＂三高＂因素与冠心病临床发作之间的关联

The association of ＂three high＂ factors with the onset of coronary artery disease

目的 探讨高血压、高血脂、高血糖,即＂三高＂因素,与冠心病临床发作之间的关联性.方法 首先对2005年6月-2009年1月入住本院的276例疑诊冠心病患者用16层螺旋CT进行冠脉CTA检查,然后根据冠脉狭窄程度将资料分为冠心病及非冠心病两组,以卡方检验、二项分类Logistic回归、均数比较及ROC曲线分析＂三高＂因素与冠心病临床发作之间的关联性.结果 卡方检验显示：冠心病的发生受年龄（χ2=13.560,P=0.001）、总胆固醇（TC）（χ2=8.260,P=0.004）、甘油三脂（TG）（χ2=5.718,P=0.017）和低密度脂蛋白（LDL）（χ2=6.375,P=0.012）影响 Logistic回归发现冠心病的发生与TC（0R=1.967,P=0.000）及年龄（OR=1.046,P=0.004）相关性更密切.冠心病患者血清TC（t=3.387,P=0.001）及LDL（t=3.662,P=0.000）水平高于非冠心病患者 TC、TG、HDL及LDL预测冠心病临床发作的ROC曲线下面积（AUC）分别为0.655、0.473、0.569及0.640.结论 ＂三高＂因素中,血清TC水平与冠心病的临床发作之间的关联性最密切,LDL次之,血压、血糖水平未显示出明显关联性,但血清TC及LDL水平对冠心病的临床发作基本无预测价值.

Objective To explore the association of hypertension and higher levels of blood lipids and sugar （＂three high＂ factors） with the onset of coronary artery disease.Methods From June 2005 to January 2009,276 hospitalized patients with suspected coronary heart disease underwent coronary angiography by sixteen-slice spiral CT. The patients were divided into two groups with or without coronary artery disease according to the findings of cardiac CTA. Chi square test,binary logistic regression,mean comparison and receiver operating characteristic （ROC） curves were used to analyze the association of ＂three high＂ factors with the onset of coronary artery disease. Results Chi square test showed that the onset of coronary heart disease was affected by age （χ2=13.560,P=0.001）,total cholesterol （TC） （χ2=8.260,P=0.004）,triglyceride （TG） （χ2=5.718,P=0.017）,and low density lipoprotein （LDL） （χ2=6.375,P=0.012）.Logistic regression exhibited that the onset of coronary heart disease closely correlated to TC （OR=1.967,P=0.000） and age （OR=1.046,P=0.004）. Serum levels of TC （t=3.387,P=0.001） and LDL （t=3.662,P=0.000） increased significantly in patients with coronary heart disease compared with those without coronary heart disease. The areas under the ROC cures of TC,TG,HDL and LDL to predict the onset of coronary heart disease was 0.655,0.473,0.569,and 0.640,respectively. Conclusions Among the ＂three high＂ factors,serum TC level shows the closest association with the onset of coronary artery disease,followed by LDL level blood presure and sugar don＇t show any association. However,serum levels of TC and LDL could hardly predict the onset of coronary heart disease.