Risk factors of premature coronary heart disease and features of coronary lesions in patients in the central region of Sichuan
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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。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.
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Key words:
- 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。 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 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 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 -
[1] 中国心血管健康与疾病报告编写组. 中国心血管健康与疾病报告2020概要[J]. 中国循环杂志, 2021, 36(6): 521-545. doi: 10.3969/j.issn.1000-3614.2021.06.001
[2] Virani SS, Alonso A, Benjamin EJ, et al. Heart Disease and Stroke Statistics-2020 Update: A Report From the American Heart Association[J]. Circulation, 2020, 141(9): e139-e596.
[3] S Yusuf, S Hawken, S Ounpuu et al. Effect of Potentially Modifiable Risk Factors Associated With Myocardial Infarction in 52 Countries(the INTERHEART study): case-control study[J]. Lancet, 2004, 364: 937-952. doi: 10.1016/S0140-6736(04)17018-9
[4] Khan SU, Nguyen RT, Javed Z, et al. Socioeconomic status, cardiovascular risk profile, and premature coronary heart disease[J]. Am J Prev Cardiol, 2022(11): 100368.
[5] 徐慧, 刘芳. 早发冠状动脉粥样硬化性心脏病相关危险因素的研究进展[J]. 上海交通大学学报(医学版), 2020, 40(8): 1148-1151. doi: 10.3969/j.issn.1674-8115.2020.08.025
[6] Khoja A, Andraweera PH, Lassi ZS, et al. Risk Factors for Early Versus Late-Onset Coronary Heart Disease(CHD): Systematic Review and Meta-Analysis[J]. Heart Lung Circ, 2023, 32(11): 1277-1311. doi: 10.1016/j.hlc.2023.07.010
[7] 杨晓, 谢勇, 徐日新, 等. 血浆致动脉硬化指数对早发冠心病的预测作用[J]. 临床心血管病杂志, 2020, 36(11): 1000-1003. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202011007.htm
[8] Wang H, Liu Z, Shao J, et al. Pathogenesis of premature coronary artery disease: Focus on risk factors and genetic variants[J]. Genes Dis, 2020, 9(2): 370-380.
[9] 郭福佳, 袁正强, 施尚鹏, 等. 早发与晚发冠心病患者临床及冠状动脉病变特点的性别差异分析[J]. 临床心血管志, 2021, 37(1): 28-31. https://www.cnki.com.cn/Article/CJFDTOTAL-LCXB202101006.htm
[10] 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 稳定性冠心病基层诊疗指南(2020年)[J]. 中华全科医师杂志, 2021, 20(3): 265-273.
[11] 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南(2019年)[J]. 中华心血管病杂志, 2019, 47(10): 766-783. https://www.cnki.com.cn/Article/CJFDTOTAL-ZJXB201709002.htm
[12] 中华医学会, 中华医学会杂志社, 中华医学会全科医学分会, 等. 非ST段抬高型急性冠状动脉综合征基层诊疗指南(实践版2019年)[J]. 中华全科医师杂志, 2021, 20(1): 6-13.
[13] 国家心血管病中心, 国家基本公共卫生服务项目基层高血压管理办公室, 国家基层高血压管理专家委员会. 国家基层高血压防治管理指南(2020版)[J]. 中国医学前沿杂志(电子版), 2021, 13(4): 26-37. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYLY202309001.htm
[14] Wang JY, Xu YK, Liu L, et al. Comparison of LASSO and random forest models for predicting the risk of premature coronary artery disease[J]. BMC Med Inform Decis Mak, 2023, 23(1);297. doi: 10.1186/s12911-023-02407-w
[15] Maréchal P, Tridetti J, Nguyen M, et al. Neutrophil Phenotypes in Coronary Artery Disease[J]. J Clin Med, 2020, 9(5): 1602-1602. doi: 10.3390/jcm9051602
[16] Wang Q, Vattai A, Vilsmaier T, et al. Immunogenomic identification for predicting the prognosis of cervical cancer patients[J]. Int J Mol Sci, 2021, 22(5): 2442. doi: 10.3390/ijms22052442
[17] Hideki W, Tomotaka D, Katsumi M, et al. Neutrophil to Lymphocyte Ratio and Long-Term Cardiovascular Outcomes in Coronary Artery Disease Patients with Low High-Sensitivity C-Reactive Protein Level[J]. Int Heart J, 2020, 61(3): 447-453. doi: 10.1536/ihj.19-543
[18] 王增武, 刘静, 李建军, 等. 中国血脂管理指南(2023年)[J]. 中国循环杂志, 2023, 38(3): 237-271. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGXH202303001.htm
[19] 车奕宏, 马国锋. 早发冠心病急性心肌梗死发生的危险因素及冠脉病变特点[J]. 血栓与止血学, 2021, 27(5): 780-782. https://www.cnki.com.cn/Article/CJFDTOTAL-XSZX202105024.htm
[20] Xie J, Qi J, Mao H, et al. Coronary plaque tissue characterization in patients with premature coronary artery Disease[J]. Int J Cardiovasc Imaging, 2020, 36: 1003-1011. doi: 10.1007/s10554-020-01794-9
[21] Biery DW, Berman AN, Singh A, et al. Association of Smoking Cessation and Survival Among Young Adults With Myocardial Infarction in the Partners YOUNG-MI Registry[J]. JAMA Netw Open, 2020, 3(7): e209649. doi: 10.1001/jamanetworkopen.2020.9649
[22] 宋春梅, 刘永升, 尹亚娟, 等. 焦虑对女性早发急性冠脉综合征病人预后的影响[J]. 中西医结合心脑血管病杂志, 2023, 21(10): 1837-1840. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYY202310020.htm
[23] Pinheiro DL, Ferreira H GG, Martins TT, et al. The Interplay of Sirtuin-1, LDL-Cholesterol, and HDL Function: A Randomized Controlled Trial Comparing the Effects of Energy Restriction and Atorvastatin on Women with Premature Coronary Artery Disease[J]. Antioxidants, 2022, 11(12): 2363-2363. doi: 10.3390/antiox11122363
[24] Khoja A, Andraweera PH, Lassi ZS, et al. Risk Factors for Premature Coronary Heart Disease in Women Compared to Men: Systematic Review and Meta-Analysis[J]. J Womens Health(Larchmt), 2023, 32(9): 908-920. doi: 10.1089/jwh.2022.0517