初发急性心肌梗死发病危险因素分析

Primary risk factors in Chinese patients with first acute myocardial infarction

目的探讨2004--2005年北京及沈阳城市居民急性心肌梗死发生的主要危险因素，并初步估计和分析各危险因素的归因危险度百分比（ARP）和人群归因危险度百分比（PARP）。方法采用1：1配比病例对照研究方法，连续纳入初发急性ST段抬高心肌梗死患者共426例，以性别和年龄为匹配因素，为每位患者匹配健康对照1例。结果经多因素条件logistic回归分析，最终纳入了8个主要危险因素，依次为大量吸烟、糖尿病史、早发冠心病家族史、豆类摄人较少、心理压力较大、海鱼摄人较少、文化程度较低及6个月内曾经历过负性生活事件。其OR值依次为3．170、2．835、2．243、2．243、2．138、1．740、1．572和1．515；ARP值依次为71．53％、58．33％、54．05％、40．81％、56．85％、41．53％、48．62％和54．00％；PARP值依次为38．79％、10．40％、4．69％、33．72％、36．03％、24．96％、29．56％，14．83％。结论2004--2005年，对我国北京和沈阳城市居民人群发生急性心肌梗死危害最大的危险因素依次为大量吸烟、心理压力较大、豆类摄人较少、文化程度较低、海鱼摄人较少、6个月内曾经历过负性生活事件、糖尿病和早发冠心病家族史。

Objective To analyze the primary risk factors of patients with first ST elevation acute myocardial infarction（FSTEMI） in Beijing and Shenyang area between 2004 -2005. The Attributable risk percentage （ARP）and population attributable risk percentage （PARP） of every risk factor were determined. Method A total of 426 consecutive FSTEMI patients and 426 gender and age matched healthy controls were included in this 1：1 matched case-control study. Result Multivariate logistic regression analysis showed that following 8 primary risk factors were associated with FSTEMI： heavy smoking （OR = 3. 170） , diabetes （OR =2. 835） , positive family history （ OR = 2. 243） , lack of soybeans intake （ OR = 2. 243）, higher psychological stress （ OR = 2. 138）, lack of fish intake （ OR = 1. 740）, lower education level （OR = 1. 572） and recent adverse life events （ 〈6 months before FSTEMI, OR = 1. 515）. The ARP are 71.53% ,58. 33% ,54. 05% ,40. 81% ,56. 85% ,41.53% ,48. 62% ,54.00% ;the PARP are 38. 79%, 10. 40%, 4. 69%, 33.72%, 36.03%, 24.96%, 29. 56%, 14. 83%, respectively. Conclusion In this patient cohort, the harmful risk factors responsible for the development of FSTEMI in Beijing and Shenyang areas during 2004 - 2005 are heavy smoking, higher psychological stress, lack of soybeans intake, lower education level, lack of fish intake, recent adverse life events, diabetes and positive family history.