早发冠心病的临床特点研究

Clinical manifestations of young and aged patients with coronary artery disease

目的分析早发冠心病患者的传统危险因素、脂类代谢情况及冠状动脉病变特点。方法收集临床资料和血管造影结果，对早发冠心病患者、非早发冠心病患者和非冠心病患者的传统危险因素、脂类代谢情况、冠状动脉病变特点进行统计学分析。结果（1）早发冠心病与非早发冠心病比较，具有以下临床特点：①传统危险因素较少（2．50±1．28比2．76±1．43，P〈0．05）；②吸烟[50.3％（73／145）比38．0％（82／217），P〈0.05]和阳性家族史[29.7％（43／145）比19．9％（43／217），P〈0．05]比率较高，高血压比率较低[59．3％（86／145）比73．3％（159／217），P〈0．05]；③甘油三酯水平较高[（2．13±1．89）mmol／L比（1．78±1．14）mmol／L，P〈0．05]；④以急性冠状动脉综合征起病为主[66．2％（96／145）比42．6％（89／209），P〈0．05]，并且以单支血管受累为主[51．0％（74／145）比30．4％（66／217），P〈0，05]；⑤病例平均病变积分较低（4．86±2．30比5．92±2．66，P〈0．05），轻度病变比率较高[46．9％（68／145）比31．2％（68／217），P〈0．05]。（2）logistic回归发现阳性家族史是早发冠心病发病的独立危险因素（OR=1．766，95％c，1．060-2．940，P：0．029），吸烟（OR=1．561，95％C10．971—2．510，P=0.066）起较重要的作用。结论与非早发冠心病相比，早发冠心病患者中传统危险因素虽所占比例较少，但冠心病阳性家族史和甘油三酯水平升高以及吸烟比例明显高于非早发冠心病患者，常以急性冠状动脉综合征起病为主，常为单支不稳定病变。提示冠心病阳性家族史即遗传倾向和代谢综合征在早发冠心病发生发展过程中起重要作用。

Objective To analyze clinical characteristics in young and aged patients with coronary artery disease （CAD）. Methods The clinical and coronary angiographic data were compared between young （PCAD, male 〈55 years old, n =74, female 〈65 years old, n =71 ） and aged （CAD, male 〉55 years old, n = 106, female 〉 65 years old, n = 111 ） patients. Seventy-one patients excluded with CAD by angiography served as controls （non-CAD）. The traditional risk factors （including age, smoking, blood pressure, lipid profile, blood glucose, BMI, family history） , coronary angiographic changes were analyzed and compared among various groups. Results （1） Compared with CAD group, PCAD patients had significantly higher rate of smoking （50. 3% vs. 38.0%, P 〈 0. 05 ）, significantly higher positive CAD family history rate （ 29.7% vs. 19.9% , P 〈 0. 05 ） and significantly higher TG level [ （ 2. 13 ～ 1.89 ） mmol/L vs. （ 1.78 ～ 1.14 ） mmol/L, P 〈 0. 05 ], while had significantly fewer traditional risk factors （2. 50 ～ 1.28 vs. 2. 76 ～ 1.43, P 〈 0. 05 ） and lower hypertension rate （ 59. 3% vs. 73. 3%, P 〈 0. 05 ）. There were significantly more PCAD patients with acute coronary syndrome （66. 2% vs. 42. 6%, P 〈 0. 05） , more PCAD patients had single vessel lesion （51.0% vs. 30. 4% ,P 〈0. 05） , lower average lesion score （4. 86 -2. 30 vs. 5.92 ～ 2. 66, P 〈 0. 05 ）. （2） The logistic regression results showed that positive CAD family history （ P = 0. 029, OR = 1. 766,95% CI 1. 060-2. 940 ） and smoking （ P = 0. 066, OR = 1. 561,95% CI 0.971-2.510） are important independent risk factors for the development of PCAD. Conclusions Smoking, positive fanfily history and the increased TG might contribute to the pathogenesis of PCAD.