不同种族女性拟诊冠心病患者冠状动脉造影及临床特点的对比研究

Differences in coronary angiography and clinical characters between the women from different races

目的目前,关于女性冠心病的种族差异研究较少。文中比较了黄种人与白种人女性拟诊冠心病患者的临床表现、冠状动脉造影(coronary artery angiography,CAG)特点及危险因素。方法 2644例女性按照人种分为黄种人组和白种人组,再分别按年龄分为中青年组(<60岁)和老年组(≥60岁)共4组。比较各组临床表现、CAG特点及危险因素的差异。结果①各年龄组黄种人女性稳定性心绞痛(stable angina pectoris,SA)发病率均显著低于同龄白人女性(5.4% vs 54.6%、7.9% vs 53.4%,P<0.01),而不稳定性心绞痛(unstable angina pectoris,UA)和不典型胸痛的发病率均显著高于同龄白人女性(29.0% vs 15.5%、35.2% vs 24.2%,58.4% vs 20.7%、44.9% vs 14.6%;P<0.01)。②黄种人和白种人女性CAG阳性率在相同年龄段内差异无显著性统计学意义(44.8% vs 47.1%、68.9% vs 69.8%,P>0.05)。冠脉病变累及的血管均依次为左前降支(left anterior descending branch,LAD)、右冠状动脉(right coronary artery,RCA)、左回旋支(left circumflex branch,LCX)、左主干(left main coronary artery,LM)。黄种人女性中青年组3支血管病变百分率显著低于同龄白人女性(8.8% vs 17.7%,P<0.01),但黄种人和白种人女性3支病变率均随年龄增长而增高(8.8% vs 24.9%、17.7% vs 29.0%,P<0.01)。③黄种人女性高血压的检出率均显著高于同龄白人女性(59.2% vs 45.1%、71.9% vs 62.1%,P<0.01),但高血脂的检出率均显著低于同龄白人女性(18.4% vs 68.9%、15.9% vs 66.3%,P<0.01)。黄种人女性中青年组糖尿病的检出率显著低于同年龄白人女性组(15.9% vs 66.3%,P<0.01),而老年组糖尿病的检出率虽低于白人女性组,但差异无统计学意义(23.7% vs 26.2%,P>0.05)。结论黄种人女性UA及不典型胸痛发病率显著高于白人女性,但白人女性SA和3支血管病变率显著高于黄种人女性。高血压是黄种人女性冠心病重要的致病因素,而高血脂和糖尿病是白人女性冠心病重要的致病因素。

Objective Nowadays investigation about racial difference in women with coronary artery diseases(CAD) is rare.This research was to compare the clinical presentation,coronary angiography and risk factors between yellow and white women.Methods 2644 female patients who were diagnosed as CAD were divided into 4 groups according to race(yellow and white) and age(<60 and ≥60).Comparison of clinical presentation,coronary angiography and risk factors were made among these groups.Results ①Between comparable age groups,the incidences of stable angina pectoris in yellow were significantly lower than those in white women(5.4% vs 54.6%,7.9% vs 53.4%,respectively,P<0.01),while the incidences of unstable angina pectoris and atypical chest pain in yellow were significantly higher than those in white women(29.0% vs 15.5% and 35.2% vs 24.2%,58.4% vs 20.7% and 44.9% vs 14.6%,respectively,P<0.01).②The CAG positive rates were similar in yellow and white women in comparable age groups(44.8% vs 47.1% and 68.9% vs 69.8%,respectively,P>0.05).The involved coronary arteries were left anterior descending branch,right coronary artery,left circumflex branch and left main coronary artery in a descending order in both yellow and white women.The incidence of three vessel disease in yellow was significantly lower than that in white in <60 age groups(8.8% vs 17.7%,P<0.01).There was an age-dependent increase of three vessel disease incidences in both yellow and white groups(8.8% vs 24.9% and 17.7% vs 29.0%,P<0.01).③The incidence of hypertension was significantly higher in yellow than in white women,respectively,between comparable age groups(59.2%vs 45.1% and 71.9% vs 62.1%,P<0.01).But the incidences of hyperlipidemia in yellow were significantly lower than those in white women,respectively,between comparable age groups(18.4% vs 68.9% and 15.9%vs 66.3%,P<0.01).The incidence of diabetes mellitus in yellow was significantly lower than that in white women of younger group(15.9% vs 66.3%,P<0.01),but not significantly lower than that in white women of older group(23.7% vs 26.2%,P>0.05).Conclusion The incidences of unstable angina pectoris and atypical chest pain in yellow women were significantly higher than those in white.But the incidences of stable angina pectoris and three vessel disease were significantly higher in white women.Hypertension is the most important risk factor for yellow women with CAD while hyperlipidemia and diabetes mellitus are more important for white ones.