早发急性冠状动脉综合征患者家族性高胆固醇血症院内诊疗现状调查

目的探讨早发急性冠状动脉综合征(ACS)患者家族性高胆固醇血症(FH)的患病率及诊疗现状。方法回顾性收集2016年1月至2017年12月收治于第906医院的早发ACS患者275例,收集患者的人口学资料、既往病史、血脂水平、冠状动脉造影检查结果及药物治疗情况等,采用荷兰脂质监测指南标准进行评分并分为可能FH组(评分≥3分)和不可能FH组(评分<3分),分析ACS患者FH患病率及院内诊疗特点。结果早发ACS患者FH患病率为0.36%。与不可能FH组比较,可能FH组患者的年龄更小(t=-2.021,P<0.05),合并冠心病家族史及冠状动脉多支病变的比例更高(χ²=5.131、2.366,P<0.05),可能FH组患者具有更高的总胆固醇、低密度脂蛋白胆固醇及载脂蛋白B水平(t=1.042、2.043、8.458,P<0.05),出院时可能FH组仍以低强度他汀治疗为主(68.66%),中等强度他汀治疗比例及联合依折麦布治疗比例较不可能FH组更高(χ²=-3.381、-2.473,P<0.05)。结论早发ACS患者具有一定的FH患病率,但诊断率较低。可能FH组患者具有更高的总胆固醇、低密度脂蛋白胆固醇及载脂蛋白B水平,发作ACS时的年龄更小,合并冠状动脉多支病变更常见,且强化降脂治疗比例低。

Familial hypercholesterolemia in patients with premature acute coronary syndrome:hospital diagnosis and treatment

Objective To investigate the prevalence,diagnosis and treatment of familial hypercholesterolemia(FH)in patients with premature acute coronary syndrome(ACS).Methods 275 patients with premature ACS admitted to 906 hospital from January 2016 to December 2017 were enrolled.Clinical features,past medical history,cholesterol levels,results of angiography and medication management in all patients were collected.FH patients were identified using the Dutch Lipid Clinic Network Criteria and divided into two groups:possible FH(score≥3)and unlikely FH(score<3).Results The prevalence of FH in premature ACS patients was 0.36%.Compared to unlikely FH group,patients in the possible FH group were younger(t=-2.021,P<0.05)with higher occurrence of familial coronary heart disease history and multi-coronary artery lesions(χ²=5.131,2.366;P<0.05).Possible FH patients also had significantly higher level of total cholesterol(TC),low-density lipoprotein cholesterol(LDL-C)and apolipoprotein B(Apo B)(t=1.042,2.043,8.458;P<0.05).At discharge,lowintensity statins were still the main treatment in possible FH group(68.66%),and the proportions of moderate intensity statins and combination with ezetimibe in possible FH group were higher than those in unlikely FH group(χ²=-3.381,-2.473;P<0.05).Conclusion The prevalence of FH is common in patients with premature ACS.However,but FH is poorly diagnosed.Possible FH patients have higher TC,LDL-C and Apo B,and also are younger with a significantly higher occurrence of multi-coronary artery lesions.The proportion of intensive lipid-lowering therapy is low.