健康查体人群冠状动脉斑块分布与冠心病危险因素的相关分析  

Relation of coronary computed tomography angiography and risk factors of coronary heart disease in asymptomatic populations

作　　者：张朔瑒[1] 盖鲁粤[1] 李岩[1] 盖兢泾[1] 

机构地区：[1]解放军总医院心内科,北京100853

出　　处：《中华健康管理学杂志》2013年第1期22-26,共5页Chinese Journal of Health Management

基　　金：国家“十一五”科技支撑计划（2006BA101A02）

摘　　要：目的研究健康查体人群中冠状动脉斑块与危险因素的相关性。方法连续选取2010年1月1日至2011年4月1日期间住院行健康查体且接受了冠状动脉CT的个体604例。以分数的第3个四分值为界，将查体患者分为冠状动脉正常组（评分=0）、轻度病变组（0〈评分≤5）和中重度病变组（评分〉5），使用X^2或秩和检验在组间比较5项体格检查、124项实验室检查、21项超声检查和出院诊断等数据。此外还把这些数据直接与冠状动脉评分进行二元相关分析。筛选出组间比较或二元相关有统计学意义的项目带人多元线性回归和二元逻辑回归，找出冠状动脉病变的主要危险因素，并绘制ROC曲线，分析其诊断冠状动脉中重度病变的价值。结果240例冠状动脉CT未见明显异常，271例有轻度病变，93例有中重度病变。平均颈动脉中-内膜厚度（cIMT）、男性、LDL—C、年龄和HDL—C进入了多元线性回归方程，其中年龄对冠状动脉积分的贡献最大（标准回归系数β=0．263），其次为cIMT（β=0．182）。二元逻辑回归和ROC曲线显示，平均cIMT为冠状动脉病变的最强危险因子（OR=7．19、95％CI：2．00—25．93），其预测冠状动脉中重度病变的价值较大（ROC=0．730、P=0．00、95％CI：0．68～0．78），但不能帮助区分轻度病变和正常冠状动脉。此外，冠状动脉斑块多分布在前降支（20．8％），性质以软斑块为主（42．5％）。结论60．2％的健康查体者被CCTA发现了冠状动脉斑块。cIMT、年龄、LDL—C和HDL—C可以较好地预测冠状动脉中重度病变，但和轻度病变关系不大。Objective To assess the relationship between coronary plaques and risk factor of coronary heart disease in a asymptomatic population. Methods A total of 604 in-patients who received coronary computerized tomography angiography （CCTA） during January 1 th,2010 and April 1 th, 2011 were enrolled in this study and assigned to the non-lesion group （ 0 ） , mild lesion group （ 0 〈 score ~〈 5 ） and moderate-severe lesion group （ 〉 5 ） according to the third quartile of CCTA score. Clinical data including physical examination, laboratory test, ultrasound sonogram and discharge diagnoses were collected and compared between the groups. Muhivariable linear regression and bivariate logistic regression were performed to find out the main risk factors of coronary heart disease. ROC curve was drawn to estimate the diagnostic value of coronary lesions. Results There were 240 individuals in the non-lesion group, 271 in the mild lesion group ,93 in the moderate-severe lesion group. Multivariablc linear regression indicated Y = -6. 56 ＋ 3.22 x mean carotid intima-media thickness （cIMT） ＋ 1. 106 x male ＋ 0. 597 x low-density lipoprotein cholesterol （ LDL-C ） ＋ 0. 116 x age - 1. 596 ~ high-density lipoprotein cholesterol （ HDL-C ） . Bivariate logistic regression and ROC curve showed that mean cIMT was the main risk factor of coronary heart disease （odds ratio （OR） =7.19, ROC =0.730,P=0.00,95% confidence interval （C1）： 0.68 to 0.78）. Furthermore,major coronary lesions were located in the LAD （20. 8% ） and was soft plaque （42.5%）. Conclusion In this investigation, 60. 2% of the asymptomatic patients showed plaques in CCTA. Age,cIMT,LDL-C and HDL-C may be predictive to moderate to severe coronary artery lesions.

关 键 词：颈动脉 危险因素 体格检查 

分 类 号：R541.4[医药卫生—心血管疾病]