摘要
目的探讨年轻(年龄<50岁)女性冠心病患者的临床危险因素和冠状动脉病变特点,以期为临床预防、诊断及治疗提供依据。方法选择2012年7月至2014年9月因冠心病或疑似冠心病于新乡医学院第一附属医院住院女性177例(年龄<50岁),根据冠状动脉造影结果分为冠心病组(A组)及冠状动脉正常组(B组),据临床特点冠心病组又分为稳定型心绞痛、不稳定型心绞痛以及急性心肌梗死组,对比分析A、B两组间冠心病危险因素及冠状动脉造影特点。结果 (1)传统危险因素:与冠状动脉正常组相比,冠心病组高血压患者、已停经患者、糖尿病患者、肥胖症患者(BMI≥28 kg/m2)、高密度脂蛋白降低、A型性格比例明显升高,雌二醇水平下降,差异有统计学意义(P<0.05),而年龄、冠心病家族史、血清低密度脂蛋白、总胆固醇、甘油三酯及脂蛋白(a)值两组间比较差异无统计学意义(P>0.05)。(2)新的可能危险因素:与冠状动脉正常组相比,冠心病组患者总胆红素、间接胆红素水平明显下降(P<0.05),而血浆纤维蛋白原水平明显升高(P<0.05),血红蛋白、血尿酸、红细胞压积、胱抑素-C两组间比较未见明显差异(P>0.05)。(3)相比单支病变组,多支病变组总胆红素、间接胆红素下降更明显,差异有统计学意义(P<0.05)。不稳定型心绞痛及急性心肌梗死组血浆纤维蛋白原水平明显高于稳定型心绞痛,差异有统计学意义(P<0.05)。(4)Logistic回归分析显示:50岁以下女性冠心病的独立危险因素依次为高血压病(OR=6.302)、高密度脂蛋白降低(OR=3.490)、A型性格(OR=3.237)及高甘油三酯(OR=2.338)(P均<0.05)。(5)冠心病组冠状动脉造影显示单支病变34例(48.57%),其中前降支病变28例(82.35%),双支病变16例(22.86%),三支病变20例(28.57%)。结论 (1)高血压、高密度脂蛋白降低、A型性格及高甘油三酯血症为50岁以下女性冠心病患者主要独立危险因素;血浆纤维蛋白原水平可反映年轻女性冠心病患者病情,尤其在急性冠状动脉综合征早期诊断中具有重要临床价值;低血清胆红素水平可能参与年轻女性冠心病发病及进展。(2)年轻女性冠状动脉病变以单支病变多见,多累及前降支。
Objective To investigate the clinical risk factors and angiographic characteristics of young women with coronary heart disease, in order to provide the basis for clinical prevention, diagnosis and treatment. Methods One hundred and seventy-seven women under the age of 50 were selected from July 2012 to September 2014 with coronary heart disease or suspected coronary heart disease in the First Affiliated Hospital of Xinxiang Medical College. They were divided into coronary heart disease group (group A) and coronary artery normal group (group B) according to coronary angiography. According to the clinical features of coronary heart disease group was divided into stable angina, unstable angina and acute myocardial infarction. Comparative analysis was performed between the two groups to study the coronary heart disease risk factors and coronary angiographic features. Results (1) Traditional risk factors: compared to group B, there were more women with hypertension, menopause, diabetes, obesity (BMI≥28 kg/m2), reduced high-density lipoprotein, A-type personality in group A (P<0.05).The level of estradiol in group A was lower than that in group B (P<0.05). But both groups had similar age, family history of coronary heart disease, LDL, total cholesterol, triglycerides, lipoprotein (a) (P>0.05). (2)New risk factors: compared with group B, serum levels of total bilirubin, indirect bilirubin were significantly decreased (P<0.05) and plasma fibrinogen significantly increased in group A (P<0.05). But hemoglobin, blood uric acid, HCT, serum Cys-C between the two groups showed no significant difference (P>0.05). (3)Compared with the single branch lesion group, total bilirubin, indirect bilirubin were significantly decreased in the multi vessel disease group, the difference was statistically significant (P<0.05). The plasma fibrinogen level in the unstable angina and acute myocardial infarction group was significantly higher than that in stable angina pectoris, the difference was statistically significant (P<0.05). (4)Logistic regression analysis showed that the independent risk factors of coronary heart disease women under the age of 50 were hypertension (OR=6.302), reduced high-density lipoprotein (OR=3.490), A-type personality (OR=3.237) and high triglycerides (OR=2.338) (P<0.05). (5)Coronary angiography of coronary heart disease group showed single vessel disease in 34 cases (48.57%), of which 28 cases of left anterior descending artery disease (82.35%), double vessel disease in 16 cases (22.86%), three lesions in 20 cases (28.57%). Conclusions (1) High blood pressure, reduced high-density lipoprotein, A-type personality and hypertriglyceridemia are the major risk factors for female patient under the age of 50 with coronary heart disease; Plasma fibrinogen level can reflect state of an illness in young female patients with coronary disease. In particular, it has an important clinical value in early diagnosis of acute coronary syndromes;Low serum bilirubin level may be involved in the pathogenesis and progress of young women with coronary heart disease. (2)The coronary artery disease is more common in single-vessel disease, mainly involving the left anterior descending artery.
出处
《中华临床医师杂志（电子版）》
CAS
2015年第22期6-11,共6页
Chinese Journal of Clinicians(Electronic Edition)
