冠心病患者冠状动脉病变进展的相关危险因素的探讨

目的:探讨影响冠状动脉粥样硬化性心脏病患者冠状动脉病变进展的危险因素。方法:选择138例在航空总医院心内科复查冠状动脉造影的冠心病患者,根据2次冠状动脉造影情况,分为冠状动脉进展组(86例)和无进展组(52例)。比较两组患者性别、年龄、吸烟史、高血压病史、糖尿病史、BMI、LDL、TG、TC、HDL-C以及两组糖尿病患者Hb A1c水平。采用多元Logistic回归分析各相关因素对冠状动脉病变进展的影响。结果:与无进展组相比,进展组男性比例更高(70%vs.42%,P<0.05),吸烟者比例更高(34.9%vs.11.5%,P<0.05),糖尿病患者比例更高(65%vs.31%,P<0.001)。糖尿病患者糖化血红蛋白比无进展组明显升高[(8.2±1.0)%vs.(6.4±0.8)%,P<0.05]。两组LDL平均值无差异,但无进展组LDL-C<1.4 mmol/L的比例明显高于进展组(23%vs.9%,P=0.03)。Logistic回归分析显示,男性(OR=4.800,95%CI:4.250~5.160,P=0.021)、吸烟(OR=3.966,95%CI:3.345~4.532 P=0.046)、糖尿病史(OR=4.048,95%CI:3.827~4.324,P=0.008)、Hb Alc(OR=59.44,95%CI:56.34~62.56,P<0.001)是冠心病患者冠状动脉病变进展的危险因素。结论:男性、吸烟、糖尿病、Hb A1c水平是冠心病患者冠状动脉病变进展最主要的危险因素,LDL促进冠状动脉病变进展。戒烟、控制Hb A1c水平以及控制LDL-c<1.4 mmol/L对延缓冠状动脉病变进展意义重大。

To investigate the risk factors associated with the progression of coronary artery lesion in patients with coronary heart disease

Objective:To explore the risk factors associated with the progression of coronary artery lesion in patients with coronary atherosclerosis heart disease.Methods:A total of 138 cases with coronary disease who underwent coronary angiography reexamination in the Department of Cardiology,Aviation General Hospital.They were divided into two groups according to the coronary angiography images:the progressive group(86 cases)and the non-progressive group(52 cases).We compared the sex,age,smoking,history of hypertension,history of diabetes,BMI,LDL-c,TG,TC and Hb A1 c between the two groups.Using multivariate Logistic regression analysis to analyze the effect of the risk factors on the coronary artery lesion progression.Results:Compared with the non-progressive coronary artery group,the proportion of males in the progressive group was higher(70%vs.42%,P<0.05).The proportion of smokers was higher in the progressive group(34.9%vs.11.5%,P<0.05).The proportion of diabetic patients was higher in the progressive group(65%vs.31%,P<0.001).The average Hb A1 c of the diabetic patients in the progressive group was significantly higher than that in the non-progressive group[(8.2±1.0)%vs.(6.4±0.8)%,P<0.05].There was no statistical difference of the average level of the LDL between the two groups.However,the proportion of the patients whose LDL<1.4 mmol/L in the non-progressive group was significantly higher than the progressive group(23%vs.9%,P=0.03).Multivariate Logistic regression analysis found that male(OR=4.8,95%CI:4.25-5.16,P=0.021),smoking(OR=3.966,95%CI:3.345-4.532,P=0.046),diabetes(OR=4.048,95%CI:3.827-4.324,P=0.008),the Hb A1 c level(OR=59.44,95%CI:56.34-62.56,P<0.001)are the independent risk factors on the coronary artery lesion progression in patients with CHD.Conclusions:Male,smoking,diabetes and Hb A1 c level are the most important risk factors of the progression of coronary artery lesion.Quitting smoking and controlling the level of glycated hemoglobin and controlling LDL below 1.4 mmol/L are of great significance in delaying the progression of coronary artery disease.