绝经前女性冠心病患者的临床和冠状动脉造影特点

目的:分析绝经前女性冠心病(CAD)患者的临床和冠状动脉(冠脉)造影特点.方法:对比2004-04至2007-12所有第一次因胸部不适而行冠脉造影的绝经前565例患者,根据造影结果分为绝经前冠心病组280例,平均年龄(44.12±4.48)岁,绝经前正常组285例,平均年龄(44.24±3.48)岁,绝经后经冠脉造影确定冠心病的患者为绝经后冠心病组721例,平均年龄(58.09±1.44)岁,分析其临床和冠脉造影特点.结果:绝经前冠心病组与绝经后冠心病组相比,高血压(55%比66%)、2型糖尿病(15.0%比31.5%)和高脂血症(23.9%比37.4%)的发生率显著减少,P均<0.05.绝经前冠心病组比绝经后冠心病组单支病变的发生率显著增高(43.2%比26.9%,P<0.001),差异有统计学意义;而三支病变的发生率则显著降低(20.4%比33.8%,P<0.001);左主干(2.9%比1.1%,P=0.048)和前降支近端(50.4%比38.6%,P<0.001)重度狭窄(狭窄≥90%)的发生率却显著增高,差异有统计学意义.结论:绝经前女性具有典型胸痛症状,冠脉造影常显示严重的冠脉狭窄病变,而且这些病变常位于左主干和前降支近端.     

50岁以下绝经与未绝经女性冠心病的临床和冠状动脉病变特点

目的:探讨50岁以下绝经与未绝经女性冠心病患者的临床和冠状动脉病变特点。方法:连续入选2000年4月~2008年6月入住北京友谊医院心脏中心并且经冠状动脉造影证实冠心病的50岁以下女性患者44例,占同期冠状动脉造影总数6395例的0.7%,根据绝经与未绝经分为绝经组和未绝经组。回顾分析2组的危险因素、临床及其冠状动脉病变特点。结果:冠心病患者共44例,其中未绝经组30例,年龄33~50岁,平均(46.6±3.8)岁;绝经组14例,年龄41~50岁,平均(47.4±2.9)岁。2组之间合并高血压、糖尿病、高脂血症等危险因素差异没有统计学意义。合并冠心病家族史在未绝经组高于绝经组,但差异无统计学意     

绝经后女性ACS患者的临床特点和危险因素分析

目的 探讨绝经后女性急性冠脉综合征(ACS)患者的临床特点及危险因素.方法 回顾性分析2012年1月至2013年12月我院明确诊断为ACS的138例绝经后女性住院患者与259例男性住院患者的临床特点及相关危险因素.结果 ①绝经后女性ACS患者发病年龄大[(62.75±8.62)岁比(56.29±10.20)岁],发病到就诊时间长[(132.30±39.56)h比(105.96±42.01)h],出现典型胸痛症状者较少(女性68.84％,男性81.47％),两组比较差异均有统计意义(P＜0.05).②绝经后女性ACS患者易合并糖尿病、高血压(女性组分别为44.93％、78.99％;男性组分别为22.01％、61.00％),两组比较差异有统计意义(P＜0.05).③绝经后女性ACS患者选择手术治疗(PCI或CABG)者少于男性组(53.62％比66.02％).造影提示女性组重度或闭塞病变较男性组发生率高(54.05％比45.03％),多支病变较男性组发生率高(78.38％比60.82％),两组比较差异有统计意义(P＜0.05).结论 绝经后女性ACS患者发病症状不典型,冠脉病变较重,其范围及严重程度与多项心血管危险因素相关,积极诊治率低,需加强对绝经后女性ACS患者的防治.     

绝经前女性急性心肌梗死患者临床特点分析

目的分析绝经前后女性急性心肌梗死患者的危险因素、临床症状和冠状动脉病变特点,探讨绝经前女性心肌梗死的临床特点。方法选取2014年1月~2016年1月因急性心肌梗死收住北京市门头沟区医院心内科且行冠状动脉造影确诊的女性患者218例,其中绝经前患者56例,绝经后患者162例,另选取同期因胸痛入院的冠状动脉造影正常的绝经前女性65例,比较分析三组患者间的危险因素、临床症状及冠状动脉病变特点。结果绝经前急性心肌梗死组与绝经前冠状动脉正常组比较:高血压、糖尿病、血脂异常、高尿酸血症、早发冠心病家族史、吸烟史及典型胸痛症状比例均显著增高(P0.05);绝经前急性心肌梗死组与绝经后急性心肌梗死组比较:高血压、糖尿病、血脂异常及高尿酸血症的发生率显著降低(P0.05),典型胸痛症状比例显著增高(P0.05),单支病变的发生率显著增高(P0.01),三支病变的发生率显著降低(P0.01),前降支病变的发生率显著增高(P0.01)。结论高血压、糖尿病、血脂异常、高尿酸血症、早发冠心病家族史及吸烟史为绝经前女性急性心肌梗死的重要危险因素,发病时有典型的胸痛症状,冠状动脉病变以单支病变多见,前降支是最易累及的血管。     

45岁以下行冠状动脉介入治疗女性冠心病患者的临床特点

目的 对照评价45岁以下行冠状动脉介入治疗的女性和男性冠心病患者的临床特点及近远期临床疗效.方法 选择2004年4月至2008年2月在阜外心血管病医院择期接受冠状动脉介入治疗的45岁以下所有未绝经的124例女性患者作为女性组,采取整群抽样的方法选择阜外心血管病医院2006至2007年所有择期行冠状动脉介入治疗的45岁以下男性患者430例作为对照(男性组).两组均在术后6个月行临床冠状动脉造影随访,所有患者均临床随访1年.结果 共入选124例女性患者160处病变,430例男性患者665处病变,两组皆完成随访.女性组的血脂异常、陈旧性心肌梗死及吸烟史比例均低于男性组(均P<0.01).左主干病变比例女性组高于男性组(11.2%比2.9%,P<0.01).左前降支比例女性组高于男性组(61.3%比46.9%P=0.016).右冠状动脉病变比例女性组低于男性组(15.6%比30.2%,P<0.01).C型病变比例女性组低于男性组(36.2%比48.9%,P=0.004).分叉病变比例女性组高于男性组(26.9%比11.1%,P<0.01).靶病变长度女性组短于男性组[(20.36±13.37)mm比(23.04±13.86)mm,P=0.027].住院期及1年随访期间,女性组与男性组主要不良心血管事件、血栓发生率及再狭窄率差异无统计学意义.结论 病变位于左主干、前降支和分叉病变的比例45岁以下女性冠心病患者高于45岁以下男性冠心病患者,但是男性患者的冠心病危险因素较多、冠状动脉病变较严重.45岁以下男、女冠心病患者冠状动脉介入治疗的近远期疗效相似.     

女性冠心病患者的临床特点

为探讨女性冠心病患者临床特点,将318例因"胸闷、胸痛"住院的女性患者,冠状动脉造影后分为冠心病组和对照组,回顾性分析冠心病发病的危险因素、临床症状及其冠状动脉病变特点.结果发现女性绝经后冠心病危险性增加.绝经后出现典型或非典型胸痛,同时伴有2个或2个以上冠心病危险因素,发生冠心病可能性大.冠状动脉病变以单支病变多见,前降支是最易累及的血管.结果提示绝经后出现典型胸痛,伴有明显危险因素者,发生冠心病可能性大.     

绝经前期女性胸痛患者冠状动脉造影及其临床意义

目的　探讨绝经前期女性冠心病 (CHD)患病的特点。方法　根据冠状动脉造影(CAG)结果 ,将 2 0 8例绝经前女性胸痛患者分为CHD组及非CHD组 ,比较两组患者危险因素及三种无创检查结果的差异。结果　绝经前女性胸痛患者CHD检出率为 2 6.4%,其中单支病变者占 81.8%,高脂血症CHD组与非CHD组比较差异有显著性 (P <0 .0 1) ,而三种无创检查阳性率两组间比较差异无显著性。结论　绝经前期女性胸痛患者CHD患病率低 ,高脂血症是其患病主要危险因素 ,无创检查对绝经前女性CHD诊断价值有限     

高血压对青年女性急性冠状动脉综合征的患病和冠状动脉病变程度的影响

目的探讨高血压对中国北方青年女性急性冠状动脉综合征(ACS)的患病和冠状动脉病变程度的影响,为临床防治提供参考。方法回顾性分析2007年1月至2016年12月间,因胸痛或胸部不适症状入院做冠状动脉造影检查的青年女性患者840例,年龄45岁。依据患者是否患有高血压分为高血压组(n=256例)和对照组(n=584)。观察两组患者中ACS的患病危险因素和患病率及冠状动脉植入支架情况。结果高血压组ACS患病率为80.9%,对照组为36.5%,两组比较差异有统计学意义(P0.05)。高血压组与对照组中的患者合并高脂血症者为37.1%比14.9%,高胆固醇血症为8.6%比3.4%,高尿酸血症为18.4%比7.2%,高同型半胱氨酸血症为10.9%比3.9%(均P0.05)。高血压组与对照组中的患者合并超重者为63.7%比29.5%(P0.05),早发冠心病家族史为15.2%比5.5%,吸烟为5.5%比4.3%,绝经者为4.7%比1.7%,2型糖尿病为24.2%比8.9%(均P0.05)。高血压组与对照组的冠状动脉双支病变为14.1%比5.7%(P0.05)。高血压组ACS患者植入支架的数量[(1.67±1.05)支]和支架的长度[(24.44±6.97)mm]大于对照组植入支架的数量[(1.41±0.85)支]和长度[(22.85±7.80)mm],组间比较差异有统计学意义(均P0.05)。结论高血压是中国北方青年女性ACS患病的重要危险因素。女性高血压患者表现更多的危险因素聚集,高血压与ACS患病独立相关。     

冠状动脉临界病变患者临床特点及病变形态学的性别差异

目的 探讨冠状动脉临界病变患者临床特点及病变形态学的性别差异.方法 连续入选北京4家三级教学医院2007年2月至2009年5月期间经冠状动脉造影证实的具有临界病变(狭窄>20%且<70%)患者1 920例,分为男性组1 281例,女性组639例,入选临界病变2 215处,其中男性组1 475处,女性组740处,进行QCA分析.结果 与男性组相比,女性组年龄较大(65.47±8.60岁比60.30±10.38岁,P<0.001),合并高血压和糖尿病的比例高(分别为74.34%比60.50%,P<0.01;26.45%比22.25%,P<0.05),吸烟、既往心肌梗死史及既往经皮冠状动脉介入治疗术比例低(分别为6.42%比48.95%、4.39%比12.1%及12.21%比18.58%,P<0.01),女性组诊断冠状动脉粥样硬化比例高(40.69%比28.81%,P<0.01),而诊断急性冠状动脉综合征的比例低(40.54%比50.67%,P<0.01),女性组钙化病变比例高(6.36%比4.14%,P<0.05),斑块面积小(7.62±3.22 mm2比9.18±4.29 mm2,P<0.01),其余病变特征均无统计学意义.结论 女性冠状动脉临界病变患者年龄大,合并危险因素多,冠状动脉病变较男性轻,钙化发生率高.     

早发冠心病的临床特点研究

目的 分析早发冠心病患者的传统危险因素、脂类代谢情况及冠状动脉病变特点.方法 收集临床资料和血管造影结果,对早发冠心病患者、非早发冠心病患者和非冠心病患者的传统危险因素、脂类代谢情况、冠状动脉病变特点进行统计学分析.结果 (1)早发冠心病与非早发冠心病比较,具有以下临床特点:①传统危险因素较少(2.50±1.28比2.76±1.43,P<0.05);②吸烟[50.3%(73/145)比38.0%(82/217),P<0.05]和阳性家族史[29.7%(43/145)比19.9%(43/217),P<0.05]比率较高,高血压比率较低[59.3%(86/145)比73.3%(159/217),P<0.05];③甘油三酯水平较高[(2.13±1.89)mmol/L比(1.78±1.14)mmol/L,P<0.05];④以急性冠状动脉综合征起病为主[66.2%(96/145)比42.6%(89/209),P<0.05],并且以单支血管受累为主[51.0%(74/145)比30.4%(66/217),P<0.05];⑤病例平均病变积分较低(4.86±2.30比5.92±2.66,P<0.05),轻度病变比率较高[46.9%(68/145)比31.2%(68/217),P<0.05].(2)logistic回归发现阳性家族史是早发冠心病发病的独立危险因素(OR=1.766,95%CI 1.060～2.940,P=0.029),吸烟(OR=1.561,95%CI 0.971～2.510,P=0.066)起较重要的作用.结论 与非早发冠心病相比,早发冠心病患者中传统危险因素虽所占比例较少,但冠心病阳性家族史和甘油三酯水平升高以及吸烟比例明显高于非早发冠心病患者,常以急性冠状动脉综合征起病为主,常为单支不稳定病变.提示冠心病阳性家族史即遗传倾向和代谢综合征在早发冠心病发生发展过程中起重要作用.     

Clinical presentation of urinary tract infection (UTI) differs with aging in women

Uncomplicated UTI is among the most common health problems seen in general practice and typically affects immunocompetent, anatomically normal women. The aim of this study was to explore the difference in clinical presentation in acute, uncomplicated UTI in otherwise healthy community dwelling, premenopausal (Pre-M) and postmenopausal (Post-M) women. A UTI was defined as uropathogen of more than 10(3)cfu/ml in midstream urine culture. Symptoms of UTI were divided to three: during voiding, local symptoms, and generalized symptoms. A total of 196 women aged a minimum of 45 years with diagnosis of UTI were studied. The patients were divided into two groups: Pre-M (n=102, mean age 48.14 years) and Post-M (n=94, mean age 69.21 years). The predominant complaints in Pre-M women were local symptoms. The clinical presentations showed more severity in the Post-M group than in Pre-M women, predominantly generalized unspecific symptoms and storage symptoms. Advanced age positively correlated with urgency of urination, painful voiding, urinary incontinence, sexual activity, low-back pain, lower abdominal pain and negatively correlated with frequency, painful and burning of urination and bladder pain. Our study showed that clinical presentation of UTI in Pre-M and Post-M women is different. The differences are presented not only by the voiding itself and by local symptoms but also by unspecified generalized symptoms that is especially important in elderly patients.     

女性生育次数及教育程度与冠心病的相关性研究

目的探讨女性生育次数及教育程度与冠心病、冠状动脉病变支数的相关性。方法采用回顾性病例对照研究,纳入2017年1月至6月就诊于新疆医科大学第一附属医院,初次行冠状动脉造影检查的女性563例,平均年龄(61.97±9.18)岁。分析患者一般资料、生育次数及受教育程度的差异性,并通过logistic多因素分析观察上述因素与女性冠心病及冠状动脉病变支数是否相关。结果根据冠状动脉造影结果分为冠心病组(360例)和正常组(203例),冠心病组患者年龄,高血压病、糖尿病、绝经比例,生育次数、文化程度构成比,低密度脂蛋白胆固醇及收缩压均显著大于正常组,而左心室射血分数、高密度脂蛋白胆固醇水平显著低于正常组,差异均有统计学意义(均P<0.05)。根据冠状动脉支数分为单支病变组(159例)、双支病变组(73例)和左主干/三支病变组(128例),三组患者年龄,高血压病、糖尿病、绝经比例,高密度脂蛋白胆固醇水平、左心室射血分数,文化程度、生育次数构成比比较,差异均有统计学意义(均P<0.05)。以生育次数进行分组,分为≤1次组(131例)、2次组(165例)、3次组(109例)及≥4次组(158例),四组患者体重指数、高密度脂蛋白胆固醇水平和高血压病、糖尿病、冠心病比例比较,差异均有统计学意义(均P<0.05)。二分类logistic多因素分析显示,年龄每增加1岁,冠心病发生的危险性增加4.1%(OR 1.041,95%CI 1.014~1.070,P=0.003),高血压病患者患冠心病风险增加2.170倍(OR 2.170,95%CI 1.465~3.215,P<0.001),糖尿病患者增加2.672倍(OR 2.672,95%CI 1.573~4.539,P<0.001),低密度脂蛋白胆固醇每增加1 mmol/L,冠心病风险增加69.5%(OR 1.695,95%CI 1.310~2.193,P<0.001);而文化程度及生育次数与冠心病的发病无相关性。有序logistic多因素分析显示,糖尿病(OR 2.171,95%CI 1.542~3.056,P=0.001)与冠状动脉病变支数呈正相关,而高密度脂蛋白胆固醇(OR 0.313,95%CI 0.148~0.663,P=0.002)是冠状动脉病变支数的保护因素;大学文化程度的患者相比于文盲患者,冠状动脉病变支数至少低一个等级的可能性,为0.367倍(OR 0.367,95%CI 0.140~0.961,P=0.041);生育次数与女性冠心病的发病无直接关系。结论生育次数与女性冠心病发病无直接相关性,受教育程度与冠心病冠状动脉病变支数呈负相关性。     

冠心病患者经皮冠状动脉介入治疗术后再次血运重建的危险因素研究

目的探讨冠心病患者PCI术后再次血运重建的相关因素分析。方法回顾性分析278例冠心病患者介入治疗的临床资料,分为再次血运重建组(血运重建组)55例,无再次血运重建组(无血运重建组)223例,比较2组的病史、症状和冠状动脉造影等临床资料。对复发胸痛再次血运重建的患者进行危险因素分析。结果与无血运重建组比较,血运重建组第一次入院诊断为急性心肌梗死(50.9%vs 14.3%,P=0.030)、心功能≥Ⅱ级(34.5%vs9.0%,P=0.020)、室壁运动异常(72.7%vs 26.9%,P=0.035)、多支冠状动脉病变(89.1%vs 40.4%,P=0.010)等均显著增高,差异有统计学意义。多因素logistic回归显示,复发胸痛(OR:2.49,95%CI:1.16～5.00,P=0.020)、左心室舒张末内径(OR:1.12,95%CI:1.00～1.22,P=0.043)是血运重建治疗的独立预测因素,而冠状动脉单支病变(OR:0.25,95%CI:0.15～0.90,P=0.040)和双支病变(OR:0.22,95%CI:0.07～0.53,P=0.006)较冠状动脉3支病变再次血运重建治疗风险低。结论冠心病患者PCI术后1年的随访提示,复发胸痛、严重的冠状动脉病变和左心室舒张末容积增大是再次血运重建治疗的独立危险因素。     

Contribution of traditional risk factors to coronary artery disease in patients with systemic lupus erythematosus.

OBJECTIVE: Several factors have been implicated in the high prevalence of premature coronary artery disease (CAD) in patients with systemic lupus erythematosus (SLE). We hypothesize that variables independent of traditional risk factors contribute significantly to the development of CAD in SLE. We investigated the relative contribution of traditional risk factors in SLE patients with CAD compared to non-SLE patients with premature CAD. METHODS: An age matched retrospective cohort analysis. The prevalence of traditional cardiovascular risk factors (hypertension, hypercholesterolemia, diabetes, smoking, family history) in patients with SLE who developed CAD during the course of their illness was compared to a group of age matched non-SLE subjects with premature CAD. Sexes were analyzed separately using Fisher's exact test and unpaired t tests. RESULTS: Thirty-five patients with SLE (27 women, 8 men) with definite ischemic heart disease were identified along with 397 non-SLE subjects (83 women, 314 men). In women with SLE the mean number of CAD risk factors per cardiac event was 2.0 +/- 0.77 versus 2.90 +/- 1.19 for the comparison group (p = 0.0008). In men with SLE the mean number of CAD risk factors was 1.87 +/- 0.83 versus 2.73 +/- 0.99 in the comparison group (p = 0.016). CONCLUSION: SLE patients with a cardiac event have fewer traditional risk factors than non-SLE patients with premature CAD. Thus premature CAD in SLE cannot be attributed solely to an excess of traditional risk factors.     

Impact of hypertension and hyperhomocysteinemia on arterial thrombosis in primary antiphospholipid syndrome

The aim of this study was to evaluate traditional risk factors for coronary artery disease (CAD), homocysteine, anti-oxidized low-density lipoprotein (anti-oxLDL), anti-lipoprotein lipase (anti-LPL) and endothelin-1 (ET-1) in patients with primary anti-phospholipid syndrome (APS), furthermore verify possible association among these variables and arterial thrombosis. Thirty-eight women with primary APS and 30 age-and-sex-matched controls were evaluated. Patients presented higher-LDL and triglycerides levels and lower-HDL levels than controls. Anti-LPL antibodies were not detected in both groups. The mean number of risk factors was higher in patients than in controls (P = 0.030). Anti-oxLDL antibodies, homocysteine and ET-1 mean levels were similar between groups, but abnormal homocysteine levels were found only among primary APS patients (P = 0.031). Hypertension and the presence of at least one risk factor for CAD were more prevalent in patients with arterial involvement than those without. Homocysteine levels and mean number of risk factors for CAD were significantly higher in patients with arterial thrombosis than controls. In a multivariate analysis hypertension was the only independently associated with arterial thrombosis (OR 14.8, 95% CI = 2.1-100.0, P = 0.006). This study showed that in primary APS patients other risk factors besides anti-phospholipid antibodies contribute for the occurrence of arterial events and the most important factor was hypertension.     

Relationship of menopausal status and exercise level to HDL-cholesterol in women

The relationship between exercise habits, menopausal status and HDL cholesterol (HDL-C) was studied in 44 long-distance runners, 47 joggers, and 45 relatively inactive females. In each group, some women were post-menopausal (Post-M) and some pre-menopausal (Pre-M). HDL-C level was higher in runners (77.6 mg/dl) and joggers (70.4 mg/dl) than in the inactive group (62.1 mg/dl), but was not different Pre-M vs Post-M. Total cholesterol (TC) and LDL-C were higher in Post-M than in Pre-M subjects, but did not differ among exercise groups. Body weight and % fat were lower in Pre-M vs Post-M groups and were lower in the runners vs inactive subjects. The HDL-C/TC ratio was higher in the runners vs inactive subjects and there was a significant exercise-menopausal interaction indicating a beneficial exercise effect. Adjustment of lipoprotein values for possible confounding variables did not alter these results. Endurance exercise by Post-M females may help prevent adverse lipid and lipoprotein changes which might predispose them to coronary heart disease.     

Comparison of remnant-like lipoprotein particles in postmenopausal women with and without coronary artery disease and in men with coronary artery disease

It is known that hypertriglyceridemia is a risk factor of coronary artery disease (CAD) in postmenopausal women. This study prospectively examined whether remnant lipoprotein, an atherogenic triglyceride-rich lipoprotein, may have a significant risk and prognostic values in postmenopausal women with angiographically verified CAD. Remnant-like lipoprotein particles cholesterol (RLP cholesterol) levels in fasting serum were measured in 134 consecutive postmenopausal women with (n = 56) or without (n = 78) CAD by an immunoseparation method. The women with CAD were followed for ≤24 months until occurrence of the following clinical coronary events: readmission or coronary revascularization due to recurrent or refractory angina pectoris, nonfatal myocardial infarction, and cardiac death. Multivariate logistic regression analysis showed that high RLP cholesterol levels (>5.7 mg/dl cholesterol; 90th percentile of the distribution of RLP cholesterol levels in controls) were a significant risk factor for the presence of CAD independent of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, and other traditional risk factors. Kaplan-Meier analysis demonstrated that women with CAD and higher RLP cholesterol levels had a significantly higher probability of developing coronary events (p <0.001). In multivariate Cox hazard analysis, high RLP cholesterol levels as well as diabetes and hypercholesterolemia were a significant predictor of future coronary events independent of other risk factors in women with CAD (odds ratio 9.7, 95% confidence intervals 1.3 to 20.3, P = 0.02). In conclusion, increased levels of RLP cholesterol are a significant and independent risk factor of CAD and predict future coronary events in postmenopausal women with CAD.     

Risk factors and predictors of coronary arterial lesions in Japanese hypertensive patients.

The morbidity rate of coronary artery disease has recently increased in Japan. This is attributable to changes from traditional to more westernized lifestyles. In this study, we therefore examined the risk factors and predictors of coronary arterial lesions in Japanese patients with essential hypertension. Coronary angiography was performed in 109 consecutive essential hypertension patients (57 men and 52 women; 66 +/- 8.0 years of age) with either angina pectoris or atypical chest pain, who were chosen from 485 consecutive hypertensive patients in a hypertension clinic in Sendai, Japan. Coronary arterial stenosis of greater than 50% was defined as significant and used as a dependent variable for the multiple regression analysis. Risk factors were defined as factors confirmed to have a causal relationship with coronary arterial lesions, whereas arteriosclerotic complications and hypertensive target organ damage were defined as predictors. Multiple logistic regression analysis was performed using these parameters as independent variables. Of 109 patients, 25 had a coronary arterial stenosis greater than 50%. A smoking habit (odds ratio (OR): 4.48; 95% confidence interval (CI): 1.13-17.82; p<0.05), hypercholesterolemia (OR: 5.34; 95% CI: 1.52-18.73; p<0.05), and 24-h diastolic blood pressure (OR: 2.33; 95% CI: 1.06-5.16; p<0.05) were significant risk factors, whereas carotid intima-media thickness (OR: 5.85; 95% CI: 1.48-23.2; p<0.05) was a significant predictor of coronary arterial lesion. When two of the major risk factors (a smoking habit, hypercholesterolemia, or impaired glucose tolerance including diabetes mellitus) were clustered in addition to the hypertension, the risk of coronary arterial lesions increased by 6.7 to 10.1 times. These findings indicate that the major risk factors established in Caucasians, i.e., a smoking habit, hypercholesterolemia and blood pressure level, are also risk factors for coronary arterial lesions in Japanese with essential hypertension. The presence of two or more risk factors increases the risk of coronary arterial lesions synergistically in the presence of hypertension.     

经皮冠状动脉介入治疗相关心肌梗死的危险因素和预测模型的建立

目的:筛选经皮冠状动脉介入治疗(PCI)相关心肌梗死(PMI)的危险因素,建立PMI发生风险的危险模型。方法:回顾性分析了北京大学人民医院801例择期PCI患者的临床基线特征、冠状动脉造影检查结果及PCI操作资料,并就此根据临床实际情况分为PMI组(n=113)和无PMI组(n=688)。同时利用多元Logistic回归分析筛选PMI的独立危险因素并建立危险模型。结果:PMI发生率为14.1%(113/801),经过多元Logistic回归分析发现PMI的独立危险因素包括年龄(OR=1.040,95%CI:1.015~1.065,P=0.001),多支病变(OR=1.740,95%CI:1.028~2.945,P=0.039),支架数目(OR=1.787,95%CI:1.404~2.275,P=0.000),旋磨(OR=4.046,95%CI:1.336~12.252,P=0.013),并建立了危险模型。该模型的ROC曲线下面积为0.706(95%CI:0.657~0.754)。结论:年龄、多支病变、支架数目及旋磨均为PMI发生的独立危险因素,由此建立的危险模型能够较好地指导临床工作者评估PMI风险。