冠心病危险因素的Logistic回归分析

目的 分析冠心病（CHD）与其常见危险因素之间的关系、心肌梗塞（MI）和心绞痛（AP）间的关系及早发冠心病的特点，为CHD的预防提供理论依据。方法 通过病例一对照研究设计，对病例组235例和对照组进行Logistic回归分析，探讨CHD的危险因素。结果 结论 高血压病史、CHD家族史、糖尿病、吸烟、血脂异常和超重是冠心病的主要危险因素；吸烟、被动吸烟史、冠心病家族史可能是冠心病患者发生心绞痛事件的危险因素；吸烟、冠心病家族史可能是导致早期发现冠心病的重要原因。     

不同年龄段心肌梗塞危险因素的比较

将２２８例急性心肌梗塞病人分成三个年龄组，以规范的流行病学调查方法对常见危险因素进行了调查和测量。结果显示：６５岁以上老年组高血压、糖尿病、女性、梗塞前心绞痛病史及心电图检出的心肌缺血等暴露率高于其它两组，而吸烟、心脑血管病家族史及心肌梗塞的诱因等暴露率则低于其它两组。脂代谢标志及冠状动脉病变无显著差异。     

青壮年冠心病危险因素的病例对照研究

目的 探讨青壮年冠心病的危险因素。方法 用病例－对照研究方法将确诊入院治疗的青壮年冠心病病人60人作为病例组（I组），另将入院的非心脏病青壮年60名（Ⅱ组）和60名老年冠心病病人（Ⅲ组）作为不同的对照组，进行询问调查和辅助检查。结果 单因素分析表明，I组病人在高血压病家族史、冠心病家族史和吸烟项目上与Ⅱ组、Ⅲ组比较差异明显（P＜0．05或P＜0．01），OR值分别是：高血压家族史为1．42和2．67，冠心病家族史为2．17和2．68，吸烟为1．93和2．28。经Logistic回归结果显示：青壮年冠心病的主要危险因素是高血压和冠心病家族史、吸烟、高血压病史及体重指数较大，与老年冠心病人发病的危险因素确有不同。结论 对于青少年，特别是具有家族阳性病史的青壮年进行有效地控制吸烟、体重和血压对于防止青壮年冠心病具有重要的意义。     

某些感染因子与冠状动脉粥样硬化性疾病的关系

冠状动脉疾病 (CoronaryArteryDisease ,CAD)是最常见的动脉粥样硬化性疾病 ,早在 2 0世纪 6 0年代 ,WHO就宣布CAD是最严重的疾病之一。全球冠心病发病呈上升趋势 ,有文献预计到 2 0 2 0年 ,冠心病将成为世界排名第一的最重要的疾病。我国冠心病新发病例达到 75万 /年 ,心血管疾病是我国城市居民第一位死因 ,心血管病死亡率已高于日本、法国等发达国家〔1〕。多年的研究显示 ,独立的冠心病危险因素包括年龄、吸烟史、心绞痛病史、心肌梗塞家族史、高血压、高血脂及糖尿病等 ,其中高脂血症、高血压、吸烟、肥胖、糖尿病等属于可改变因素…     

早发冠心病患者危险因素的临床研究

目的探讨早发冠心病患者的危险因素特点。方法152例经冠状动脉造影确诊的冠心病患者,根据年龄分为早发冠心病组（男性〈55岁,女性〈65岁）74例和对照组78例。对两组患者的相关资料进行回顾性统计分析,比较二者的血脂水平、高血压病史、糖尿病病史、冠心病家族史、吸烟史、饮酒史等,评价在两组人群间是否存在差异性。结果旱发冠心病组中吸烟史,冠心病家族史,血清总胆固醇高于老年冠心病组;而高血压病史、糖尿病史低于老年冠心病组。结论早发冠心病患者吸烟、冠心病阳性家族史,高胆固醇血症是主要的危险因素。     

武汉市中青年心肌梗塞发病的相关危险因素分析

目的 探讨武汉市中青年心肌梗塞发病的相关危险因素,为中青年心肌梗塞的预防提供理论依据。 方法 采用病例对照研究方法分析武汉市第一医院2013年1月—2018年12月就诊的18~45岁中青年心肌梗塞患者及健康体检者,并对心肌梗塞的相关危险因素进行单因素分析和多因素logistic回归分析。 结果 通过对病例组及对照组研究对象相关危险因素进行单因素分析发现,两组在性别、BMI、腰臀比、文化程度、人均月收入、高血压、糖尿病、高血脂、高尿酸、冠心病家族史、吸烟、酗酒及每日睡眠时间等方面差异均有统计学意义(均P＜0.05);两组生化指标对比分析发现,病例组在总蛋白、谷氨酸天冬氨酸转移酶、天门冬氨酸氨基转移酶、谷氨酰转肽酶、总胆红素、直接胆红素、尿素氮、肌酐、血尿酸、血钠、血同型半胱氨酸、促甲状腺激素、血小板计数及平均血小板体积等方面与对照组相比差异有统计学意义(均P＜0.05);将心肌梗塞相关危险因素单因素分析中有统计学差异的因素纳入logistic回归模型中进行中青年心肌梗塞的多因素分析,结果显示,性别(OR=5.936)、血压(OR=3.228)、血脂(OR=1.912)、冠心病家族史(OR=3.380)、吸烟(OR=4.242)、酗酒(OR=1.415)、每日睡眠时间(OR=6.527)是中青年心肌梗塞的影响因素,且均有统计学意义(均P＜0.05)。 结论 男性、高血压、高血脂、有冠心病家族史、吸烟、酗酒、每日睡眠时间＜6 h是武汉市中青年心肌梗塞的相关危险因素,因此建议中青年应戒烟限酒,改变不良生活才习惯,重视体检,尽早发现高血压、高血脂等危险因素并进行针对性预防。     

比较不同性别早发冠心病患者临床危险因素的差异

目的比较不同性别早发冠心病患者的危险因素差异。方法就本院治疗的160例男性及148例女性冠心病患者的临床资料进行回顾性分析,对高脂血症、糖尿病、高血压、早发冠心病家族史、脑卒中病史、吸烟等冠心病高危因素进行比较分析。结果男性吸烟率明显高于女性,女性高血压患病率明显高于男性,两组吸烟率、高血压患病率比较差异具有统计学意义(P<0.01);两组高脂血症、糖尿病、早发冠心病家族史、脑卒中病史比较差异无统计学意义(P>0.05)。结论吸烟是男性早发冠心病的高危因素,高血压则是女性的高危因素,临床应针对男女不同高危因素制定干预方案。     

冠心病心绞痛患者急性心血管事件发生的影响因素

目的探讨冠心病心绞痛患者急性心血管事件发生的影响因素。方法选取2018年1月至10月在本院就诊的冠心病心绞痛患者131例。收集患者性别、年龄、吸烟情况以及合并糖尿病、高血压、高脂血症、冠心病家族史情况。现场测量患者身高、体重、心率,同时抽取空腹外周静脉血,检测C反应蛋白(CRP)、肌钙蛋白T、B型钠尿肽前体(pro-BNP)水平。离院后进行为期3个月的随访,根据急性心血管事件发生情况分为急性心血管事件组和对照组(未发生急性心血管事件),分析影响因素。结果随访3个月内发生急性心血管事件21例(16.03%),将其归入急性心血管事件组,其余110例归入对照组。急性心血管事件组年龄、心率以及肥胖、吸烟、糖尿病、高血压、高脂血症、冠心病家族史、CRP升高、pro-BNP升高的比例均明显高于对照组,差异均有统计学意义(均P0.01)。多因素Logistic回归分析显示,年龄、心率、吸烟、糖尿病、高血压、CRP升高、pro-BNP升高是冠心病心绞痛患者急性心血管事件发生的独立影响因素(均P0.05)。结论冠心病心绞痛患者急性心血管事件率处于较高水平,应针对高龄、心率偏高、吸烟等危险因素采取预防措施。     

早发冠心病危险因素的研究

对４３４例冠心病患者以规范的流行病学调查方法对常见危险因素进行了调查和测量,分成中青年组、老年前期组和老年组三个年龄层比较早发和晚发冠心病的危险因素的异同。单因素分析显示：早发冠心病的主要危险因素是男性、吸烟史、冠心病、高血压和脑卒中家族史,其优势比（ＯＲ）分别为３．４５、２．５８、２．１４、２．０７和２．０８,早发冠心病组每日吸烟量显著高于其他两组（Ｐ＜０．０５）。多因素分析结果显示：被筛选进入Ｌｏｇｉｓｔｉｃ回归方程的变量是高血压病史、高血压和冠心病家族史、每日吸烟量、血清总胆固醇和高密度脂蛋白水平。     

新的冠心病危险因素及其与冠状动脉病变的研究进展

冠心病是发病率较高的心血管疾病，迄今滴因尚未明确。冠心病的危险因素众多，其中高血压、吸烟、脂代谢紊乱、糖尿病与胰岛素抵抗、年龄、性别、早发心血管疾病家族史是冠心病公认的传统危险因素。而一些流行病学及实验研究都提示一些新的因素与冠心病的发生相关。这些新的危险因素及它们与冠状动脉病变的关系，成为了国内外学者研究的热点。     

Predictors of subsequent coronary events,stroke, and death among survivors of first hospitalized myocardial infarction

We identified predictors of prognosis among n = 2,677 health maintenance organization enrollees 30 to 79 years old who survived a first hospitalized myocardial infarction (MI) during 1986-1996 (mean follow-up 3.4 years). Independent risk factors for reinfarction/fatal coronary heart disease (CHD) (incidence = 49.0/1,000 person-years, 445 events) were age, diabetes, chronic congestive heart failure (CHF), angina, high body mass index (BMI), low diastolic blood pressure (DBP), high serum creatinine, and low/high-density lipoprotein (HDL) cholesterol. Independent risk factors for stroke (incidence = 13.0/1,000 person-years, 124 events) were age, diabetes, CHF, high DBP, and high creatinine. Independent predictors of death (incidence = 44.2/1,000 person-years, 431 events) were age, diabetes, CHF, continued smoking after MI, low DBP, high pulse rate, high creatinine, and low HDL cholesterol, while BMI had a significant U-shaped association with death (elevated risk at low and high BMI). The occurrence of study end points did not differ significantly between men and women after adjustment for other risk factors and use of preventive medical therapies, although men tended to have higher rates of reinfarction/CHD than women among older subjects. In summary, we demonstrated that the major cardiovascular risk factors age, diabetes, CHF, smoking, and dyslipidemia are important prognostic factors in the years after nonfatal MI. Elevated BMI was associated with increased risk of reinfarction/CHD and death and elevated DBP with increased risk of stroke, but we also observed high mortality among those with low BMI and high risk of recurrent coronary disease and death among those with low DBP. Finally, high creatinine was a strong, independent predictor of a variety of adverse outcomes after first MI.     

Parental history of coronary heart disease, hypertension, diabetes, and stroke: Relationship to coronary heart disease risk factor variables in their adult children

Relationships of parental (familial) history of coronary heart disease, stroke, hypertension, and diabetes to major coronary heart disease (CHD) risk factors were examined in 738 adults (average age, 40 years) in the Cincinnati Lipid Research Clinics Princeton School study. Men reporting parental CHD had higher plasma triglyceride and higher systolic and diastolic blood pressure than comparison group men reporting no parental CHD, stroke, hypertension, or diabetes. Women reporting parental CHD had higher plasma triglycerides than comparison group women reporting no parental CHD, stroke, hypertension, or diabetes. Men reporting stroke in one parent had higher total plasma cholesterol and triglyceride levels than comparison men. Women reporting stroke in one parent had higher triglyceride levels than comparison group women. Women reporting hypertension in one parent had higher mean triglyceride and systolic blood pressure than comparison women. Men and women reporting diabetes in one parent had higher triglyceride than comparison adults. Matching men whose fathers had died of CHD with those whose fathers were free of CHD revealed significant increments in triglyceride levels, systolic, and diastolic blood pressure in the men with positive family history of CHD. Matching women whose fathers had died of CHD with those whose fathers were free of CHD revealed higher total plasma cholesterol, low-density lipoprotein cholesterol, and Quetelet index. In men, categorical assessment by CHD risk factor levels (low, intermediate, high), revealed that plasma triglycerides and systolic blood pressure were positively associated with a parental history of CHD, while high-density lipoprotein cholesterol was inversely related. In women, similar observations were made for triglycerides. Family history is a practical tool for identification of risk to CHD, hypertension, stroke, and diabetes. Serial risk factor measurements in offspring from CHD-, hypertension-, stroke-, and diabetes-positive families should have considerable utility in early recognition and documentation of CHD risk factor levels which, in turn, should facilitate primary intervention designed to ameliorate or prevent the development of CHD.     

冠心病家族史在冠心病发病中作用地位的研究

108例经冠状动脉造影检查(CAG)确诊为冠心病和45例CAG检查结果正常的病人进行了冠心病危险因素的病例对照研究.发现冠心病家族史、高血压病家族史、吸烟、高脂饮食习惯和年龄是冠心病的主要危险因素,其中冠心病家族史的优势比(OR)为5.82,占诸危险因素的首位.冠心病、高血压和脑卒中家族史合并出现时,冠心病的OR值显著提高.多因素分析和分层分析均提示,冠心病家族史是一个独立的危险因素.     

Fibrinogen and coronary heart disease: test of causality by 'Mendelian randomization'

BACKGROUND: Blood concentrations of fibrinogen have been associated with coronary heart disease risk in epidemiological studies, but it is uncertain whether this association is causal or reflects residual confounding by other risk factors. We investigated the relationship between the single nucleotide polymorphism at position -148 in the beta-fibrinogen gene promoter (beta - 148C/T), blood fibrinogen levels, and risk of myocardial infarction (MI) in sufficiently large numbers of coronary disease cases to reliably address this question. METHODS: Genotyping and measurement of blood fibrinogen concentration were carried out in 4,685 cases of confirmed MI and 3,460 controls with no history of coronary disease. A meta-analysis of ISIS and 19 other studies of beta-fibrinogen genotypes involving a total of 12,220 coronary disease cases and 18,716 controls was conducted. RESULTS: Among the ISIS controls, mean plasma fibrinogen concentrations with the C/C, C/T and T/T genotypes were 3.34 (SE 0.015), 3.48 (0.022), and 3.60 (0.064) g/l, respectively, corresponding to an increase of 0.14 (0.024) g/l per T allele (trend P < 0.0001). In the case-control comparison, 0.14 g/l higher usual plasma fibrinogen concentration was associated with an age-adjusted and sex-adjusted risk ratio for MI of 1.17 [95% confidence interval (95% CI) 1.14-1.19; P < 0.0001]. But, after further adjustment for smoking, body mass index, and plasma apolipoprotein B/A(1) ratio, this risk ratio fell to 1.03 (95% CI 1.00-1.05; P = 0.05). Moreover, fibrinogen genotype was not significantly associated with MI incidence: risk ratio of 1.06 (95% CI 0.96-1.16) per higher-fibrinogen allele in ISIS alone and of 1.00 (95% CI 0.95-1.04) per allele in the meta-analysis. CONCLUSIONS: Genotypes that produce lifelong differences in fibrinogen concentrations do not materially influence coronary disease incidence. As these genotype-dependent differences in fibrinogen were allocated randomly at conception (Mendelian randomization), this association is not likely to be confounded by other factors. Consequently, these genetic results provide strong evidence that long-term differences in fibrinogen concentrations are not a major determinant of coronary disease risk.     

50岁以下女性冠心病的临床和冠状动脉造影特点

目的 探讨50岁以下女性冠心病患者的危险因素、临床和冠状动脉造影特点.方法 连续入选2000年4月至2008年6月行冠状动脉造影的50岁以下女性患者126例,回顾性分析女性冠心病患者的危险因素、临床及冠状动脉病变特点.结果 同期行冠状动脉造影6395例,50岁以下女性患者126例,占1.97%,其中冠心病患者44例(冠心病组),平均年龄(46.8 ±3.6)岁;非冠心病患者82例(非冠心病组),平均年龄(45.4±4.3)岁.两组合并原发性高血压[77.3%(34/44)比26.8%(22/82)]、糖尿病[34.1%(15/44)比4.9%(4/82)]、高脂血症[43.2%(19/44)比7.3%(6/82)]、冠心病家族史[43.2%(19144)比7.3%(6,82)]及冠心病危险因素家族史[52.3%(23/44)比12.2%(10/82)]比较差异有统计学意义(P<0.01).冠心病患者以急性冠脉综合征为主[占88.6%(39/44)],冠状动脉病变以单支病变多见[占50.0%(22/44)],左前降支是最易累及的血管,病变钙化程度较轻,病变类型以局限性和节段性为主.结论 原发性高血压、高脂血症、糖尿病、冠心病家族史及冠心病危险因素家族史为50岁以下女性冠心病的重要危险因素.有典型心绞痛症状伴有多重危险因素者,患冠心病的可能性增大.     

Association between toenail scandium levels and risk of acute myocardial infarction in European men: the EURAMIC and Heavy Metals Study

The association between scandium status and risk of acute myocardial infarction (MI) was examined in a multicentre case control study in 10 centres from Europe and Israel. Scandium in toenails was assessed in 684 cases and 724 controls less than 70 years of age. Mean concentrations of toenail scandium were 6.74 micro/kg in cases and 7.75 microg/kg in controls. Scandium among controls, adjusted for age and centre was positively associated with concentrations of lycopene and oleic acid in adipose tissue (P = 0.002 for both nutrients). Pearson correlations adjusted for age and centre were significant (P < 0.05) between scandium and lycopene (r = 0.08), zinc (r = 0.08), mercury (r = 0.18) and oleic acid (r = 0.21). Overall, cases had lower levels of scandium than controls after adjustment for age and centre (case control ratio, 0.87; 95% CI 0.79-0.96). This association persisted after adjustment for other cardiovascular risk factors (case-control ratio 0.88; 95% CI, 0.79-0.98). The risk of MI at high scandium levels was reduced after adjustment for age and centre (P-trend = 0.04). Further adjustments for BMI, history of hypertension, smoking, alcohol intake, diabetes, family history of CHD, alpha-tocopherol, beta-carotene, lycopene, selenium and mercury slightly attenuated this trend (P = 0.055). Our results suggest that toenail scandium level is associated with a reduced risk of acute MI, but we are uncertain whether this element can really play a protective role in the development of CHD. Without an identified plausible mechanism, these results should be regarded as preliminary and should be tested in future studies.     

青壮年高血压危险因素病例-对照研究

目的探讨与青壮年高血压发病有关的危险因素。方法采用病例_对照研究方法,在广州市6所大型医院对研究对象问卷调查,对调查结果进行单因素和多因素Logistic回归分析。结果单因素分析显示与青壮年高血压相关的危险因素有:性格、家境、精神紧张、便秘、蔬果摄入、豆或奶制品摄入、高脂食品摄入、饮茶、高血脂、家族史等。非条件Logistic回归分析显示,影响高血压的独立危险因素有:体质指数(BMI)>27、生育子女多、少吃豆或奶制品、家族高血压病史。结论高血压病是多因素综合作用所致,在高血压病的防治过程中,应采取综合防治的策略。     

Risk factors for coronary heart disease among firefighters in Cincinnati

Since 1984, coronary heart disease (CHD) risk, factors have been prospectively assessed among Cincinnuti, firefighters, free of CHD at study entry. In total, 806 firemen with a mean age of 37 years at entry have been, followed for 6.4 years on average, contributing 5,173 person-years. CHD risk, factors were measured every 1-4 years and included weight, blood pressure, cigarette use, fasting glucose, and lipid profile. When, in aggregate, these CHD risk, factors were, found to be in a high risk range, suggestions were made serially to reduce CHD risk. A composite high CHD risk factor score led to an exercise electrocardiogram (ECG) with thallium scan, which was repeated every 1-4 yeurs. Myocardial infarction (MI) occurred in 7 men, with 1.35 Mis/1,000 mean-years; 15 others developed CHD, with 4.25 MI + CHD/1,000 mean-years. The firefighters' MI event rate (1.35 MIS/1,000 man-years) was lower (but not significantly, p > 0.1) than that for employed 30- to 39-year-old men free of CHD at entry (2.07/1,000 man years), who had an average follow-up of 5.4 years in the NHANES I study. At study entry, the 22 men who later developed CHD (vs. the 784 who did not develop CHD) were older (p=.0001), smoked more (p=.001), and were more likely to have first degree relatives with CHD before age 60 (p=.017). After covariance adjusting for age, race, and Quetelet index, men with CHD (vs. those CHD free) had higher systolic and diastolic blood pressures (p=.0001,.0001), higher LDL cholesterol (p=.04), higher total cholesterol (p=.014), and higher triglycerides (p=.03). By Poisson regression, significant independent predictors of CHD events were age (p=.0007), cigarette smoking (p=.001), diastolic blood pressure (p=.056), and family history of CHD at ave ≤60 (p=.048). Men who later developmed CHD and those without CHD did not differ by histroy of smoke inhalation (p > 0.3). The calculated ratio of savings to cost attributable to the program per year was 5.9/1 ($258.500/$43,600). In the current study, firefighting as an occupation was not associated with increased CHD event rates. CHD events that did develop were, for the most part, associated with modifiable CHD risk factors.     

河南省商丘地区农村居民高血压危险因素分析

目的调查河南省商丘地区农村居民高血压患病情况并分析其危险因素。方法以整群抽样法对商丘地区2个行政村18周岁及其以上常住居民816人,进行健康体检和高血压危险因素问卷调查;采用SAS软件进行单因素和多因素分析。结果总标化患病率52.38%。单因素分析显示年龄、文化水平、饮酒、体质指数(BMI)、腰臀比(WHR)、家族史等与高血压患病有关。经Logisti逐步回归分析显示,性别、年龄、体质指数、腰臀比、饮酒、高血压家族史为高血压患病危险因素,在调查中仅有5%的人知道高血压的诊断标准。结论此地区农村居民高血压患病率较高,应注重加强高血压防制知识宣传,从饮食及行为习惯等方面预防高血压。