重庆地区冠心病危险因素分析

Analysis on risk factors for coronary heart disease in Chongqing area

目的:探讨重庆地区冠心病(Coronary heart disease,CHD)危险因素。方法:收集我院2008年10月-2011年4月行冠状动脉造影病例1 834例,其中确诊CHD 1 169例,排除CHD 665例。分析比较各组间各危险因素的百分比、水平和比率。采用多因素Logistic回归分析方法筛选CHD相关因素。结果:1.CHD组的男性、有CHD家族史、糖尿病、高血压病、吸烟、高尿酸血症及高纤维蛋白原血症等指标比例均明显高于非CHD组(均为P<0.01)。CHD组年龄、收缩压、脉压、高血压病程、白细胞计数、载脂蛋白B、血肌酐、尿素氮、血尿酸、血浆纤维蛋白原、空腹指血血糖、餐后2 h指血血糖等指标水平均明显高于非CHD组(均为P<0.01)。CHD组总胆固醇/高密度脂蛋白胆固醇,甘油三酯/高密度脂蛋白胆固醇,低密度脂蛋白胆固醇/高密度脂蛋白胆固醇,载脂蛋白B/载脂蛋白AI等指标比值均明显高于非CHD组(均为P<0.01)。CHD组高密度脂蛋白胆固醇和载脂蛋白AI水平均明显低于非CHD组(均为P<0.01)。两组间肥胖、舒张压、甘油三酯、总胆固醇、低密度脂蛋白胆固醇等指标差异无统计学意义(均为P>0.05)。2.多因素Logistic回归分析表明男性、CHD家族史、糖尿病、高血压、吸烟、高纤维蛋白原血症、年龄、白细胞计数、载脂蛋白B均与CHD呈显著正相关(β值分别为0.496、1.149、0.595、0.592、0.953、0.282、0.050、0.155、1.488,均为P<0.01),高密度脂蛋白胆固醇与CHD呈显著负相关(β值为-0.575,P<0.05)。结论:1.男性、CHD家族史、糖尿病、高血压、吸烟、高纤维蛋白原血症、年龄、白细胞计数、载脂蛋白B与本地区CHD呈正相关,高密度脂蛋白胆固醇与本地区CHD呈负相关。2.降低载脂蛋白B水平、升高高密度脂蛋白胆固醇水平,控制糖尿病及高血压和戒烟等措施可以降低本地区CHD发病率及改善CHD预后。

Objective：To explore the risk factors for coronary heart disease in Chongqing area.Methods：A total of 1 834 consecutive patients who had been diagnosed as coronary heart disease（CHD）（n=1 169） or non-CHD（n=665）by coronary angiography between October 2008 and April 2011 were studied retrospectively.The percentage,level and ratio of each risk factor were analyzed and compared,the correlative factors of CHD were screened by multi-factor logistic regression analysis.Results：1.The percentages of male,family history of CHD,diabetes mellitus（DM）,hypertension,smoking,hyperuricemia and hyperfibrinogenemia were significantly higher in CHD group than those in non-CHD group（all P0.01）.The levels of age,systolic blood pressure（SBP）,pulse pressure（PP）,hypertension duration,WBC count,apolipoprotein B（apoB）,serum creatinine（Scr）,blood urea nitrogen（BUN）,serum uric acid（SUA）,plasma fibrinogen（FIB）,fasting capillary whole blood glucose,and 2-hour postprandial capillary blood glucose were significantly higher in CHD group than those in non-CHD group（all P0.01）.The levels of high-density lipoprotein cholesterol（HDL-C） and apolipoprotein AI（apoAI）were significantly lower in CHD group compared with those in non-CHD group（all P0.01）.The ratios of TC/HDL-C,TG/HDL-C,LDL-C/HDL-C,apoB/apoAI were significantly higher in CHD group than those in non-CHD group（all P0.01）.There were no significantly differences in obesity,diastolic blood pressure（DBP）,triglyceride（TG）,total cholesterol（TC）,or low-density lipoprotein cholesterol（LDL-C）between the two groups（P0.05）.2.The multi-factor Logistic regression analysis showed that all the parameters of male,family history of CHD,DM,hypertension,smoking,hyperfibrinogenemia,age,WBC count and apoB were significantly positively correlated with CHD（β=0.496,1.149,0.595,0.592,0.953,0.282,0.050,0.155 and 1.488,respectively,all P0.01）,and HDL-C was significantly negatively correlated with CHD（β=-0.575,P0.05）.Conclusion：1.Male,family history of CHD,diabetes mellitus,hypertension,smoking,hyperfibrinogenemia,age,WBC count,and apoB are significantly positively correlated with CHD in Chongqing area;HDL-C is significantly negatively correlated with CHD.They play an important role in occurrence and progression of coronary heart disease.2.Reducing the level of apoB,increasing the level of HDL-C,controlling DM and hypertension and quitting smoking may be the effective measures to reduce the morbidity and to improve the prognosis of CHD in this area.