75岁及以上老年患者冠脉三支病变的危险因素及临床特点  

Risk factors and clinical characteristics in patients over 75 years old with three-vessel coronary artery disease

作　　者：张亮[1] 朱毅[1] 邱朝晖[1] 陈阳[1] 郭新贵[1] 

机构地区：[1]复旦大学附属华东医院心内科,上海市200040

出　　处：《老年医学与保健》2013年第2期103-105,111,共4页Geriatrics & Health Care

摘　　要：目的分析老年冠脉三支病变患者的危险因素及临床特点。方法连续入选择期冠脉造影的75岁及以上患者192例，根据造影结果分为非冠脉病变组、一支或两支冠脉病变组和三支冠脉病变组。对3组患者基线特征、危险因素以及心功能情况进行比较。结果3组的年龄、尿酸、空腹血糖、甘油三酯、体质指数（BMI）无差异，而性别、低密度脂蛋白胆固醇（LDL—C）、血清肌酐水平及糖尿病患者比例在3组间有差异，男性患者、高LDL—C者、肌酐高者及糖尿病患者冠脉病变趋于严重（趋势检验P值分别为0．003、0．038、0．020、0．024）。随着冠脉病变的加重，患者左室射血分数（LVEF）逐渐降低、氨基末端脑钠素前体（NT—proBNP）和红细胞体积分布宽度（RDW）依次升高（趋势检验P值分别为0．040、0．045、0．045）。同时RDW与LVEF有正相关趋势（r=0．201，P=0．065）；LVEFI〉55％患者的RDW低于LVEF〈55％患者【（13．05±1．29）VS（13．51±1．39），P=0．044）】，RDW与Log（NT—proBNP）也存在相关性（r=0．340，P=0．020）。结论男性、肾功能不全、糖尿病、高LDL—C等是老年患者三支病变的危险因素。随着冠脉病变数的增加，患者心功能下降、RDW水平升高。Objective To investigate the risk factors and clinic characteristics of old patients with three-vessel coronary artery disease. Methods We consecutively enrolled 192 patients over 75 years old referring to our hospital for selected coronary angiography. The patients were divided into 3 groups, no vessel disease group, one-or two-vessel disease group and three-vessel disease group, according to the results of coronary artery angiography. The demographic characteristics, risk factors and cardiac function among three groups were compared. Results There were no differences of age, uric acid, fasting blood glucose level, triglyceride and body mass index （BMI） among three groups in the baseline condition, but not gender, low density lipoprotein cholesterol （LDL-C）, serum creatinine levels and percentage of diabetic patients. In patients with male gender, high LDL-C level, high creatinine level and type 2 diabetes mellitus were tended to suffer more serious coronary lesions （trend test, P=0.003, P=0.038, P=0.020 and P = 0. 024, respectively）. With the exacerbation of coronary lesions, left ventricular ejection fraction （LVEF） of the patients was decreased, while N-terminal pro -brain natriuretic peptide （NT-proBNP） and red blood cell distribution width （RDW） were increased （trend test, P=0.040, P=0.045 and P=0.045, respectively）. Meanwhile, there was a trend that RDW was positively correlated with LVEF （r=0.201, P=0.065）. The level of RDW was lower in patients with LVEF~〉55% than in patients with LVEF〈55% [（13.05＋1.29） vs （13.51 ＋1.39）, P=0.044]. RDW were also related with Log （NT-proBNP） （r=0.340, P=0.020）. Conclusions Male gender, renal insufficiency, diabetes mellitus and high LDL-C level are risk factors in old patients with three-vessel coronary artery disease. The cardiac function is decreased and the result of RDW is increased in these patients.

关 键 词：老年患者 冠状动脉疾病 三支病变 危险因素 红细胞宽度 2型糖尿病 

分 类 号：R543.3[医药卫生—心血管疾病]