颈动脉重度狭窄合并冠心病患者的临床危险因素分析  

Clinical risk factors in patients with severe carotid artery stenosis complicated by coronary artery disease

作　　者：邢浩然 张闽[1] 郑铁晋[2] 张楠[3] 范承哲[3] 左惠娟 宋现涛[1] 张宏家[5] Xing Haoran;Zhang Min;Zheng Tiejin;Zhang Nan;Fan Chengzhe;Zuo Huijuan;Song Xiantao;Zhang Hongjia(Center of Coronary Heart Disease,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;不详)

机构地区：[1]首都医科大学附属北京安贞医院心脏内科冠心病中心,北京100029 [2]首都医科大学附属北京安贞医院神经外科,北京100029 [3]首都医科大学附属北京安贞医院脑血管病科,北京100029 [4]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,北京100029 [5]首都医科大学附属北京安贞医院心脏外科中心心血管疾病精准医学北京实验室,北京100029

出　　处：《中国循证心血管医学杂志》2024年第5期577-582,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

基　　金：首都卫生发展科研专项(2022-1-2061,2022-2G-1055);“登峰”人才培养计划(DFL20220603)。

摘　　要：目的探究颈动脉重度狭窄合并冠状动脉粥样硬化性心脏病(冠心病,CHD)患者的临床危险因素。方法回顾性纳入2016年1月1日至2021年9月30日于首都医科大学附属北京安贞医院心血管内科、脑血管病科及神经外科就诊,接受侵入性脑动脉造影检查并提示至少1支颈动脉存在重度狭窄患者,根据合并冠心病诊断情况,分为合并冠心病组(n=654)与不合并冠心病组(n=464),比较两组患者的临床危险因素及生化指标差异,分析颈动脉重度狭窄合并冠心病患者的临床与生化危险因素。结果最终共纳入1118例颈动脉重度狭窄患者,其中颈动脉重度狭窄合并冠心病患者654例(58.5%)。与非CHD患者相比,合并冠心病患者具有更高比例的高血压、糖尿病、合并椎动脉/锁骨下动脉重度狭窄,以及更高的脂蛋白(a)[Lp(a)]与糖化血红蛋白水平,差异有统计学意义(P<0.05)。多因素回归分析结果显示,年龄、男性、高血压、重度锁骨下动脉狭窄、重度椎动脉狭窄、重度脑动脉狭窄、高Lp(a)以及高密度脂蛋白胆固醇(HDL-C)减低为颈动脉重度狭窄合并冠心病的独立危险因素(P<0.05)。在<60岁的人群中,危险因素以高血压为主;在>60岁的人群中,危险因素为男性、合并锁骨下动脉及椎动脉重度狭窄、高Lp(a)及低HDL-C。随累积危险因素的增加,颈动脉重度狭窄合并冠心病比值比(OR)予以增加,差异有统计学意义(P<0.05)。结论年龄、男性、高血压、合并锁骨下动脉/椎动脉/脑动脉重度狭窄、Lp(a)升高以及HDL-C减低为颈动脉重度狭窄患者合并冠心病的独立危险因素。危险因素在<60岁与>60岁人群中的分布存在差异。颈动脉狭窄合并冠心病风险随危险因素累积数量增加而升高。Objective To study the clinical risk factors in patients with severe carotid artery stenosis(SCAS)complicated by coronary artery disease(CHD).Methods The patients received cerebral angiography with at least one vessel of SCAS were retrospectively chosen from Department of Cardiovascular Medicine,Department of Cerebrovascular Disease and Department of Neurosurgery in Beijing Anzhen Hospital,Capital Medical University from Jan.1,2016 to Sept.30,2021.All patients were divided,according to whether complicated by CHD or not,into SCAS+CHD group(n=654)and SCAS group(n=464).The differences in clinical risk factors and biochemical indexes were compared between 2 groups.The clinical risk factors and biochemical indexes were analyzed in patients with SCAS complicated by CHD.Results There were totally 1118 patients with SCAS and among them there were 654(58.5%)complicated by CHD.The percentages of hypertension,diabetes,complicated severe vertebral/subclavian artery stenosis,and higher levels of lipoprotein(a)[Lp(a)]and glycated hemoglobin(HbAlc)were higher in SCAS+CHD group than those in SCAS group(P<0.05).The results of multi-factor regression analysis showed that age,male,hypertension,severe vertebral/subclavian artery stenosis,higher Lp(a)and lower highdensity lipoprotein-cholesterol(HDL-C)were independent risk factors of SCAS complicated by CHD(P<0.05).The risk factor was mainly hypertension in group aged under 60,and were male,severe vertebral/subclavian artery stenosis,higher Lp(a)and lower HDL-C in group aged over 60.As increase of cumulative risk factors,odds ratio(OR)for SCAS complicated by CHD increased(P<0.05).Conclusion Age,male,hypertension,severe vertebral/subclavian/cerebral artery stenosis,higher Lp(a)and lower HDL-C are independent risk factors of SCAS complicated by CHD.There is difference in risk factor distribution between group aged under 60 and group aged over 60.The risk of SCAS complicated by CHD will increase with the accumulation of risk factors.

关 键 词：冠心病 颈动脉重度狭窄 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]