不同性别急性冠状动脉综合征患者的多重危险因素模型分析  

Multiple risk factors models of patients with acute coronary syndromes of different genders

作　　者：孙王乐贤[1] 呼铁民[1] 黄贤胜[1] 张英[1] 郭金锐[1] 王文丰[1] 史菲[1] 王鹏飞[1] 王华荣[1] 孙静[1] 李春华[1] 

机构地区：[1]承德医学院附属医院心内科承德市心血管病研究所,067000

出　　处：《中华医学杂志》2014年第47期3735-3739,共5页National Medical Journal of China

基　　金：河北省科技厅指令性计划课题项目（13277789D）

摘　　要：目的：建立不同性别急性冠脉综合征（ ACS）患者的多重危险因素模型，定量评价各种因素对ACS的致病危险。方法2010年1月至2012年12月河北省承德医学院附属医院心内科住院的冠心病患者3117例，其中ACS患者2388例，符合纳入标准的2308例均连续入选，同时连续入选同期住院的冠状动脉正常的患者256例。分4组：女性和男性ACS组，分别为970和1338例；女性和男性对照组，分别为136和120例。收集所有患者的人口学特征、临床特征与治疗措施等资料，分别建立不同性别ACS患者的多因素Logistic回归模型。结果年龄＞45岁、血脂异常、2型糖尿病、高血压与肥胖等均为ACS患病的独立危险因素（均P＜0．05）。但各种危险因素对不同性别ACS致病风险不同：女性45岁以后，年龄每增加5岁， ACS患病风险增加1．45倍，而男性增加1．13倍（P＜0．05）；血脂异常、2型糖尿病、肥胖与高血压，导致女性患ACS的风险（OR）分别增加3．45、4．06、2．93、1．78倍（均P＜0．05），2型糖尿病、血脂异常、高血压、现症吸烟、脑梗死与肥胖，导致男性患ACS的风险（ OR）分别增加2．33、1．68、3．80、5．49、3．36、1．91倍（均P＜0．05）。三大经典危险因素的致病危险比较：女性患者，2型糖尿病、血脂异常与肥胖导致女性ACS的发病危险最高，尤其是糖尿病最为显著；而男性患者则以吸烟、高血压、2型糖尿病致病危险最高，尤其脑梗死是男性ACS重要等危症。结论2型糖尿病、血脂异常、高血压、吸烟和肥胖等危险因素，对不同性别患者导致ACS的危险不同，在ACS的一级预防中应予高度重视。Objective To establish the multiple risk factors models for patients with acute coronary syndromes （ ACS） of different genders and quantitatively assess the pathopoiesis of all factors.Methods A total of 2 308 consecutive ACS inpatients and a control group of 256 cases with normal coronary artery from January 2010 to December 2012 were enrolled and divided into 4 groups of female ACS （ n=970 ） , male ACS （n=1 338）, female control （n=136） and male control （n=120）.All demographic and clinical data were collected by the physicians and master degree candidates in the division of cardiology.Results The Logistic regression models of multiple risk factors were established for ACS by different genders.More than 45 years of age, dyslipidemia, type 2 diabetes mellitus, obesity and hypertension were all independent risk factors of ACS for different genders （P〈0.05）.However, the same risk factors had different pathogenic effects on ACS between genders.The odds ratio （ OR） was markedly different for females and males： per 5-year increase aged over 45 years （1.45 vs 1.13）, dyslipidemia （3.45 vs 1.68）, type 2 diabetes mellitus （4.06 vs 2.33）, obesity （2.93 vs 1.91） and hypertension （1.78 vs 3.80） respectively （all P〈0.05）. In addition, current smoking increased the risk of ACS attack in males by 5.49 （ P 〈0.05 ） while not statistically significant in females.Particularly cerebral ischemic stroke increased the risk of ACS attack by 5.49 folds in males other than females （P〈0.05）.Conclusion Type 2 diabetes mellitus, dyslipidemia and obesity may present higher risks of ACS attack for females than males.And smoking and hypertension are much more dangerous for males.Males with cerebral infarction are more susceptible for ACS than females.

关 键 词：急性冠状动脉综合征 性别 危险因素 一级预防 

分 类 号：R541.4[医药卫生—心血管疾病]