冠心病发病及预后的影响因素研究

目的　通过对上海地区冠心病患者进行回顾性分析，探讨可能影响冠心病发病及预后的危险因素，以期对冠心病防治起到积极作用。方法　回顾性分析2009年在上海交通大学医学院附属瑞金医院心内科接受冠状动脉造影的患者756例，经冠状动脉造影确诊为冠心病576例，为冠心病组；非冠心病患者180例，为非冠心病组。收集患者一般资料，并对冠心病组患者进行为期7年的电话或再住院随访，终点事件为主要不良心血管事件（MACE）。结果　Logistic回归分析结果显示，性别〔OR=1.972，95%CI（1.240，3.138）〕、年龄〔OR=1.371，95%CI（1.115，1.686）〕、吸烟史〔OR=1.923，95%CI（1.168，3.165）〕、血肌酐（Scr）〔OR=1.138，95%CI（1.021，1.269）〕、总胆固醇（TC）〔OR=1.238，95%CI（1.016，1.509）〕、高密度脂蛋白胆固醇（HDL-C）〔OR=0.448，95%CI（0.239，0.842）〕是冠心病发病的影响因素（P<0.05）。平均随访时间为（63.3±26.4）个月，有224例（38.9%）发生MACE。Cox比例风险回归分析结果显示，年龄〔HR=1.197，95%CI（1.003，1.428）〕、糖尿病〔HR=1.824，95%CI（1.370，2.429）〕、舒张压（DBP）〔HR=1.145，95%CI（1.000，1.312）〕、估算肾小球滤过率（eGFR）〔HR=0.903，95%CI（0.825，0.987）〕、服用抗血小板药物〔HR=0.713，95%CI（0.532，0.956）〕、心肌梗死〔HR=1.401，95%CI（1.046，1.877）〕是冠心病患者发生MACE的影响因素（P<0.05）。结论　冠心病发病及预后与多种危险因素相关。男性、高龄、吸烟史、Scr、TC水平升高是诱发冠心病的危险因素；而HDL-C可能是降低冠心病发病风险的保护性因素。高龄、合并糖尿病、高DBP、心肌梗死病史患者的远期MACE发生风险明显升高，而高eGFR、长期接受标准抗血小板药物治疗可明显改善患者预后。

Multivariate Analysis of Risk and Prognostic Factors in Patients with Coronary Heart Disease

Objective　To determine the risk factors associated with the development and prognosis of coronary heart disease （CHD） by retrospectively analyzing clinical data on patients with CHD in Shanghai City，to guide the prevention and treatment of CHD.Methods　A retrospective analysis was performed on 756 patients who underwent coronary angiography in the Department of Cardiology of Shanghai Ruijin Hospital，Shanghai Jiaotong University School of Medicine in 2009.There were 576 patients who were diagnosed with CHD by coronary angiography.Those patients were placed into a CHD group，and the other 180 patients without CHD were placed into a non-CHD group.General patient data were collected，and the CHD patients were followed up for 7 years by telephone or through re-hospitalization.The endpoint events were major adverse cardiac event （MACE）.Results　Logistic regression analysis showed that sex 〔OR=1.972，95%CI（1.240，3.138）〕，age 〔OR=1.371，95%CI（1.115，1.686）〕，smoking 〔OR=1.923，95%CI（1.168，3.165）〕，serum ereatinine （Scr） 〔OR=1.138，95%CI（1.021，1.269）〕，total cholesterol （TC） 〔OR=1.238，95%CI（1.016，1.509）〕，high-density lipoprotein cholesterol （HDL-C）〔OR=0.448，95%CI（0.239，0.842）〕were factors influencing the incidence of CHD （P<0.05）．The average follow-up time was （63.3±26.4） months．MACE occurred in 224 cases （38.9%）．Cox regression analysis showed that age 〔HR=1.197，95%CI（1.003，1.428）〕，diabetes 〔HR=1.824，95%CI（1.370，2.429）〕，diastolic pressure （DBP）〔HR=1.145，95%CI（1.000，1.312）〕，estimated glomerular filtration rate （eGFR） 〔HR=0.903，95%CI（0.825，0.987）〕，use of anti-platelet drugs 〔HR=0.713，95%CI（0.532，0.956）〕，myocardial infarction 〔HR=1.401，95%CI（1.046，1.877）〕 were the factors influencing the occurrence of MACE in the CHD patients （P<0.05）．Conclusion　The development and prognosis of CHD are associated with multiple risk factors.Male sex，old age，history of smoking，elevated Scr and TC are risk factors for CHD；HDL-C may thus be a protective factor that reduces the risk of CHD.Patients with advanced age，high DBP，and a history of diabetes and myocardial infarction have a significantly higher risk for long-term MACE events.High eGFR and long-term administration of standard antiplatelet therapy significantly improved patient outcomes.