早发冠心病血运重建后临床危险因素及其与预后的相关性分析

Correlation between clinical risk factors and prognosis in premature coronary heart disease after revascularization

目的:探讨早发冠心病(Premature coronary heart disease,PCHD)患者血运重建后临床危险因素及其与预后的关系,为PCHD血运重建后的健康干预及预后提供科学参考依据。方法:入选2000年2月1日至2010年1月31日我院接受冠脉介入治疗(Percutaneous coronary intervention,PCI)或冠状动脉旁路移植术(Coronary artery bypass graft,CABG)的2 134例患者,根据性别及年龄分为早发组和对照组(晚发组),分析2组间一般情况、血液生化检验结果的差异,探讨PCHD患者血运重建后的临床危险因素。对PCHD血运重建术后患者组进行随访,用COX回归模型分析影响PCI或CABG术后预后的危险因素。结果:吸烟史、冠心病(Coronary heart disease,CHD)家族史和总胆固醇(Total cholesterol,TC)、甘油三酯(Triglyceride,TG)、纤维蛋白原及血红蛋白水平是PCHD血运重建后的临床危险因素,吸烟史及CHD家族史、血浆中TC偏高及血红蛋白偏低为PCHD术后预后的危险因素。结论:对于PCHD血运重建后患者,应针对性地对一些高危因素进行干预,加强控烟宣传及合理饮食指导,重视有阳性CHD家族史人群,对改善PCHD患者血运重建后发病及预后有一定参考意义。

Objective： To explore the correlation between clinical risk factors and prognosis in premature coronary heart disease （PCHD） after revascularization and to provide the scientific references for prevention, cure and prognosis of PCHD. Methods：Totally 2 134 patients who received percutaneous coronary intervention（PCI） or coronary artery bypass graft（CABG） from February 1 st, 2000 to January 31st,2010 in our hospital were selected. All the patients were divided into two groups by age and gender,namely premature group and control group. The differences in the general condition and blood biochemical inspection results between the two groups were analyzed. The clinical risk factors in patients with PCHD after revascularization were discussed. After operation, the premature group was followed-up with an average of 24 months. COX regression model was used to find the risk factors affecting the postopera tire prognosis of PCI or CABG. Results ：The smoking history, family history of CHD,level of total cholesterol（TC）, triglyceride （TG）, p lasma fibrinogen（Fig） and hemoglobin（HGB） were the risk factors for PCHD. The smoking history,family history of CHD,high level of TC and the low level of HGB were the risk factors for postoperative prognosis of PCI or CABG. Conclusions：Patients with PCHD after the revascularization should take some targeted interventions to cope with the high risk factors of PCHD,strengthen the smoking control and rational diet propaganda and pay high attention to those with the positive family history of CHD.