风湿性心脏病伴发冠心病的情况分析  

Prevalence of coronary artery disease in patients with rheumatic heart disease in China

作　　者：李白翎[1] 李莉[1] 侯霄雷[2] 何斌[1] 张冠鑫[1] 陈克彪[1] 徐志云[1] 

机构地区：[1]第二军医大学附属长海医院胸心外科,上海200433 [2]上海中医药大学附属岳阳中西医结合医院ICU

出　　处：《中华医学杂志》2007年第47期3313-3316,共4页National Medical Journal of China

基　　金：中国人民解放军"十五"重点课题基金(01Z063)

摘　　要：目的探讨风湿性心脏病患者冠状动脉粥样硬化性心脏病(CAD)的并发情况及其与冠状动脉粥样硬化风险因素的关系。方法对651例年龄大于40岁的拟行瓣膜手术的风湿性瓣膜病患者行冠状动脉造影检查,左、右冠状动脉单支(含)以上管腔狭窄≥50%判定为 CAD。根据Framingham 研究中 CAD 主要危险因素,结合患者术前临床资料和选择性冠状动脉造影的结果进行综合分析。结果发现并发有 CAD 患者(CAD 组)71例,40岁以上风心病患者的冠心病发生率为10.91%,CAD 组平均年龄(63±9)岁明显高于非 CAD 组(54±9)岁(t=7.96,P<0.01),冠状动脉造影检查提示病变多累及左前降支(38.12%),双支以上病变38例(53.52%)。CAD 组中糖尿病(7.41%)、高血压(29.58%)患者多于非 CAD 组[分别为32.39%(P<0.01)和20.58%(P=O.0471)],而风心病患者血脂异常(14.66%vs 15.49%,P=0.851)和心电图 ST-T 改变(86.03%vs83.10%,P=0.505)与有否合并冠心病无明显相关性。各种瓣膜病变 CAD 发生率与本组平均发生率差异无统计学意义。结论风湿性心脏病外科手术前,60岁以上者不论有无冠心病危险因素,均应常规行冠状动脉造影检查,以减少手术并发症,确保瓣膜置换术后复跳成功。Objective To investigate the prevalence of coronary artery disease （CAD） and the atherosclerotic risk factors in the patients undergoing valvular surgery due to rheumatic heart disease. Methods Consecutive 651 patients with rheumatic heart disease aged 〉 40 who were scheduled for valve surgery underwent diagnostic coronary angiography to delineate coronary arteries. Significant coronary artery disease was considered to be present if one or more single coronary branches showed 50% or more luminal stenosis. Symptoms, such chest pain, were evaluated. Established risk factors for CAD, such as diabetes mellitus, systemic hypertension, smoking, and dyslipidemia were evaluated. Previous history of myocardial infarction and coronary artery bypass surgery was also recorded. Results Seventy-one patients （ 10. 91% ） ,54 males and 17 females, were detected as with CAD. The mean age of the patients with CAD was （63 ± 9）, significantly higher than that of the patients with normal coronary arteries [ （54 ± 9）, P 〈 0. 01 ]. The antheromatous lesion mostly involved the left descending branch （ 38.12% ） , and 38 patients （53.52%） showed lesions in 2 or more branches. The prevalence rates of diabetes mellitus and hypertension in the CAD group were 32. 39% and 29. 58% respectively, both significantly higher than those in the non- CAD group （7. 41% and 19.48% respectively; P 〈0. 01 and P =0. 047）. The smoking rate of the CAD group was 36. 62%, significantly higher than that of the non-CAD group （ 12. 93% ; P 〈 0. 01 ）. However, there were not significant differences in the prevalence rates of dyslipidemia and ECG ST-T changes between these 2 groups （ both P 〉 0. 05 ）. No relation was found between the rheumatic disease and coronary disease distribution （P 〉 0. 05）. Conclusion Coronary angiography should be performed in all patients clinically suspected with CAD, aged 〉 50 and the patients with angina and/or coronary risk factors in order to decrease the occurrence of operative c

关 键 词：风湿性心脏病 冠状动脉疾病 患病率 

分 类 号：R541.2[医药卫生—心血管疾病]