老年血脂水平与颈动脉和冠状动脉狭窄关系的临床分析

目的探讨老年人群中血脂水平对颈动脉、冠状动脉(冠脉)狭窄发生的影响。方法选择315例冠脉造影患者,181例年龄≥65岁为老年组、其余<65岁的134例为对照组。同时进行血脂水平测定、冠脉和颈动脉造影;采用定量分析方法对冠脉病变特征,计算冠脉狭窄病变积分,并依据有无血脂异常、冠脉狭窄程度进一步分为不同的亚组。结果老年组与对照组平均年龄为(73.73±5.34)岁、(55.96±6.54)岁,诊断血脂异常分别为53例(29.28%),36例(26.86%)。冠脉病变严重程度积分老年组明显高于对照组(P<0.05),血脂异常亚组的积分明显高于非血脂异常亚组[老年组(7.03±6.65)分vs(6.61±5.73)分,对照组(5.72±5.90)分vs(4.59±5.00)分,P<0.05]。随冠脉狭窄的严重程度的升高、总胆固醇、甘油三酯、低密度脂蛋白胆固醇、脂蛋白(a)、载脂蛋白B的水平相应升高的趋势,而高密度脂蛋白胆固醇、载脂蛋白A1水平则呈现逐渐降低趋势,老年组与对照组无显著差异(P>0.05)。颈动脉狭窄老年组的检出率明显高于对照组(20.99%vs8.20%,P<0.05),血脂异常可增加老年组颈动脉狭窄的发生率(P<0.05),但冠脉病变的轻重程度与颈动脉狭窄的发生无显著关联。结论血脂异常可增加老年人群颈动脉、冠脉狭窄的发生率,血脂异常的程度与冠脉病变的程度呈正相关,冠脉病变的程度与颈动脉狭窄的检出无明显关联。

The clinical analysis on relation between the serum lipid levels and coronary artery and carotid stenosis in the elderly

Objective To investigate the possible relation between the serum lipid levels and coronary artery and carotid stenosis in the elderly patients.Method 315 patients receiving coronary angiography and carotid angiography were enrolled.The patients were divided into aged group of over 65 years old and control group.The serum levels of lipids were measured.According to the levels of serum lipids and coronary angiography results,each group was further divided into different subgroups.The clinical data were used in analysis of relation between the serum lipid levels and coronary stenosis scores and the characteristics of coronary lesions or carotid stenosis.Results The mean ages of aged group and control group were(73.73±5.34) years vs (55.96±(6.54)) years respectively.The incidence rates of hyperlipidemia were 29.28% vs 26.86% respectively.The coronary stenosis scores were higher in aged group than in control group(P<0.05).Compared with no hyperlipidemia subgroup,hyperlipidemia subgroup had more severe coronary stenosis.The patients with carotid and coronary artery stenosis were found to have higher serum levels of TC,TG,LDL,Lp(a),ApoB and lower levels of HDL and ApoA1.A total of 49 cases with carotid stenosis were found.The incidence of carotid artery stenosis was higher in aged group than in control group(20.99% vs 8.20%,)and in hyperlipidemia subgroup than in no hyperlipidemia subgroup(P<0.05).The incidence of carotid artery stenosis was not different between mild,moderate and severe coronary stenosis subgroups(P>0.05).Conclusions The incidence of carotid and coronaryarterystenosis wasincreased by hyperlipidemiainaged people.The patients withcarotid and cor-onary artery stenosis were foundto have higher serumlevels of lipids.There was no significant correlation be-tweenthe degree of coronary stenosis and carotid artery stenosis.