早发冠心病患者危险因素及血运重建分析

目的探讨早发冠心病患者的危险因素及血运重建情况。方法选择356例行冠脉造影术确诊为冠心病的患者,按年龄分为早发冠心病组(PCHD组,男性≤55岁,女性≤65岁,70例)和晚发冠心病组(LCHD组,男性55岁,女性65岁,286例)。对两组患者的性别、体重指数、PCHD家族史、高血压病史、糖尿病史、吸烟史、饮酒史,血脂、糖化血红蛋白、尿酸、高敏C反应蛋白水平以及冠脉血运重建情况进行比较分析。结果①患者一般情况PCHD组的男性发病率、吸烟率、饮酒率、体重指数均高于LCHD组;PCHD组的年龄、PCHD家族史阳性率、高血压、糖尿病患病率均明显低于LCHD组,且高血压病程也明显短于LCHD组(P0.05)。②PCHD组的总胆固醇、低密度脂蛋白胆固醇、甘油三酯水平均明显高于LCHD组(P0.01),而高密度脂蛋白胆固醇水平低于LCHD组(P=0.013);PCHD组血尿酸、高敏C反应蛋白水平均低于LCHD组(P0.05)。③早发冠心病的多因素Logistic回归分析显示吸烟史(OR 7.793,P0.001)和高LDL-C水平(OR 3.745,P0.001)与早发冠心病明显相关,为其独立危险因素。④PCHD组介入治疗率高于LCHD组,但差异未达到统计学意义(P=0.340);PCHD组患者未选择血运重建的比率低于LCHD组,差异有统计学意义(P=0.044);PCHD组需行冠状动脉旁路移植术(CABG)比率低于LCHD组,差异有显著统计学意义(P0.001)。结论吸烟、高胆固醇血症是早发冠心病患者的独立危险因素,早期干预有助于降低早发冠心病的患病率。早发冠心病患者选择CABG术和非血运重建的比率均低于晚发者,选择合理的介入治疗和优化的药物治疗可能有助于改善PCHD患者预后。

Analysis on the risk factors and revascularization in patients with premature coronary heart disease

Objective To analyze the risk factors and revascularization in patients with premature coronary heart disease（ PCHD）.Methods 356 coronary heart disease patients（ underwent coronary angiography and confirmed） were selected into this study. 70 patients with PCHD and 286 patients with late CHD（ LCHD） were divided according to age. The risk factors including sex,body mass index（ BMI）,history of hypertension,diabetes,smoking,alcohol consumption,premature family history of cardiovascular disease,and the level of glycosylated hemoglobins（ HbA1c）,blood lipid,high sensitivity C reactive protein（ hs- CRP）,serum uric acid,and different coronary revascularizations between PCHD group and LCHD group were analyzed. Results ①Patients with PCHD had higher level of BMI and rate of male incidence,smoking and alcohol drinking compared with the LCHD group,but the rate of premature family history of CHD,hypertension and diabetes were lower than others. ②Patients with PCHD had higher level of total cholesterol（ TC）,triglyceride（ TG）,low- density lipoprotein cholesterol（ LDL- C）. The level of high- density lipoprotein cholesterol（ HDL- C）,hs- CRP and serum uric acid is lower than that of others. ③ Among the risk factors by multivariate Logistic regression analysis of PCHD,smoking（ OR 7. 793,P〈0. 001） and higher level of LDL- c（ OR 3. 745,P 〈0. 001） were significant. ④Patients with PCHD had higher rate of percutaneous coronary intervention（ PCI） than Patients with LCHD,but the difference was not significant. Patients with PCHD had lower rate of requiring coronary artery bypass grafting（ CABG） compared with the LCHD group. Conclusion Smoking and hyperlipemia are major risk factors for PCHD. Therefore,early prevention can help to reduce the incidence of PCHD. The patients with PCHD had lower rate of requiring CABG and non- revascularization. Given a reasonable PCI and the optimized drugs to the patients with PCHD could help to improve their prognosis.