川中地区早发冠心病患者的危险因素及冠状动脉病变特点

罗倩; 刘磊; 李双; 刘益均; 任宏强; 谭震

doi:10.13201/j.issn.1001-1439.2024.03.009

川中地区早发冠心病患者的危险因素及冠状动脉病变特点

- 遂宁市中心医院心内科(四川遂宁，629000)

详细信息

通讯作者: 谭震，E-mail：tanzhen78@163.com

中图分类号: R541.4

收稿日期: 2023-10-25

刊出日期: 2024-03-13

Risk factors of premature coronary heart disease and features of coronary lesions in patients in the central region of Sichuan

- Department of Cardiology, Suining Central Hospital, Suining, Sichuan, 629000, China

More Information

Corresponding author: TAN Zhen, E-mail: tanzhen78@163.com

Received Date: 25 October 2023

Publish Date: 13 March 2024

摘要

摘要: 目的探讨川中地区早发冠心病患者的临床危险因素及冠状动脉(冠脉)病变特点。方法采用回顾性病例对照研究方法，收集2020年11月—2022年6月就诊于遂宁市中心医院行冠脉造影检查的患者603例，其中早发冠心病患者163例(早发冠心病组)、非早发冠心病患者240例(非早发冠心病组)、非冠心病患者200例(非冠心病组)。记录并比较各组患者一般资料、生化指标和冠脉造影结果，采用SYNTAX评分评估患者冠脉病变。采用多因素logistic回归分析早发冠心病的临床危险因素。结果与非早发冠心病组患者比较，早发冠心病组女性、吸烟史、早发冠心病家族史比例显著升高(均P＜0.05)，中性粒细胞、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)水平显著升高(均P＜0.05)。多因素logistic回归分析显示，男性(OR=5.421，95%CI：2.687~11.47，P＜0.001)、中性粒细胞计数(OR=1.706，95%CI：1.469~2.017，P＜0.001)、LDL-C(OR=1.350，95%CI：1.004~1.826，P=0.048)、空腹血糖(OR=1.213，95%CI：1.106~1.353，P＜0.001)、室间隔厚度(OR=1.251，95%CI：1.052~1.498，P=0.012)、年龄(OR=1.161，95%CI：1.095~1.237，P＜0.001)是早发冠心病的独立危险因素，左室射血分数(LVEF)是保护性因素(OR=0.915，95%CI：0.876~0.951，P＜0.001)。在病变特征方面，早发冠心病组急性心肌梗死比例增加(45.4% vs 59.5%，P=0.007)，单支病变比例显著升高(26.7% vs 40.5%，P=0.005)，前降支病变比例(90.8% vs 75.5%，P＜0.001)和SYNTAX评分水平显著降低[11.00(7.00，16.50) vs 9.00(6.00，13.50)，P＜0.001]。结论男性、中性粒细胞、LDL-C、空腹血糖、室间隔厚度、年龄是川中地区患者早发冠心病的独立危险因素；早发冠心病患者的冠脉病变以单支病变较多，起病方式多为急性心肌梗死，其血管病变复杂程度低于非早发冠心病患者。
- 冠心病 /
- 危险因素 /
- 冠状动脉病变
Abstract: Objective To explore risk factors of premature coronary heart disease(PCHD) and features of coronary lesions in patients in the central region of Sichuan. Methods This is a retrospective case-control study. A total of 603 patients who underwent coronary angiography at Suining Central Hospital from November 2020 to June 2022 were collected. All patients were divided into the PCHD group(n=163), non-PCHD group(n=240), and non-CHD group(n=200). The baseline data including general information, biochemical indicators, and coronary angiography results were collected and compared. Coronary artery disease was measured by SYNTAX score. Multivariate logistic regression analysis was performed to assess risks of PCHD. Results Compared with the non-PCHD group, the proportion of female, smoking history, and family history of PCHD in the PCHD group were significantly increased(all P < 0.05), and the levels of neutrophil, low-density lipoprotein cholesterol(LDL-C), and triglyceride(TG) were significantly increased(all P < 0.05). Multivariate logistic regression analysis showed that male(OR=5.421, 95%CI: 2.687-11.47, P < 0.001), neutrophil count(OR=1.706, 95%CI: 1.469-2.017, P < 0.001), LDL-C(OR=1.350, 95%CI: 1.004-1.826, P=0.048), fasting blood glucose(OR=1.213, 95%CI: 1.106-1.353, P < 0.001), interventricular septal thickness(OR=1.251, 95%CI: 1.052-1.498, P=0.012), and age(OR=1.161, 95%CI: 1.095-1.237, P < 0.001) were independent risk factors for PCHD, left ventricular ejection fraction(LVEF) was a protective factor(OR=0.915, 95%CI: 0.876-0.951, P < 0.001). In the PCHD group, the proportion of acute myocardial infarction(45.4% vs 59.5%, P=0.007) and single-vessel lesion(26.7% vs 40.5%, P=0.005) significantly increased, and the proportion of left anterior descending vessel lesion(90.8% vs 75.5%, P < 0.001) and SYNTAX score[11.00(7.00, 16.50) vs 9.00(6.00, 13.50), P < 0.001]significantly decreased. Conclusion Male, neutrophil, LDL-C, fasting blood glucose, interventricular septal thickness, and age are independent risk factors for PCHD in patients in the central region of Sichuan. In patients with PCHD, there are more single vessel lesions and acute myocardial infarction, the complexity of vascular lesions is lower than that of PCHD.
- coronary heart disease /
- risk factors /
- coronary artery lesion

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表 1 患者基本临床资料

Table 1. General clinical data 例(%), M(P₂₅, P₇₅)

项目	非PCHD组(240例)	非CHD组(200例)	PCHD组(163例)	统计值	P
男性	212(88.3)	93(46.5)	114(69.9)	0.650	＜0.001
女性	28(11.7)	107(53.5)	49(30.1)	0.650	＜0.001
年龄/岁	65.0(59.0，69.0)	51.0(48.0，54.2)	53.0(50.0，55.0)	2.700	＜0.001
BMI/(kg/m²)	23.6(22.6，24.8)	25.0(23.4，26.6)	24.6(23.4，25.7)	0.310	＜0.001
吸烟史	32(13.3)	23(11.5)	29(17.8)	0.214	0.119
高血压	118(49.2)	44(22.0)	67(41.1)	0.391	＜0.001
糖尿病	111(46.2)	45(22.5)	71(43.6)	0.429	＜0.001
PCHD家族史	9(3.75)	9(4.50)	16(9.82)	0.163	0.024
TC/(mmol/L)	4.82(3.96，5.59)	5.00(4.27，5.84)	5.14(4.47，6.12)	0.277	0.002
TG/(mmol/L)	1.33(0.97，2.32)	1.60(1.14，2.71)	1.52(1.13，2.65)	0.223	0.002
HDL-C/(mmol/L)	1.21(1.07，1.44)	1.33(1.10，1.59)	1.16(1.00，1.34)	0.357	0.001
LDL-C/(mmol/L)	2.90(2.19，3.60)	2.98(2.39，3.47)	3.17(2.55，4.01)	0.240	0.004
Ua/(μmol/L)	373(305，430)	331(281，397)	364(305，455)	2.778	0.001
Scr/(μmol/L)	76.0(67.5，89.8)	64.0(53.8，75.0)	76.0(62.2，88.5)	0.356	＜0.001
FPG/(mmol/L)	6.61(5.40，8.94)	5.60(4.96，6.90)	6.32(5.31，9.94)	0.429	＜0.001
LVEDD/mm	46.0(42.0，48.0)	43.0(41.0，46.2)	45.0(42.0，50.0)	0.708	＜0.001
IVST/mm	10.0(9.00，11.0)	9.00(8.00，10.0)	10.0(9.00，11.0)	0.594	＜0.001
LVEF/%	62.0(56.0，68.0)	68.0(64.0，72.0)	63.0(57.5，67.5)	1.070	＜0.001
白细胞计数/(×10⁹/L)	7.40(5.75，9.80)	5.90(5.10，7.12)	8.60(6.80，11.1)	0.704	＜0.001
中性粒细胞计数/(×10⁹/L)	4.88(3.59，7.74)	3.70(3.04，4.70)	6.26(4.16，9.20)	0.576	＜0.001
单核细胞计数/(×10⁹/L)	0.48(0.38，0.63)	0.39(0.31，0.50)	0.52(0.42，0.68)	0.109	＜0.001
淋巴细胞计数/(×10⁹/L)	1.40(1.03，1.80)	1.65(1.24，2.03)	1.52(1.15，1.95)	0.109	＜0.001
血小板计数/(×10⁹/L)	184(144，227)	210(172，254)	209(158，245)	2.072	＜0.001
用药情况
阿司匹林	221(92.1)	12(6)	158(96.9)	3.256	0.071
P₂Y₁₂受体拮抗剂	231(96.3)	16(8)	161(98.8)	0.162	0.225
他汀类	237(98.8)	64(32)	159(97.5)	0.089	0.603
硝酸酯类	127(52.9)	0	122(74.8)	18.854	＜0.001
ACEI/ARB/ARNI	90(37.5)	26(13)	46(28.2)	3.335	0.068
β受体阻滞剂	98(40.8)	2(1)	124(76.1)	47.311	＜0.001
钙离子拮抗剂	53(22.1)	18(9)	23(14.1)	3.528	0.060
ACEI：血管紧张素转化酶抑制剂；ARB：血管紧张素Ⅱ受体抑制剂；ARNI：沙库巴曲缬沙坦。

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表 2 PCHD危险因素的logistic回归分析

Table 2. Risk factors of PCHD analyzed by logistic regression analysis

变量	单因素			多因素
变量	B	OR(95%CI)	P	B	OR(95%CI)	P
男性	0.985	2.677(1.740~4.158)	＜0.001	1.690	5.421(2.687~11.47)	＜0.001
中性粒细胞计数	0.542	1.720(1.516~1.981)	＜0.001	0.534	1.706(1.469~2.017)	＜0.001
LDL-C	0.354	1.425(1.145~1.788)	＜0.001	0.300	1.350(1.004~1.826)	0.048
IVST	0.369	1.446(1.266~1.665)	＜0.001	0.224	1.251(1.052~1.498)	0.012
FPG	0.229	1.257(1.154~1.386)	＜0.001	0.193	1.213(1.106~1.353)	＜0.001
年龄	0.047	1.048(1.012~1.086)	0.010	0.149	1.161(1.095~1.237)	＜0.001
TC	0.139	1.149(0.984~1.348)	0.082
吸烟史	0.510	1.665(0.924~3.033)	0.091
家族史	0.837	2.310(1.012~5.597)	0.052
淋巴细胞计数	-0.313	0.732(0.519~1.005)	0.064
TG	-0.056	0.946(0.838~1.059)	0.082
BMI	-0.051	0.951(0.873~1.033)	0.237
LVEF	-0.108	0.898(0.866~0.928)	＜0.001	-0.089	0.915(0.876~0.951)	＜0.001

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表 3 冠脉病变特点

Table 3. Features of coronary artery lesions 例(%), M(P₂₅, P₇₅)

组别	非PCHD组(240例)	PCHD组(163例)	P
病变支数
单支病变	64(26.7)	66(40.5)	0.005
多支病变	176(73.3)	97(59.5)	0.005
累积病变部位
左主干	9(3.75)	4(2.45)	0.663
左前降支	217(90.8)	123(75.5)	＜0.001
左回旋支	126(52.5)	86(52.8)	1.000
右冠脉	150(62.5)	96(58.9)	0.533
起病方式
稳定性心绞痛	17(7.08)	8(4.91)	0.498
不稳定性心绞痛	114(47.5)	58(35.6)	0.023
急性心肌梗死	109(45.4)	97(59.5)	0.007
SYNTAX评分	11.00(7.00，16.50)	9.00(6.00，13.50)	＜0.001

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