老年疑诊冠心病患者冠心病的危险因素以及冠状动脉病变程度的相关因素  

Relationship between coronary artery stenosis severity and cardiovascular risk factors in elderly Chinese patients with suspected coronary artery disease

作　　者：陈学智[1] 唐强[1] 王智[1] 曲华清[1] 唐群中[1] 颜东[1] 史震涛[1] 

机构地区：[1]北京大学首钢医院心内科,北京100141

出　　处：《心脏杂志》2016年第2期170-174,共5页Chinese Heart Journal

摘　　要：目的探讨老年(≥60岁)疑诊冠心病患者的冠心病危险因素及其冠状动脉病变严重程度的相关因素。方法选择我中心首次行诊断性冠状动脉造影(CAG)的老年疑诊冠心病患者4 732例。根据CAG结果分为冠心病组(3 539例)和非冠心病组(1 193例)。冠状动脉病变程度特点用Gensini积分和主要血管受累支数进行评价。采用多元线性回归和logistic回归进行数据分析。结果 1多元线性回归分析表明Gensini积分与患者年龄、男性、高血压病、高脂血症、糖尿病、慢性肾脏病及空腹血糖水平呈独立正相关,与血清总胆红素呈独立负相关。2多元线性回归分析表明病变支数与患者年龄、吸烟、男性、高血压病、高脂血症、糖尿病、慢性肾脏病、脑血管病及空腹血糖水平呈独立正相关,与血清总胆红素呈独立负相关。3二分类多因素Logistic分析显示,糖尿病是冠状动脉造影诊断冠心病最显著的独立相关危险因素(OR=2.591,95%CI:1.942-3.458,P<0.01),其他危险因素依次为男性、高血压病、吸烟、慢性肾脏病、高脂血症和年龄,总胆红素为其独立保护因素(OR=0.960,95%CI:0.941-0.979,P<0.01)。结论糖尿病是现阶段老年住院疑诊冠心病患者冠状动脉造影诊断冠心病最显著的独立相关危险因素,总胆红素水平为其独立相关保护因素。AIM To analyze coronary artery disease （CAD） risk factors and the relationship between coronary artery stenosis severity and CAD risk factors in elderly Chinese patients with suspected CAD. METHODS A large cohort of 4 732 consecutive patients （aged 〉160 years） who had been diagnosed with CAD or without CAD by coronary angiography was studied retrospectively. In all, 3 539 consecutive patients with angiographically proven CAD （CAD group） and 1 193 consecutive individuals without CAD （control group） were included in the study. CAD risk factors, coronary artery lesion severity, Gensini cumulative scores and branch numbers of coronary artery stenosis were examined and compared. RESULTS Multiple linear regression analysis demonstrated that Gensini scores were positively correlated with age, male gender, hypertension, hyperlipemia, diabetes mellitus, chronic kideny disease, cerebro- vascular disease and fasting blood-glucose but were negatively correlated with total bilirubin levels. Branch numbers of coronary artery stenosis were positively correlated with age, smoking, male gender, hypertension, hyperlipidemia, diabetes mellitus, chronic kidney disease, eerebrovascular disease and fasting blood-glucose and were also negatively correlated with total bilirubin levels. Multivariate binary logistic regression analysis showed that diabetes mellitus （ OR = 2. 591, 95% CI： 1.942 - 3. 458, P 〈 0. 01 ） was the most important independent risk factor for CAD followed by male gender, hypertension, smoking, chronic kidney disease, high low-density lipoprotein cholesterol, and age. However, total bilirubin level was a protective factor for CAD （OR =0. 960, 95% CI： 0. 941 -0. 979 （P 〈0. 01）. CONCLUSION Diabetes mellitus is the most important independent CAD risk factor in elderly Chinese patients with suspected CAD. However, total bilirubin is an independent protector factor.

关 键 词：冠状动脉疾病 危险因素 冠状动脉造影 GENSINI积分 总胆红素 

分 类 号：R541.4[医药卫生—心血管疾病]