50岁以上瓣膜性心脏病冠脉造影分析

The Prevalence of Coronary Artery Disease in elder Patients with Valvular Heart Disease.

目的探讨老年瓣膜性心脏病合并冠心病的情况。方法96例50岁以上瓣膜性心脏病住院患者,其中男性38例,女性58例,常规予Judkins法经股动脉或桡动脉行冠脉造影。并结合冠心病的危险因素、瓣膜病的病因、病变部位进行多因素分析。结果96例瓣膜性心脏病患者合并冠心病11例,总发生率11.5%。其中风湿性瓣膜性心脏病82例,合并冠心病7例,发生率8.5%,非风湿性瓣膜性心脏病14例,合并冠心病4例,发生率28.5%,两组相比P<0.05。多危险因素组46例,合并冠心病9例,发生率19.6%,少危险因素组50例,合并冠心病2例,发生率4%,两组相比P<0.05。主动脉瓣病变者合并冠心病2例,二尖瓣病变者合并冠心病3例,联合瓣膜病变者合并冠心病5例,各组相比P>0.05。结论瓣膜性心脏病合并冠心病发生率不高且合并冠心病者多为非风湿性病因,其中危险因素组冠心病发生率较高,不同瓣膜病变在合并冠心病发病率上无显著性差异。

Objective This study was conducted to determine the prevalence of coronary artery disease（CAD） in patients with valvular heart disease in elder people. Methods 96 consecutive patients （38 males, 58 females） with valvular heart disease and age 〉 50 years were included in this study. All patients underwent diagnostic coronary angiography with Judkins technic. The presense of CAD risk factors （e.g.hypertension, smoking, hyperlipidemia, diabetes mullitus, family history of CAD）, predictors of CAD were identified by logistic regression analysis. Results 11 cases of CAD were presented in all 96 patients （11.5%）, including 6 males and 5 females. The incidence of CAD in patients with more CAD risk factors was higher than in patients with less CAD risk factors （20% Vs 4% P〈 0.05）. CAD incidence was higher in patients with acquired valvualar disease than in patients with rheumatic heart disease （28.5% Vs 8.5%, P 〈 0.05）. The CAD incidence was 10.7%, 10.5% and 12.5% respectively in patients with mitral valve disease, aortic valve disease and combined mitral and aortic valve diaease. There was no significant different among these groups （ P 〉 0.05）. Condusions Our results indicated that in age 〉 50 years patients, CAD incidence was lower in rheumatic valvular heart disease than in acquired valvular heart disease. The CAD incidence was related with CAD risk factors and acquired heart disease. Different valvular heart disease had the same CAD incidence.