发生部位的临床分析[J].实用心脑肺血管病杂志,1997,5(2):61.
28 罗仁,茶春喜,梁金排.不同年龄组维吾尔族与汉族冠心病患者的危险因素与冠状动脉病变特征分析[J].重庆医学,2014,43(4):445- 447,450.
29 刘博,张源明.乌鲁木齐地区维吾尔族与汉族早发冠心病患者危险因素相关研究[J].中华实用诊断与治疗杂志,2011,25(3):243- 244+247.
30 Wong CP,Loh SY,Loh KK,et al.Acute myocardial infarction:Clinical features and outcomes in young adults in Singapore[J].World J Cardiol,2012,4(6):206- 210.
31 Pang J,Zhang Z,Zheng T,et al.The clinical,angiographic and prognosis characteristics of elderly patients with acute ST- segment elevation myocardial infarction- - the first elderly STEMI population study in northwest China[J].Int J Cardiol,2015,179:326- 328.
32 Chua SK,Hung HF,Shyu KG,et al.Acute ST- elevation myocardial infarction in young patients:15 years of experience in a single center[J].Clin Cardiol,2010,33(3):140- 148.
33 苏玉娟,李春雨,姜婷,等.新疆维吾尔自治区克州地区三个民族急性心肌梗死患者的危险因素分析[J/CD].中华卫生应急电子杂志,2018,4(4):204- 211.