无传统危险因素的冠心病患者心肌梗死相关危险因素分析

目的探讨无传统心血管危险因素的冠心病患者发生心肌梗死(MI)的独立危险因素。方法纳入2013年1月1日至2013年12月31日以及2017年1月1日至2018年12月31日在中国医学科学院阜外医院接受冠脉造影检查的所有患者共74612例,排除冠状动脉粥样硬化性心脏病(CHD)、合并高血压、糖尿病、高脂血症或有吸烟史的患者后,共604例患者纳入分析。根据既往病史、冠脉造影、实验室及影像学检查结果,分为无传统心血管危险因素冠心病非心肌梗死组(非心肌梗死组,n=479);和无传统心血管危险因素冠心病心肌梗死组(心肌梗死组,n=125)。收集患者基线资料、实验室检查结果,通过多因素Logistic回归模型,探讨无传统心血管危险因素冠心病人群发生心肌梗死的独立危险因素。结果与非心肌梗死组相比,心肌梗死组男性患者更多、左室射血分数(EF)更低,N端脑钠肽前体(NT-proBNP)、高敏C反应蛋白(hsCRP)、血白细胞(WBC)、血肌酐(Scr)更高。两组患者有统计意义的差异化验指标进入多因素Logistic回归分析,校正混杂因素后,hsCRP仍与无传统心血管危险因素心肌梗死的发病风险呈正相关,且有显著统计学意义(OR=1.101,95%CI:1.026-1.180,P=0.007)。ROC曲线下面积为0.584有统计学意义(P=0.004)。此外,在不同年龄及性别亚组,均有心梗组hsCRP高于非心梗组的趋势。结论本研究发现hsCRP与无传统心血管危险因素冠心病患者发生心肌梗死的风险呈正相关。因此hsCRP可能是冠心病患者发生心肌梗死的新型危险因素,并为预防心肌梗死发生的新靶点提供线索。

Analysis of Risk Factors Related to Myocardial Infarction in Coronary Heart Disease Patients without Traditional Risk Factors

Objective To explore independent risk factors for myocardial infarction(MI)in patients who had coronary heart disease(CHD)without traditional cardiovascular risk factors.Methods A total of 74612 patients were included who underwent coronary angiography at Fuwai Hospital from January 1,2013 to December 31,2013 and January 1,2017 to December 31,2018.After excluding patients without coronary heart disease,hypertension,diabetes,hyperlipidemia,or a history of smoking,a total of 604 patients were included in this analysis.According to the results of previous medical history,coronary angiography,laboratory and imaging findings,the patients were divided into non-myocardial infarction group without conventional cardiovascular risk factors(non-myocardial infarction group,n=479)and myocardial infarction group without traditional cardiovascular risk factors(myocardial infarction group,n=125).Patients’baseline data and laboratory test results were collected,and independent risk factors for myocardial infarction in CHD people without traditional cardiovascular risk factors were explored through a multivariate logistic regression model.Results Compared with the non-MI group,the MI group had more male patients,lower left ventricular ejection fraction,N-terminal brain natriuretic peptide precursor(NT-proBNP),high-sensitivity C-reactive protein(hsCRP),white blood cells(WBC),and serum creatinine(Scr)was higher.The statistically significant differences between the two groups of patients entered multivariate logistic regression analysis.After adjusting for confounding factors,hsCRP was still positively correlated with the risk of myocardial infarction without traditional cardiovascular risk factors,and there was statistically significant(OR=1.101,95%CI:1.026-1.180,P=0.007).The area under the ROC curve was 0.584,which was statistically significant(P=0.004).In addition,hsCRP tended to be higher in myocardial infarction group than in non-MI group at different age and gender subgroups.Conclusion hsCRP is positively correlated with the risk of myocardial infarction in patients who had coronary heart disease without traditional cardiovascular risk factors.Therefore,hsCRP may be a new risk factor for myocardial infarction in patients who had coronary heart disease without traditional cardiovascular risk factors,and provide clues for the prevention of myocardial infarction.