超高龄冠心病患者危险因素与冠状动脉病变特点的相关性

目的 探讨超高龄冠状动脉硬化性心脏病(简称"冠心病",CAD)患者的临床特点,并进行危险因素与冠状动脉病变的相关性分析.方法 回顾性分析行经皮冠状动脉介入治疗(PC1)的391例CAD患者的临床资料,比较超高龄组(≥80岁,n=116)、老年组(71～79岁,n=275)的临床及介入治疗资料的特点.结果 与老年组比较,超高龄组心力衰竭患病率(25.9% vs 11.3%)、术前肌钙蛋白T(cTnT)阳性率(41.4% vs 28.4%)、高密度脂蛋白胆固醇(HDL-C)水平[(1.19±0.35) vs (1.12±0.29)mmol/L]、PCI术前术后肌酐差值[(1.84±17.5) vs (-2.01±12.2)μmol/L]、ST段抬高心肌梗死(STEMI)患者比例(21.6% vs 13.5%)、Gensini积分[(45.62±31.18) vs (40.48±28.12)]均明显增高(均为P＜0.05);总体病例分析显示男性、合并糖尿病、血清肌酐水平高的患者Gensini积分显著升高(均P＜0.01),Gensini积分随着脂蛋白a[Lp(a)]的升高而升高(P＜0.05)、随HDL-C的升高而降低(P＜0.05);胱抑素C(Cys C)与估算的肾小球滤过率(eGFR)呈显著负相关(r=-0.509,P＜0.01);eGFR≥60ml/(min·1.73m2)组的Cys C水平显著低于eGFR＜60ml/(min·1.73m2)组[(1.30±0.26) vs (2.01±0.53)mg/L,P＜0.01].结论 超高龄CAD患者中,冠状动脉病变程度重,急性冠脉综合征比例大,多合并心力衰竭.

Correlation of cardiovascular risk factors with features of coronary lesions in super-aged patients with coronary artery diseases

Objective To investigate the clinical features of coronary lesions in the super-aged patients with coronary artery disease（CAD）, and the correlation of the features with cardiovascular risk factors. Methods Totally 391 patients who were diagnosed as CAD undergoing pereutaneous coronary intervention （PCI） in our department from May 2011 to August 2012 were divided into aged group （71 to 79 years old, n=275）, and super-aged group （≥80 years old, n=116）. Their clinical and interventional procedure data were analyzed respectively. Results Compared with the aged group, the super-aged group had a higher incidence of heart failure （25.9% vs 11.3%）, higher rate of preoperative positive troponin T （cTnT） （41.4% vs 28.4%）, higher levels of high density lipoprotein cholesterol （HDL-C） [（1.19±0.35） vs （1.12±0.29）mmol/L], higher increase of creatinine concentration after the operation [（1.84±17.5） vs （-2.01±12.2）μmol/L], higher proportion of ST-segment elevation myocardial infarction （STEMI） （21.6% vs 13.5%）, and higher Gensini score [（45.62±31.18） vs （40.48±28.12）; P〈0.05 for all]. Among these 391 patients, male, diabetes, and high level of creatinine were positively related with the higher score of Gensini （P〈0.01 for all）, so was serum level of lipoprotein a [Lp（a）; P〈0.05], while HDL-C was negatively correlated with the score （P〈0.05）. Serum cystatin C （Cys C） was negatively associated with estimated glomerular filtration rate （eGFR; r=-0.509, P〈0.01）. For those with eGFR≥60ml/（min·1.73m2）, their serum level of Cys C was significantly lower than those with eGFR〈60ml/（min·1.73m2） [（1.30±0.26） vs （2.01±0.53）mg/L, P〈0.05]. Conclusion Super-aged patients with CAD are always complicated with heart failure, acute coronary syndrome, and severe coronary lesions.