合并强直性脊柱炎的急性冠状动脉综合征患者的传统危险因素特点
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摘要
目的分析合并强直性脊柱炎(AS)的急性冠状动脉综合征(ACS)患者的传统危险因素特点。方法回顾性分析2002年1月至2017年6月在首都医科大学附属北京安贞医院住院的76例合并AS的ACS患者的临床资料(观察组),同期完全随机选取住院的未合并AS的76例ACS患者的临床资料(对照组)。比较2组患者发生ACS传统危险因素方面的差异。结果观察组男性比例高于对照组,ACS发病年龄小于对照组[94.7%(72/76)比82.9%(63/76)、(51±10)岁比(56±10)岁],差异有统计学意义(P<0.05)。2组体重指数、心血管病家族史、吸烟史、糖尿病史、高血压史、脑卒中史比例差异均无统计学意义(均P>0.05)。观察组患者的高密度脂蛋内胆固醇(HDL-C)水平明显低于对照组[(0.94±0.22)mmol/L比(1.05±0.23)mmol/L],差异有统计学意义(P<0.05)。2组三酰甘油、总胆固醇、低密度脂蛋白胆固醇(LDL-C)、三酰甘油/HDL-C、总胆固醇/HDL-C及LDL-C/HDL-C比值差异均无统计学意义(均P>0.05)。结论对于早发、尤其是青年男性,以HDL-C降低更为突出的ACS患者,应详细询问病史,排除AS的合并情况。
Objective To analyze the traditional risk factors of acute coronary syndrome( ACS) complicated with ankylosing spondylitis(AS). Methods Clinical data of 76 cases of ACS with AS(observation group)and 76 cases of ACS without AS( control group) in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed from January 2002 to June 2017. Traditional risk factors of ACS were compared between groups. Results Male ratio in observation group was significantly higher and age of onset was significantly lower than those in control group[94.7%(72/76) vs 82. 9%(63/76),(51 ± 10) years old vs(56 ± 10) years old](P < 0. 05). Body mass index, family history of cardiovascular disease, smoking history, diabetes history,hypertension history and stroke history showed no significant differences between groups(P >0. 05). High-density lipoprotein cholesterol( HDL-C) level in observation group was significantly lower than that in control group[(0. 94 ± 0. 22) mmol/L vs(1. 05 ± 0. 23) mmol/L ](P < 0. 05). Levels of triacylglycerol, total cholesterol,low-density lipoprotein cholesterol(LDL-C), triacylglycerol/HDL-C, total cholesterol/HDL-C and LDL-C/HDL-C showed no significant differences between groups(P > 0. 05). Conclusion Medical history should be carefully collected in ACS patients to exclude AS, especially in premature, young, male ACS patients with low HDL-C level.
Objective To analyze the traditional risk factors of acute coronary syndrome( ACS) complicated with ankylosing spondylitis(AS). Methods Clinical data of 76 cases of ACS with AS(observation group)and 76 cases of ACS without AS( control group) in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed from January 2002 to June 2017. Traditional risk factors of ACS were compared between groups. Results Male ratio in observation group was significantly higher and age of onset was significantly lower than those in control group[94.7%(72/76) vs 82. 9%(63/76),(51 ± 10) years old vs(56 ± 10) years old](P < 0. 05). Body mass index, family history of cardiovascular disease, smoking history, diabetes history,hypertension history and stroke history showed no significant differences between groups(P >0. 05). High-density lipoprotein cholesterol( HDL-C) level in observation group was significantly lower than that in control group[(0. 94 ± 0. 22) mmol/L vs(1. 05 ± 0. 23) mmol/L ](P < 0. 05). Levels of triacylglycerol, total cholesterol,low-density lipoprotein cholesterol(LDL-C), triacylglycerol/HDL-C, total cholesterol/HDL-C and LDL-C/HDL-C showed no significant differences between groups(P > 0. 05). Conclusion Medical history should be carefully collected in ACS patients to exclude AS, especially in premature, young, male ACS patients with low HDL-C level.
引文
[1]Chou CH,Lin MC,Peng CL,et al.A nationwide populationbased retrospective cohort study:increased risk of acute coronary syndrome in patients with ankylosing spondylitis[J].Scand J Rheumatol,2014,43(2):132-136.DOI:10.3109/03009742.2013.822097.
[2]Bengtsson K,Forsblad-d'Elia H,Lie E,et al.Are ankylosing spondylitis,psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events?A prospective nationwide population-based cohort study[J].Arthritis Res Ther,2017,19(1):102.DOI:10.1186/s13075-017-1315-z.
[3]Braun J,Sieper J.Ankylosing spondylitis[J].Lancet,2007,369(9570):1379-1390.
[4]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.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.DOI:10.3760/cma.j.issn.0253-3758.2015.05.003.Chinese Society of Cardiology,Editorial Committee of the Chinese Journal of Cardiovascular Disease.Guideline for diagnosis and treatment of patients with ST-elevation myocardial infarction[J].Chinese Journal of Cardiology,2015,43(5):380-393.DOI:10.3760/cma.j.issn.0253-3758.2015.05.003.
[5]Wright RS,Anderson JL,Adams CD,et al.2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction(Updating the 2007 Guideline):a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].Circulation,2011,123(18):2022-2060.DOI:10.1161/CIR.0b013e31820f2f3e.
[6]van der Linden S,Valkenburg HA,Cats A,et al.Evaluation of diagnostic criteria for ankylosing spondylitis.A proposal for modification of the New York criteria[J].Arthritis Rheum,1984,7(4):361-368.DOI:10.1002/art.1780270401.
[7]Rubinstein A.National Cholesterol Education Program,second report of the Expert Panel on detection,evaluation,and treatment of high blood cholesterol in adults[J].Circulation,1995,91(3):908-909.
[8]National Cholesterol Education Program(NCEP)Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults(Adult Treatment PanelⅢ).Third Report of the National Cholesterol Education Program(NCEP)Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults(Adult Treatment PanelⅢ)final report[J].Circulation,2002,106(25):3143-3421.
[9]杨伟宪,杨铮,吴永健,等.青年冠心病患者的危险因素分析[J].中国医药,2014,9(9):1249-1253.DOI:10.3760/cma.j.issn.1673-4777.2014.09.001.Yang WX,Yang Z,Wu YJ,et al.Risk factors of coronary heart disease in young patient[J].China Medicine,2014,9(9):1249-1253.DOI:10.3760/cma.j.issn.1673-4777.2014.09.001.
[10]Karabag T,Akpinar I,Okten RS,et al.Severe main coronary artery disease in a young woman with ankylosing spondylitis[J].Intern Med,2012,51(18):2635-2637.
[11]Zhang X,Liu R,Wang J,et al.Risk of premature cerebrovascular disease in patients with ankylosing spondylitis[J].Acta Reumatol Port,2016,41(4):322-327.
[12]武志强,杨滨,冯伟华,等.强直性脊柱炎患者血脂水平及与疾病活动度的相关性[J].检验医学,2017,32(5):370-373.DOI:10.3969/j.issn.1673-8640.2017.05.005.Wu ZQ,Yang B,Feng WH,et al.Correlation of blood lipid levelswith ankylosing spondylitis[J].Lab Med,2017,32(5):370-373.DOI:10.3969/j.issn.1673-8640.2017.05.005.
[13]Gkolfinopoulou C,Stratikos E,Theofilatos D,et al.Impaired antiatherogenic functions of high-density lipoprotein in patients with ankylosing spondylitis[J].J Rheumatol,2015,42(9):1652-1660.DOI:10.3899/jrheum.141532.
[14]毋静,古洁若,黄建林.200例强直性脊柱炎患者血脂及心电图变化回顾分析[J].诊断学理论与实践,2006,5(5):433-434.DOI:10.3969/j.issn.1671-2870.2006.05.016.Wu J,Gu JR,Huang JL.A retrospective analysis of changes of blood lipids and electrocardiogram in 200 patients with ankylosing spondylitis[J].Journal of Diagnostics Concepts&Practice,2006,5(5):433-434.DOI:10.3969/j.issn.1671-2870.2006.05.016.
[15]Semb AG,Kvien TK,DeMicco DA,et al.Prediction of cardiovascular events in patients with ankylosing spondylitis[J].J Rheumatol,2012,39(7):1433-1440.DOI:10.3899/jrheum.111307.
[16]Berg IJ,van der Heijde D,Dagfinrud H,et al.Disease activity in ankylosing spondylitis and associations to markers of vascular pathology and traditional cardiovascular disease risk factors:a cross-sectional study[J].J Rheumatol,2015,42(4):645-653.DOI:10.3899/jrheum.141018.
[2]Bengtsson K,Forsblad-d'Elia H,Lie E,et al.Are ankylosing spondylitis,psoriatic arthritis and undifferentiated spondyloarthritis associated with an increased risk of cardiovascular events?A prospective nationwide population-based cohort study[J].Arthritis Res Ther,2017,19(1):102.DOI:10.1186/s13075-017-1315-z.
[3]Braun J,Sieper J.Ankylosing spondylitis[J].Lancet,2007,369(9570):1379-1390.
[4]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.急性ST段抬高型心肌梗死诊断和治疗指南[J].中华心血管病杂志,2015,43(5):380-393.DOI:10.3760/cma.j.issn.0253-3758.2015.05.003.Chinese Society of Cardiology,Editorial Committee of the Chinese Journal of Cardiovascular Disease.Guideline for diagnosis and treatment of patients with ST-elevation myocardial infarction[J].Chinese Journal of Cardiology,2015,43(5):380-393.DOI:10.3760/cma.j.issn.0253-3758.2015.05.003.
[5]Wright RS,Anderson JL,Adams CD,et al.2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction(Updating the 2007 Guideline):a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].Circulation,2011,123(18):2022-2060.DOI:10.1161/CIR.0b013e31820f2f3e.
[6]van der Linden S,Valkenburg HA,Cats A,et al.Evaluation of diagnostic criteria for ankylosing spondylitis.A proposal for modification of the New York criteria[J].Arthritis Rheum,1984,7(4):361-368.DOI:10.1002/art.1780270401.
[7]Rubinstein A.National Cholesterol Education Program,second report of the Expert Panel on detection,evaluation,and treatment of high blood cholesterol in adults[J].Circulation,1995,91(3):908-909.
[8]National Cholesterol Education Program(NCEP)Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults(Adult Treatment PanelⅢ).Third Report of the National Cholesterol Education Program(NCEP)Expert Panel on Detection,Evaluation,and Treatment of High Blood Cholesterol in Adults(Adult Treatment PanelⅢ)final report[J].Circulation,2002,106(25):3143-3421.
[9]杨伟宪,杨铮,吴永健,等.青年冠心病患者的危险因素分析[J].中国医药,2014,9(9):1249-1253.DOI:10.3760/cma.j.issn.1673-4777.2014.09.001.Yang WX,Yang Z,Wu YJ,et al.Risk factors of coronary heart disease in young patient[J].China Medicine,2014,9(9):1249-1253.DOI:10.3760/cma.j.issn.1673-4777.2014.09.001.
[10]Karabag T,Akpinar I,Okten RS,et al.Severe main coronary artery disease in a young woman with ankylosing spondylitis[J].Intern Med,2012,51(18):2635-2637.
[11]Zhang X,Liu R,Wang J,et al.Risk of premature cerebrovascular disease in patients with ankylosing spondylitis[J].Acta Reumatol Port,2016,41(4):322-327.
[12]武志强,杨滨,冯伟华,等.强直性脊柱炎患者血脂水平及与疾病活动度的相关性[J].检验医学,2017,32(5):370-373.DOI:10.3969/j.issn.1673-8640.2017.05.005.Wu ZQ,Yang B,Feng WH,et al.Correlation of blood lipid levelswith ankylosing spondylitis[J].Lab Med,2017,32(5):370-373.DOI:10.3969/j.issn.1673-8640.2017.05.005.
[13]Gkolfinopoulou C,Stratikos E,Theofilatos D,et al.Impaired antiatherogenic functions of high-density lipoprotein in patients with ankylosing spondylitis[J].J Rheumatol,2015,42(9):1652-1660.DOI:10.3899/jrheum.141532.
[14]毋静,古洁若,黄建林.200例强直性脊柱炎患者血脂及心电图变化回顾分析[J].诊断学理论与实践,2006,5(5):433-434.DOI:10.3969/j.issn.1671-2870.2006.05.016.Wu J,Gu JR,Huang JL.A retrospective analysis of changes of blood lipids and electrocardiogram in 200 patients with ankylosing spondylitis[J].Journal of Diagnostics Concepts&Practice,2006,5(5):433-434.DOI:10.3969/j.issn.1671-2870.2006.05.016.
[15]Semb AG,Kvien TK,DeMicco DA,et al.Prediction of cardiovascular events in patients with ankylosing spondylitis[J].J Rheumatol,2012,39(7):1433-1440.DOI:10.3899/jrheum.111307.
[16]Berg IJ,van der Heijde D,Dagfinrud H,et al.Disease activity in ankylosing spondylitis and associations to markers of vascular pathology and traditional cardiovascular disease risk factors:a cross-sectional study[J].J Rheumatol,2015,42(4):645-653.DOI:10.3899/jrheum.141018.