冠心病危险因素的临床评价

目的 探讨冠心病危险因素与冠状动脉病变的关系。方法 对341例冠状动脉造影患者可能伴有的危险因素进行询问和检测。结果 (1)冠状动脉造影显示有病变者214例,冠状动脉造影显示无病变者127例。两组的年龄、糖尿病病史、高脂血症史、冠心病家族史、吸烟史、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、总胆固醇／高密度脂蛋白胆固醇比率(TC／HDL-C)、脂蛋白(a)Lp(a)]、纤维蛋白原(Fbg)、高敏C反应蛋白(hs-CRP)比较,差异均有显著性。(2)冠状动脉造影显示有病变者其病变积分与危险因素的相关性依次排列为hs-CRP、Lp(a)、TC／HDL-C、Fbg、高脂血症史、TC、LDL-C和甘油三酯(r=0．338、0．250、0．241、0．207、0．167、0．147、0．140和0．139)。(3)对冠状动脉造影患者与危险因素应用ROC曲线分析结果依次为hs-CRP、TC／HDL-C、Lp(a)、Fbg、LDL-C、高脂血症史,其ROC曲线下面积比分别是0．810、0．669、0．626、0．625、0．619和0．618。结论 高脂血症史是冠心病发生的预告信号,脂质检查项目中对冠心病的预测作用以TC／HDL-C和Lp(a)为优;提示当前冠状动脉炎性损伤以hs-CRP为优。

Clinical evaluation of risk factors for coronary heart disease

Objective To explore the relationship between risk factors for coronary heart disease (CHD) and coronary artery lesions. Method Potential risk factors were studied in 341 patients underwent coronary angiography. Results (1) Coronary angiography showed coronary artery lesions in 214 patients (lesion group), and no lesion in 127 patients (non-lesion group). There was significant difference in age, past history of diabetes, family history of CHD, smoking history, high-density lipoprotein cholesterol (HDL-C), lower-density lipoprotein cholesterol (LDL-C), ratio of total cholesterol to HDL-C (TC/HDL-C), lipoprotein(a) , fibrinogen (Fbg) and high-sensitivity C-reactive protein (hs-CRP) between two groups (P<0.05). (2) There was significant correlation between severity of coronary artery lesions and hs-CRP, Lp(a), TC/HDL-C, Fbg, hyperlipidemia, TC, LDL-C and TG (with coefficients of correlation of 0.338, 0.250, 0.241, 0.207, 0.167, 0.147, 0.140 and 0.139; repsectively,P<0.05). (3) Analysis of receiver operating characteristics (ROC) curve for patients with coronary angiography and risk factors for CHD showed that the areas under ROC curve were 0.810, 0.669, 0.626, 0.625, 0.619 and 0.618 for hs-CRP, TC/HDL-C, Lp(a), Fbg, LDL-C and past history of hyperlipidemia, respectively. Conclusions Past history of hyperlipidemia was a predictor for occurrence of CHD. Ratio of TC/HDL-C and blood level of Lp(a) could be used as predictors in screening for high blood lipid, which were much stronger than others. It is suggested that hs-CRP had an excellent predictive value in current coronary inflammatory lesions.