早发冠心病患者的临床和冠状动脉病变特点研究

目的 探讨早发冠心病(PCAD)患者的临床危险因素及冠状动脉病变特点.方法 收集经冠状动脉造影明确的284例早发冠心病患者(男<55岁,女<65岁)、182例晚发冠心病患者(男≥55岁,女≥65岁)和226例非冠心病对照者(男<55岁,女<65岁)的临床资料,分别对三组入选患者的传统危险因素和冠状动脉病变特点进行统计学分析.结果 (1)早发冠心病组与非冠心病对照组比较,早发冠心病组患者的传统心血管危险因素个数多[(2.01±1.22)个vs.(1.01±0.93)个,P<0.05],高血压、2型糖尿病、吸烟、饮酒、肥胖及早发冠心病家族史比例均高(P均<0.05);早发冠心病组患者的男性比例高[52.8%(150/284)vs.28.3%(64/226),P<0.05].(2)早发冠心病组与晚发冠心病组患者比较,具有以下临床特点:①传统心血管危险因素个数少[(2.01±1.22)个vs.(2.89±1.41)个,P<0.05];②早发冠心病家族史比例高[21.1%(60/284)vs.12.1%(22/182),P<0.05];③左心室射血分数值高(0.63±0.1 vs.0.61±0.12,P<0.05);④单支冠状动脉病变患者比例高[45.4%(129/284)vs.19.8%(36/182),P<0.001],两组患者均显示冠状动脉左前降支血管病变率高[83.8%(238/284)vs.90.7%(165/182),P<0.05].(3)Logistic回归分析显示:高血压、肥胖、2型糖尿病、吸烟及早发冠心病家族史是早发冠心病的独立危险因素[95% CI:高血压1.604～3.788(P<0.001),肥胖1.303～3.376(P=0.002),2型糖尿病2.040～7.771(P<0.001),吸烟1.783～5.488(P<0.001),早发冠心病家族史6.063～107.431(P<0.001)],Logistic回归分析结果提示早发冠心病家族史在早发冠心病的发病中起着重要作用[B=3.240,Exp(B)=25.522,95% CI:6.063～107.431,P<0.001].结论 与晚发冠心病组患者相比,早发冠心病组患者的血脂异常、2型糖尿病、肥胖、饮酒等危险因素较少,但早发冠心病组患者的早发冠心病家族史比例较高,单支病变患者比例较高.提示早发冠心病家族史即遗传倾向在早发冠心病发生发展过程中起重要作用.

The clinical and coronary features of patients with premature coronary artery disease

Objective To evaluate the risk factor of clinical and coronary artery lesions in patients with premature coronary artery disease(PCAD).Methods The baseline clinical and coronary angiographic data of 692 patients undergoing coronary angiography(CAG)were collected and analyzed.All patients were divided into PCAD group(n=284,female<65 years,male<55 years),Later-onset CAD(aged coronary artery disease)group(n=182,female≥65 years,male≥55 years)and non-CAD group(n=226,female<65 years,male<55 years).Results (1)Compared with non-CAD group,patients in PCAD group had significantly more traditional cardiovascular risk factors(2.01±1.22 vs.1.01±0.93,P<0.05),significantly higher ratio of male patients,hypertension,type 2 diabetic mellitus,smoking,drinking,obesity and family history of PCAD(all P<0.05).(2)Compared with Later-onset CAD group,patients in PCAD group had significantly fewer traditional cardiovascular risk factors(2.01±1.21 vs.2.89±1.41,P<0.05),while had significantly higher ratio of family history of PCAD [60/284(21.1%)vs.22/226(12.1%),P<0.05],higher LVEF values(0.63±0.1 vs.0.61±0.12,P<0.05)and significantly higher ratio of single vessel lesion [129/284(45.4%)vs.36/226(19.8%),P<0.001].Both groups had significantly higher ratio of vessel lesions in LAD[238/284(83.8%)vs.165/226(90.7%),P<0.05].(3)The logistic regression analysis showed that family history of PCAD,smoking,hypertension,type 2 diabetic mellitus and obesity were independent risk factors for the development of PCAD[95% CI:hypertension 1.604-3.788(P<0.001),obesity 1.303-3.376(P=0.002),type 2 diabetic mellitus 2.040-7.771(P<0.001),smoking 1.783-5.488(P<0.001),family history of PCAD 6.063-107.431(P<0.001)].Conclusions Patients with PCAD had higher ratio of family history of PCAD.