青年初发急性心肌梗死患者的血脂异常患病率及趋势变化分析  

Prevalence and trend of dyslipidemia in young patients with initial acute myocardial infarction

作　　者：张丽君[1] 左惠娟[2] 宋现涛[3] ZHANG Lijun;ZUO Huijuan;SONG Xiantao(Department of Comprehensive of Medical,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所医学影像科,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所人群防治研究室,100029 [3]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科,100029

出　　处：《心肺血管病杂志》2021年第6期538-543,共6页Journal of Cardiovascular and Pulmonary Diseases

基　　金：心血管疾病精准医学北京实验室(PXM2018_014226_000013)。

摘　　要：目的:探讨初发急性心肌梗死(AMI)的青年患者不同标准和类型的血脂异常患病率、变化趋势及与冠状动脉狭窄程度的相关关系。方法:收集2007年1月至2017年12月,初次诊断为AMI青年住院患者2 781例。通过电子病历系统提取年龄、性别、出院诊断等一般临床资料以及高血压病史、糖尿病史、肥胖、吸烟以及TC、LDL-C、HDL-C和TG检测结果。结果:初发AMI的青年患者平均年龄(38.9±4.7)岁,男性2 657例(95.5%)。TC、LDL-C以及HDL-C平均水平分别为:(4.48±1.19)mmol/L、(2.82±0.97)mmol/L和(0.91±0.21)mmol/L,TG中位水平1.92 mmol/L。血脂异常患病率为81.0%(2 254/2 781),男性患病率显著高于女性(81.8%vs.65.3%,P<0.001)。低HDL-C患病率最高,为71.2%(1 971/2 781),其次为高TG(36.3%,1 009/2 781)。<35岁组高TC和高LDL-C患病率显著高于其他两年龄组(P值均<0.001)。调整相关影响因素后,HDL-C以及TG与冠状动脉狭窄≥50%无显著相关关系。TC 5.2~6.19 mmol/L:OR=2.58,95%CI:1.42~4.68;≥6.2 mmol/L:OR=2.96,95%CI:1.37~6.42以及LDL-C 3.4~4.09 mmol/L:OR=3.15,95%CI:1.46~6.82;≥4.1 mmol/L:OR=3.22,95%CI:1.46≥7.11与冠状动脉狭窄≥50%显著相关。结论:初发AMI的青年患者血脂异常患病率2倍于普通人群,2007年至2017年间血脂异常及各组份异常患病率并未呈现趋势性变化。<35岁AMI患者高TC和高LDL-C较其他年龄组更突出。LDL-C≥3.4 mmol/L或TC≥5.2 mmol/L与冠状动脉狭窄≥50%的危险增加相关。Objective:The present study aimed to investigate the prevalence and trend of dyslipidemia in young patients with initial acute myocardial infarction(AMI)according to different criteria and types,and its correlation with the coronary artery stenosis.Methods:We included 2781 patients in whom initial AMI occurred before age of 45 years from January 2007 to December 2017.General clinical data such as age,gender,discharge diagnosis,hypertension history,diabetes history,obesity,smoking,TC,LDL-C,HDL-C and TG were extracted by electronic medical record system.Results:The average age of young patients with initial AMI was(38.9±4.7)years old,including 2657 males(95.5%).The average levels of TC,LDL-C and HDL-C were(4.48±1.19)mmol/L,(2.82±0.97)mmol/L and(0.91±0.21)mmol/L,respectively.The median level of TG was 1.92 mmol/L.The prevalence of dyslipidemia was 81.0%(2254/2781),and the morbidity of males was significantly higher than that of females(81.8%vs.65.3%,P<0.001).The highest prevalence of low HDL-C was 71.2%(1971/2781),followed by high TG(36.3%,1009/2781).The preva-lence of high TC and high LDL-C in<35 years old group was significantly higher than that in other two age groups(P<0.001).After adjusting the related factors,HDL-C and TG had no significant correlation with significant coronary artery stenosis(≥50%).TC 5.2-6.19 mmol/L:OR=2.58,95%CI:1.42-4.68;≥6.2 mmol/L:OR=2.96,95%CI:1.37-6.42;and LDL-C 3.4-4.09 mmol/L:OR=3.15,95%CI:1.466.82;≥4.1 mmol/L:OR=3.22,95%CI:1.46-7.11 were significantly associated with coronary artery stenosis(≥50%).Conclusions:The prevalence of dyslipidemia in young patients with initial diagnosed AMI is twice as high as that in the general population,and there is no trend change in the prevalence of dyslipidemia and its components from 2007 to 2017.High TC and LDL-C were more prominent in AMI patients<35 years old than in other age groups.LDL-C≥3.4 mmol/L or TC≥5.2 mmol/L was associated with an increased risk of significant coronary artery stenosis(≥50%).

关 键 词：心血管疾病 血脂异常 趋势 青年 

分 类 号：R54[医药卫生—心血管疾病]