不同年龄男性急性心肌梗死患者危险因素特点及其与冠脉病变程度相关性的Logistic回归分析
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摘要
目的分析不同年龄段男性急性心肌梗死(AMI)患者的危险因素特点及其与冠脉病变程度的相关性。方法回顾性分析行冠状动脉造影术的1 740例男性AMI患者的临床资料,计算Gensini积分并分为4个等级。分别比较不同年龄组(青年组、中年组及老年组)男性AMI患者4个积分等级的各项危险因素,然后采用有序Logistic回归法分析各年龄组AMI与各项危险因素间的相关程度,并进行排序。结果不同冠脉病变积分等级之间,青年组男性AMI患者的吸烟、高血脂症、冠心病家族史、SBP、DBP、LVEF、LDL-C、TBil、IBil和Lp(a)均存在明显差异(P均<0. 05);中年组男性AMI患者的吸烟、糖尿病、高血脂症、冠心病家族史、高血压家族史、LVEF、TC、Lp(a)和ApoA均存在明显差异(P均<0. 05);老年组男性AMI患者的高血压、糖尿病、冠心病家族史、FPG、TBil、Lp(a)和ApoA/B均存在明显差异(P均<0. 05)。有序Logistic回归分析显示:各年龄组男性AMI患者的独立危险因素,在青年组依次是吸烟(OR=18. 973,P=0. 012,)、高LDL-C(OR=11. 799,P=0. 026)、低TBil(OR=3. 633,P=0. 043)和冠心病家族史(OR=2. 662,P=0. 008);在中年组依次是糖尿病(OR=9. 738,P=0. 010)、高TC(OR=3. 819,P=0. 001)和低LVEF (OR=3. 404,P=0. 000);在老年组依次是高FPG(OR=2. 841,P=0. 024)和糖尿病(OR=2. 230,P=0. 035)。结论不同年龄段男性AMI患者的危险因素各有特点,吸烟、高LDL-C、低TBil和冠心病家族史会严重影响青年男性冠脉病变程度;糖尿病、高TC和低LVEF可加重中年男性的冠脉病变;高FPG及糖尿病是严重威胁老年男性冠脉健康的最主要危险因素。
Objective It is to analyze the characteristics of risk factors and their correlation with coronary artery lesions in male patients with acute myocardial infarction( AMI) at different ages. Methods The clinical data of 1 740 male AMI patients undergoing coronary angiography were retrospectively analyzed. Their Gensini scores were calculated and divided into four grades. The risk factors of four grades of male AMI in different age groups( young group,middle-aged group and elderly group) were compared,and then the correlation between AMI and various risk factors in each age group was analyzed by ordered logistic regression and the results were ordered. Results Between the scores of different coronary lesions,there were differences in smoking,hyperlipidemia,family history of coronary heart disease,SBP,DBP,LVEF,LDL-C,TBil,IBil,and Lp( a) in male AMI patients( P < 0. 05); There were differences in smoking,diabetes,hyperlipidemia,family history of coronary heart disease,family history of hypertension,LVEF,TC,Lp( a) and Apo A in male AMI patients in middle-aged group( P < 0. 05); There were differences in hypertension,diabetes,family history of coronary heart disease,FPG,TBil,Lp( a) and Apo A/Apo B in elderly male AMI patients( P < 0. 05). Ordered logistic regression analysis showed that the independent risk factors for male AMI patients in all age groups were: smoking( OR = 18. 973,P =0. 012),high LDL-C( OR = 11. 799,P = 0. 026),low TBil( OR = 3. 633,P = 0. 043) and family history of coronary heart disease( OR = 2. 662,P = 0. 008) in the youth group; diabetes( OR = 9. 738,P = 0. 010),high TC( OR = 3. 819,P = 0. 001) and low LVEF( OR = 3. 004,P = 0. 000) in the middle-aged group; high FPG( OR = 2. 841,P = 0. 024)and diabetes( OR = 2. 230,P = 0. 035) in the elderly group. Conclusion The risk factors of male AMI patients at different ages have their own characteristics. Smoking,high LDL-C,low TBil and family history of coronary heart disease can seriously influence the degree of coronary artery disease in young men; diabetes high TC and low LVEF can aggravate coronary lesions in middle-aged males; high FPG and diabetes are the most important risk factors for severe coronary heart disease in older men.
Objective It is to analyze the characteristics of risk factors and their correlation with coronary artery lesions in male patients with acute myocardial infarction( AMI) at different ages. Methods The clinical data of 1 740 male AMI patients undergoing coronary angiography were retrospectively analyzed. Their Gensini scores were calculated and divided into four grades. The risk factors of four grades of male AMI in different age groups( young group,middle-aged group and elderly group) were compared,and then the correlation between AMI and various risk factors in each age group was analyzed by ordered logistic regression and the results were ordered. Results Between the scores of different coronary lesions,there were differences in smoking,hyperlipidemia,family history of coronary heart disease,SBP,DBP,LVEF,LDL-C,TBil,IBil,and Lp( a) in male AMI patients( P < 0. 05); There were differences in smoking,diabetes,hyperlipidemia,family history of coronary heart disease,family history of hypertension,LVEF,TC,Lp( a) and Apo A in male AMI patients in middle-aged group( P < 0. 05); There were differences in hypertension,diabetes,family history of coronary heart disease,FPG,TBil,Lp( a) and Apo A/Apo B in elderly male AMI patients( P < 0. 05). Ordered logistic regression analysis showed that the independent risk factors for male AMI patients in all age groups were: smoking( OR = 18. 973,P =0. 012),high LDL-C( OR = 11. 799,P = 0. 026),low TBil( OR = 3. 633,P = 0. 043) and family history of coronary heart disease( OR = 2. 662,P = 0. 008) in the youth group; diabetes( OR = 9. 738,P = 0. 010),high TC( OR = 3. 819,P = 0. 001) and low LVEF( OR = 3. 004,P = 0. 000) in the middle-aged group; high FPG( OR = 2. 841,P = 0. 024)and diabetes( OR = 2. 230,P = 0. 035) in the elderly group. Conclusion The risk factors of male AMI patients at different ages have their own characteristics. Smoking,high LDL-C,low TBil and family history of coronary heart disease can seriously influence the degree of coronary artery disease in young men; diabetes high TC and low LVEF can aggravate coronary lesions in middle-aged males; high FPG and diabetes are the most important risk factors for severe coronary heart disease in older men.
引文
[1]国家“九五”科技攻关课题协作组.我国中年人群心血管主要危险因素流行现状及从80年代初至90年代末的变化趋势[J].中华心血管病杂志,2001,29(2):70-80
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[3] Masood A,Jafar SS,Akram Z. Serum high sensitivity Creactive protein levels and the severity of coronary atherosclerosis assessed by angiographic gensini score[J]. J Pak Med Assoc,2011,61(4):325-327
[4] Rumana N,Kita Y,Turin TC,et al. Trend increase in the Incidence of Acutemyocardial infarction in a Japanese Population[J]. Am Epidemiol,2008,4(1):11-12
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[7]刘金涛,王梅,周云,等.青年冠心病患者的临床特征与青年人冠心病发病相关因素[J].医学综述,2017,23(1):134-137
[8] Stallones RA. The association between tobacco smoking and coronary heart disease[J]. Int J Epidemiol,2015,44(3):735-743
[9]吴燕丹. TC/HDL-C、LDL-C/HDL-C、TG/HDL-C与冠心病不同程度相关性[J].临床误诊误治,2014,27(6):64-67
[10]姚兆基.血清胆红素与尿酸检验在冠心病诊断中的价值研究[J].医学检验与临床,2017,28(5):47-48
[11]朱灿,石红勋,陈伟,等. 40岁以下青年冠心病患者冠状动脉造影的特点及其危险因素的Logistic回归分析[J].岭南心血管病杂志,2016,22(2):141-144
[12]卢秀英,刘红.青年与老年急性心肌梗死患者危险因素及冠状动脉病变特征对比分析[J].宁夏医科大学学报,2017,39(3):348-350
[13]陈国伟.血脂异常与冠心病.中国实用内科杂志,2004,24(5):261-262
[14]张新娅,韩雅玲,荆全民,等.老年冠心病患者心血管病危险因素与冠状动脉病变程度的相关性分析[J].解放军医学杂志,2011,36(4):340-343
[15]陶涛,袁静.血压、血脂、血糖及肾功能不同水平对老年高血压心血管事件的影响[J].河北医药,2017,39(2):204-207
[2]胡大一.重视东方循证医学的证据,做好中国心血管疾病的预防[J].中国心血管病研究,2007,5:721-723
[3] Masood A,Jafar SS,Akram Z. Serum high sensitivity Creactive protein levels and the severity of coronary atherosclerosis assessed by angiographic gensini score[J]. J Pak Med Assoc,2011,61(4):325-327
[4] Rumana N,Kita Y,Turin TC,et al. Trend increase in the Incidence of Acutemyocardial infarction in a Japanese Population[J]. Am Epidemiol,2008,4(1):11-12
[5]王晨,王建安.内科学[M].北京:人民卫生出版社,2015
[6]高阅春,何继强,姜腾勇,等.冠心病患者冠状动脉病变严重程度与冠心病危险因素的相关分析[J].中国循环杂志,2012,27(3):178-181
[7]刘金涛,王梅,周云,等.青年冠心病患者的临床特征与青年人冠心病发病相关因素[J].医学综述,2017,23(1):134-137
[8] Stallones RA. The association between tobacco smoking and coronary heart disease[J]. Int J Epidemiol,2015,44(3):735-743
[9]吴燕丹. TC/HDL-C、LDL-C/HDL-C、TG/HDL-C与冠心病不同程度相关性[J].临床误诊误治,2014,27(6):64-67
[10]姚兆基.血清胆红素与尿酸检验在冠心病诊断中的价值研究[J].医学检验与临床,2017,28(5):47-48
[11]朱灿,石红勋,陈伟,等. 40岁以下青年冠心病患者冠状动脉造影的特点及其危险因素的Logistic回归分析[J].岭南心血管病杂志,2016,22(2):141-144
[12]卢秀英,刘红.青年与老年急性心肌梗死患者危险因素及冠状动脉病变特征对比分析[J].宁夏医科大学学报,2017,39(3):348-350
[13]陈国伟.血脂异常与冠心病.中国实用内科杂志,2004,24(5):261-262
[14]张新娅,韩雅玲,荆全民,等.老年冠心病患者心血管病危险因素与冠状动脉病变程度的相关性分析[J].解放军医学杂志,2011,36(4):340-343
[15]陶涛,袁静.血压、血脂、血糖及肾功能不同水平对老年高血压心血管事件的影响[J].河北医药,2017,39(2):204-207