不同年龄冠心病患者临床特点及冠状动脉病变危险因素分析
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摘要
(1)目的探讨不同年龄冠心病患者临床特点、冠状动脉危险因素与冠状动脉粥样硬化病变程度的关系。(2)方法选取唐山工人医院心内科2016年2月~2017年2月入院后行冠状动脉造影的冠心病患者610例,收集其一般资料及其他临床指标。(3)结果单因素分析中青年组冠心病患者性别、抽烟、饮酒、体质量指数(BMI)、家族史显著高于老年组,而高血压、糖尿病、HDL-C、血浆脂蛋白磷脂酶A2(Lp-PLA2)水平和Gensini评分均低于老年组,差异均有统计学意义。Logistic回归分析显示中青年冠心病冠状动脉病变程度加重的独立危险因素依次为糖尿病、高血压、吸烟、高血脂、家族史、胆固醇(TC),其OR值依次为19.015、16.990、13.971、6.507、6.358、3.500;高密度脂蛋白(HDL-C)为保护性因素,其OR值为0.008;老年冠心病冠状动脉病变程度加重的独立危险因素依次为家族史、饮酒、TC、LpPLA2,其OR值依次为5.421、2.613、1.445、1.009。(4)结论不同年龄冠心病患者的临床特点与危险因素有差异性。中青年冠心病患者主要与糖尿病、高血压、吸烟、家族史、低HDL-C有关;老年冠心病患者与饮酒、Lp-PLA2有关;而家族史、TC可影响任何年龄冠状动脉病变;这些危险因素均可使冠状动脉粥样硬化病变程度增加。
Objective To explore the correlation between cardiovascular risk factors and severity of coronary artery disease in patients with different ages.Methods A total of 610 patients who underwent coronary angiography in Tangshan Gongren Hospital from Feb 2016 to Feb 2017 were studied.Collected general information and other clinical indicators.Results Single factor analysis showed that the youth and middle age group among gender,smoking,drinking,BMI and family history of hereditary disease were greater than the elderly group(P <0.05),but hypertension,systolic blood pressure,diabetes,cholesterol,serum Lp-PLA2 level and Gensini score were lower than the elderly group(P <0.05).Logistic regression analysis showed that young and middle-aged degree aggravating the independent risk factors of coronary heart disease(CHD)of coronary lesions were diabetic,hypertension,smoking,high blood fat,family history and TC,(The OR value of 19.015、16.990、13.971、6.507、6.358、3.500),HDL-C was protective,(OR=0.008);The independent risk factors of coronary artery disease in elderly patients were the family history,drinking,TC,Lp-PLA2(The OR value of 5.421、2.613、1.445、1.009).Conclusion The risk factors of coronary heart disease in different ages are different.Young and middle-aged patients with CHD are also related to diabetes,hypertension,smoking,family history and low HDL-C.Elderly patients with CHD are associated with alcohol and Lp-PLA2.Family history and hyperlipidemia can affect coronary artery disease.These risk factors can increase the degree of coronary atherosclerosis.
Objective To explore the correlation between cardiovascular risk factors and severity of coronary artery disease in patients with different ages.Methods A total of 610 patients who underwent coronary angiography in Tangshan Gongren Hospital from Feb 2016 to Feb 2017 were studied.Collected general information and other clinical indicators.Results Single factor analysis showed that the youth and middle age group among gender,smoking,drinking,BMI and family history of hereditary disease were greater than the elderly group(P <0.05),but hypertension,systolic blood pressure,diabetes,cholesterol,serum Lp-PLA2 level and Gensini score were lower than the elderly group(P <0.05).Logistic regression analysis showed that young and middle-aged degree aggravating the independent risk factors of coronary heart disease(CHD)of coronary lesions were diabetic,hypertension,smoking,high blood fat,family history and TC,(The OR value of 19.015、16.990、13.971、6.507、6.358、3.500),HDL-C was protective,(OR=0.008);The independent risk factors of coronary artery disease in elderly patients were the family history,drinking,TC,Lp-PLA2(The OR value of 5.421、2.613、1.445、1.009).Conclusion The risk factors of coronary heart disease in different ages are different.Young and middle-aged patients with CHD are also related to diabetes,hypertension,smoking,family history and low HDL-C.Elderly patients with CHD are associated with alcohol and Lp-PLA2.Family history and hyperlipidemia can affect coronary artery disease.These risk factors can increase the degree of coronary atherosclerosis.
引文
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[12]裴勇.中青年冠心病发病相关因素Logistic分析[J].中国医学创新,2015,12(13):3-6
[13]Ruidavets JB,Ducimetier P,Evans A,et al.Patterns of alcohol consumption and ischaemic heart disease in cultrally divergent countries:the Prospective Epidemiological Study of Myocardial Infarction(PRIME)[J].BMJ,2010,23:341-347
[14]黄久仪,李良寿,何耀,等.冠心病家族史在冠心病发病中作用地位的研究[J].中国慢性病预防与控制,1993,1(4):158-160
[15]Graham IM,Daly LE,Refsum HM,et al.Plasma homocysteine as a risk factor for vascular disease.The Europe an Concerted Action Project[J].JAMA,1997,277(22):1775-1781
[16]Olafiranye O,Zizi F,Brimah P,et al.Management of hypertension among patients with coronary heart disease[J].Int J Hypertens,2011,2011:653903
[17]Packard CJ,O'Reilly DS,Caslake MJ,et al.Lipoproteinassociated phospholipase A2as an independent predictor of coronary heart disease[J].West of Scotland Coronary Prevention Study Group,N Engl J Med,2000,343(16):1148-1155
[18]Corson MA,Jones PH,Davidson MH.Review of the evidence for the clinical utility of lipoprotein-associated phospholipaseA2as a cardiovascular risk marker[J].Am J Cardiol,2008,101(12A):41F-50F
[19]费菲.最新解读“脂蛋白相关磷脂酶A2临床应用中国专家建议”-第26届长城国际心脏病学会议(GWICC)暨亚太心脏大会2015现场回顾[J].中国医药科学,2015,5(21):4-8
[20]蔡红雁,冯星星,赵玲,等.冠状动脉狭窄程度和病变血管支数与冠心病危险因素的相互关系研究[J].昆明医学院学报,2010,31(2):25-30
[2]国家卫生和计划生育委员会.中国卫生和计划生育统计年鉴[M].北京:中国协和医科大学出版社,2016,293-323
[3]王彦斌,邱服斌,任素芳.高尿酸血症与冠心病及危险因素的相关性分析[J].中西医结合心脑血管病杂志,2012,10(1):9-11
[4]方圻,王钟林,宁田海,等.血脂异常防治建议[J].中华心血管病杂志,1997,25(3):10-14
[5]Gabir MM,Hanson RL,Dabelea D,et al.The1997 American Diabetes Association and 1999World Health Organization criteria hyperglycemia in the diagnosis and prediction of diabetes[J].Diabetes Care,2000,23(8):1108-1112
[6]Gensini GG.A more meaningful scoring system for determining the severity of coronary heart disease[J].Am J Cardiol,1983,51:606
[7]林彬.游离脂肪酸和稳定型冠心病及急性冠脉综合征相关性分析[D].福州:福建医科大学,2016
[8]Christodoulidis G,Vittorio T J,Fudim M,et al.Inflammation in coronary artery disease[J].Cardiol Rev,2014,22(6):279-288
[9]Dufour AB,Hannan MT,Murabito JM,et al.Sarcopeniadefinitions considering body size and fat mass are associated withmobility limitations:the Framingham Study[J].Gerontol A Biol SciMed Sci,2013,68(2):168-174
[10]Neaton JD,Wentworth D.Srum cholesterol,blood pressure,cigarettesmoking and coronary heart disease-over-all finding and differencesby age for 316,099 white men[J].Arch Intern Med,1992,152(1):56-64
[11]胡司淦,陈耀,卢冬雨,等.中青年与老年男性冠心病患者的临床特征比较[J].中国老年学杂志,2015,35(6):1557-1559
[12]裴勇.中青年冠心病发病相关因素Logistic分析[J].中国医学创新,2015,12(13):3-6
[13]Ruidavets JB,Ducimetier P,Evans A,et al.Patterns of alcohol consumption and ischaemic heart disease in cultrally divergent countries:the Prospective Epidemiological Study of Myocardial Infarction(PRIME)[J].BMJ,2010,23:341-347
[14]黄久仪,李良寿,何耀,等.冠心病家族史在冠心病发病中作用地位的研究[J].中国慢性病预防与控制,1993,1(4):158-160
[15]Graham IM,Daly LE,Refsum HM,et al.Plasma homocysteine as a risk factor for vascular disease.The Europe an Concerted Action Project[J].JAMA,1997,277(22):1775-1781
[16]Olafiranye O,Zizi F,Brimah P,et al.Management of hypertension among patients with coronary heart disease[J].Int J Hypertens,2011,2011:653903
[17]Packard CJ,O'Reilly DS,Caslake MJ,et al.Lipoproteinassociated phospholipase A2as an independent predictor of coronary heart disease[J].West of Scotland Coronary Prevention Study Group,N Engl J Med,2000,343(16):1148-1155
[18]Corson MA,Jones PH,Davidson MH.Review of the evidence for the clinical utility of lipoprotein-associated phospholipaseA2as a cardiovascular risk marker[J].Am J Cardiol,2008,101(12A):41F-50F
[19]费菲.最新解读“脂蛋白相关磷脂酶A2临床应用中国专家建议”-第26届长城国际心脏病学会议(GWICC)暨亚太心脏大会2015现场回顾[J].中国医药科学,2015,5(21):4-8
[20]蔡红雁,冯星星,赵玲,等.冠状动脉狭窄程度和病变血管支数与冠心病危险因素的相互关系研究[J].昆明医学院学报,2010,31(2):25-30