230例老年冠状动脉病变与冠心病危险因素分析

Analysis of coronary risk factors in 230 old patients suspected with coronary atherosclcrosis

目的探讨老年冠脉造影患者血糖、血压、吸烟史、年龄、性别等心血管危险因素与冠状动脉病变程度的关系。方法对长海医院2007年6月至2008年6月230例疑似冠心病而行冠状动脉造影的老年患者，采集病历数据，包括性别、年龄、体质指数、腰臀比、吸烟、高血压病、收缩压、舒张压、2型糖尿病病史；测定肝功：天门冬氨酸氨基转移酶（AST）、丙氨酸氨基转移酶（ALT）、碱性磷酸酶（ALP）、r-GT、血脂，肾功能：肌酐（Cr）、尿素氮fBUN）、空腹血糖（FBG）、空腹胰岛素等生化指标。以SPSS12．0软件系统进行统计，两组配对t检验进行组间比较，多组均数进行ANOVA方差分析，对不符合正态分布者采用非参数检验比较各组差异。计数资料采用χ^2检验。采用多元线性回归进行多因素分析，探讨老年患者心血管危险因素与冠状动脉病变程度的关系。结果冠状动脉病变组（AS组）年龄较无病变组（C组）大，且男性多于女性；高血压发病率AS组较C组高，血AST、r-GT、空腹血糖亦高于造影阴性对照组（P〈0．05）。但两组中体重指数、腰臀比、收缩压、舒张压、糖尿病患病率、吸烟率、血脂、糖化血红蛋白、肌酐等水平差异均无统计学意义。按冠脉病变程度分为四组后发现，随着冠脉病变程度的加重，AST、总胆固醇（TC）、FBG水平均有所升高。但多元线性回归分析显示：冠脉病变程度与TC、AST、r-GT呈线性相关，与空腹血糖无明显相关。结论年龄、性别是老年冠心病不可控制的危险因素，随着年龄的增加，老年冠心病发病率增高。老年冠心病发病率在性别上的差异可能与女性雌激素的代谢效应有关。在其他危险因素中，空腹血糖升高、高血压、肝酶升高、血脂在老年冠心病发病中发挥重要作用。

Objective To explore the association between the severity of coronary artery atherosclerosis and risk factors. Methods 230 patients with suspected coronary heart disease were divided into 4 groups according to coronary angiography and clinical manifestations. Fasting plasma glucose, lipids, aspartate aminotransferase （AST）, aminoleucine transferase （ALT）, r-GT, creatinine, urea nitrogen and insulin were measured. Related parameters including blood pressure, body mass index （BMI）, and histories of smoking and diabetes mellitus also collected. Results （1） Patients with AS were older than those without AS, and male patients had stronger liability than female patients. Patients with AS hadhigherlevelsofAST, r-GT and fasting glucose than those without AS （P〈0.05）, but there was no significant difference in BMI, SBP, diabetes morbidity, smoking history, plasma lipids, HbA1C and creatinine between the two groups. （2） According to Gensini score, the patients were divided into 4 groups. It was found that plasma AST, TC, FBG levels increased dramatically in group III and IV. （3） Linear regression analysis showed that plasma TC, AST and r-GT levels were positively correlated with Gensini score. Conclusions Both age and gender were uncontrollable risk factors in old patients suspected with coronary atherosclerosis. The incidence of coronary atherogensis increases with age in old people. Hyperglycemia, hypertension, increased aminotransferase and hyperlipemia play important roles in the pathogenesis of coronary atherosclerosis in old patients.